The 2009 Hajj pilgrimage, expected to draw more than 2.5 million people from over 160 countries to Muslim holy sites in Saudi Arabia, may present a serious public health challenge in the face of the H1N1 pandemic. To meet this challenge, the Kingdom of Saudi Arabia (KSA) and the World Health Organization worked together this past summer to produce a list of prevention efforts and medical strategies to help stem the transmission of H1N1 virus during this global event.
Some of these recommendations are simple, and Hajj pilgrims might adopt them with ease, according to the authors of a Policy Forum published in the 30 October Science Express.But the annual Hajj, held this year in the last week of November, presents a unique set of environmental, geopolitical, and religious factors that might increase pilgrims’ vulnerability to diseases like the H1N1 flu, according to Shahul H. Ebrahim from the U.S. Centers for Disease Control and Prevention and colleagues
The recommendations urge pilgrims who are particularly at risk of developing complications from the H1N1 virus (pregnant women, those with chronic diseases, children under 12 years of age, and adults over 65 years of age) to abstain voluntarily from the 2009 Hajj. However, the KSA will not restrict anyone from performing Hajj based on their age.
Supplicating pilgrims at Masjid Al Haram. Mecca, Saudi Arabia [Photo © Ali Imran, licensed Creative Commons Attribution Creative Commons Share Alike 2.5]
Common prevention measures, such as face masks and hand sanitizers, are strongly recommended to all pilgrims, but the Policy Forum experts caution that religious beliefs might detract from their use and effectiveness.
“The density of pilgrims, the nature of the rituals, and the shoulder-to-shoulder contact recommended during prayers provide a perfect transmission atmosphere,” Ebrahim writes in the Policy Forum. “The floor or carpets in the mosque and Hajj objects of religious significance are routinely touched… and compliance with mask use may be challenging due to factors including high temperatures and religious considerations. The specific dress code for men during Hajj excludes stitched clothes, and women are required to expose their face.”
The KSA Ministry of Health says that thermal screening equipment is in place at KSA airports to identify individuals with high fevers, and it asks that receiving airports make room for as many as 200 to 300 pilgrims who might be symptomatic with influenza-like illness and need to be isolated in order to evaluate them on the spot. They will help pilgrims who are separated from their Hajj groups to rejoin them when it is safe to do so.
Since it takes a full 14 days for the H1N1 vaccine to start protecting individuals from the virus, it is unlikely that most pilgrims will receive their vaccinations in time to benefit from the protection on their journey. Once the global availability of H1N1 vaccines has been announced, the KSA government will request official correspondence from each country sending pilgrims regarding the country’s availability of H1N1 vaccines. If the KSA government receives official notice that vaccines are available in a certain country early enough, then proof of vaccination may be required for pilgrims traveling from that particular country.
In addition, the KSA government has secured adequate amounts of antiviral agents, and will offer them free of charge to any pilgrims in need, regardless of their national origin.
The Science authors suggest that Islamic politicians and religious entities could help to minimize global transmission of the H1N1 virus by endorsing these recommendations and safety measures. Pilgrims can receive updated information on the recommendations from the KSA Ministry of Health  or the Ministry of Hajj .