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Prevalence of Influenza Among Hajj Pilgrims: A Systematic Review and Meta-Analysis

Published online by Cambridge University Press:  24 March 2021

Hamid Safarpour
Department of Nursing, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Meysam Safi-Keykaleh
Nahavand School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
Iman Farahi-Ashtiani
Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Jafar Bazyar
Prehospital Emergency Center, Ilam University of Medical Sciences, Ilam, Iran
Salman Daliri
Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
Ali Sahebi*
Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
Corresponding author: Ali Sahebi, Email:



Respiratory transmission, especially in mass gatherings, is considered one of the main ways of influenza transmission. The Hajj ceremony, as one of the largest gatherings worldwide, can increase the distribution of influenza infection. Thus, the present study aimed to evaluate the incidence of influenza among Hajj pilgrims.


In this present systematic review and meta-analysis, all English studies published by 2019 were extracted from several databases such as the Web of Science, PubMed, Scopus, Cochrane Library, Science Direct, and Google Scholar. Finally, the data were extracted using a pre-prepared checklist and then analyzed by fixed and random effects model tests in the meta-analysis, Cochran, meta-regression, and Begg’s test.


Eighteen studies with a sample size of 62 431 were entered into the meta-analysis process. The overall prevalence of influenza, in addition to the prevalence of types A, B, and C influenza, was estimated at 5.9 (95% CI: 4.3-8.0), 3.6 (95% CI: 2.6-4.9), 2.9 (95% CI: 2.8-3.1), and 0.9% (95% CI: 0.5-1.5), respectively.


In general, influenza remains widespread regardless of vaccinating pilgrims and following health protocols. Therefore, it is recommended that comprehensive management and educational approaches be used to reduce the prevalence of influenza and its adverse consequences among the pilgrims.

Systematic Review
© Society for Disaster Medicine and Public Health, Inc. 2021

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