Respiratory infections due to Streptococcus pneumoniae and the influenza virus in South Africans undertaking the Hajj

The Hajj is the largest annual mass gathering on Earth. Respiratory infections are one of the leading causes of disease and hospitalisation during the pilgrimage, with pneumonia and influenza most common among these infections despite the availability of prophylactic vaccines. In fact, immunisation against influenza and pneumococcal disease is currently not a requirement for South African pilgrims entering Saudi Arabia. This review examines the burden of respiratory infections during the Hajj, particularly pneumonia and influenza, with a focus on pilgrims from South Africa. Although the number of South African pilgrims attending the Hajj has been capped at 2 000 since 2013, 30 000 South Africans perform the minor Umrah pilgrimage annually. Understanding the aetiology of disease in this group could have implications for medical resourcing during the Hajj.