Safety measures could minimize H1N1 transmission at 2009 Hajj

The 2009 Hajj pilgrimage, expected to draw more than 2.5 million people from more than 160 countries to Muslim holy sites in Saudi Arabia, may present a serious public health challenge in the face of the H1N1 pandemic, according to a story posted by the American Association for the Advancement of Science.

To meet this challenge, Saudi Arabia 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 Oct. 30 Science Express. But the annual Hajj, which takes place 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 such as 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 Saudi Arabian government will not restrict anyone from performing Hajj based on their age.

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 wrote 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 Saudi Arabian Ministry of Health says that thermal screening equipment is in place at the country’s 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.

Because it takes 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 Saudi Arabian government will request official correspondence from each country sending pilgrims regarding the country’s availability of H1N1 vaccines. If the Saudi 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.