bPilgrims returning from the Hajj (pilgrimage to Mecca) can be carriers of multidrug-resistant bacteria (MDR). Pharyngeal and rectal swab samples were collected from 98 pilgrims before and after they traveled to the Hajj in 2014 to investigate the acquisition of MDR bacteria. The bacterial diversity in pharyngeal swab samples was assessed by culture with selective media. There was a significantly higher diversity of bacteria in samples collected after the return from the Hajj than in those collected before (P ‫؍‬ 0.0008). Surprisingly, Acinetobacter baumannii strains were isolated from 16 pharyngeal swab samples (1 sample taken The Hajj (pilgrimage to Mecca) is the world's largest annual mass gathering which brings together millions of people from many countries to perform rituals in Saudi Arabia. Interaction and close contact are important factors for the transmission and dissemination of infectious diseases among pilgrims. Several airborne infectious diseases have been reported during the Hajj, including meningitis, flu, and tuberculosis (1). Common respiratory pathogens have been reported among pilgrims with clinical pneumonia, including Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, Mycobacterium tuberculosis, Klebsiella spp., Pseudomonas aeruginosa, Staphylococcus aureus, and Acinetobacter baumannii (2, 3) Moreover, high rates of acquisition of rhinovirus and Streptococcus pneumoniae as well as coronavirus E229 by pilgrims were reported during the 2013 Hajj (4). With the global spread of antibiotic-resistant bacteria, international travelers are potentially at risk of acquiring multidrugresistant (MDR) bacteria and antibiotic resistance (AR) genes and of transferring these to other people when they return to their home countries (5, 6). This has been well documented, with reports describing the acquisition of NDM-1-producing bacteria in travelers returning from the Indian subcontinent to the United Kingdom (7) and KPC-producing bacteria in French patients who had traveled to the United States (8). We recently reported the acquisition of colistin-resistant Salmonella enterica serotype Newport in rectal swab samples taken from French pilgrims during the 2013 Hajj (6, 9). Acinetobacter species, particularly MDR A. baumannii strains, are primarily associated with hospital-acquired pneumonia. However, several studies have reported cases of community-acquired A. baumannii pneumonia, such as in Australia during the rainy season, for which the source and mode of transmission remain unknown (10). We aimed to determine, using pharyngeal and rectal swabs, whether pilgrims might have acquired MDR bacteria during the 2014 Hajj. Here we report for the first time the acquisition of cephalosporin-and imipenem-resistant A. baumannii and Escherichia coli among pilgrims returning from Saudi Arabia. MATERIALS AND METHODSStudy design. Data were obtained between 19 September and 12 October 2014 (24 days) from a cohort of pilgrims that was traveling from France to Mecca in Saudi Arabia with a specialize...

The Hajj cough is highly common, likely a result of crowded conditions at religious places. Pilgrims should be advised to carry symptomatic relief for the Hajj cough such as cough suppressant, soothing throat lozenges and paracetamol. Use of antibiotics should be discouraged.