Objectives Influenza outbreaks have been widely studied. However, the patterns between influenza and religious festivals remained unexplored. This study examined the patterns of influenza and Hanukkah in Israel, and that of influenza and Hajj in Bahrain, Egypt, Iraq, Jordan, Oman and Qatar. Method Influenza surveillance data of these seven countries from 2009 to 2017 were downloaded from the FluNet of the World Health Organization. Secondary data were collected for the countries population, and the dates of Hajj and Hanukkah. We aggregated the weekly influenza A and B laboratory confirmations for each country over the study period. Weekly influenza A patterns and religious festival dates were further explored across the study period. Results We found that influenza A peaks closely followed Hanukkah in Israel in six out of seven years from 2010 to 2017. Aggregated influenza A peaks of the other six Middle East countries also occurred right after Hajj every year during the study period. Conclusions We predict that unless there is an emergence of new influenza strain, such influenza patterns are likely to persist in future years. Our results suggested that the optimal timing of mass influenza vaccination should take into considerations of the dates of these religious festivals.
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