21 October 2010
Ministry of Health of Saudi Arabia
issues requirements and recommendations for the Hajj and Umra Seasons this =
year
The annual Hajj season for pilgrims in =
Saudi Arabia
begins next month in November. According to the Ministry of Health of Saudi Arabia: “In 2009,=
Hajj
was attended by over 2.5 million Muslims, of whom at least 1.6 million were
foreign visitors. The vast majority (88% of all pilgrims) arrived by=
air
and although the Hajj ritual only takes one week many will gather for the
month-long Hajj season.” Memish ZA. The Hajj: Communicable and non-communicable
health hazards and current guidance for pilgrims. Eu=
ro
Surveillance. 2010; 15 (39):pii=3D196=
71. (30
September).
Public Health guidance for next
month’s 2010 Hajj is provided in this Eurosurveillance paper and in a
related one, also by Dr. Ziad A. Memish, Assistant Deputy Minister of Health
for Preventive Medicine, Ministry of Health, Saudi Arabia.
The latter publication is referenced in the World Health Organization (WHO)=
30
September 2010 “International travel and health” website under =
the
heading “Saudi Arabia-Hajj”, and is available online at: http://www.who.int/ith/=
updates/20100930/en/ This 30 Sept 2010 WHO
update states: ‘Requirements and recommendations for entry visas for =
the
Hajj seasons in 2010 have been published in the latest issue of the Saudi
Arabian “Journal of Infection and Public Health’ (volume 3, pag=
es
92-94). This paper by Dr. Ziad Memish, titled
“Health conditions for travelers to <=
st1:place
w:st=3D"on">Saudi Arabia for (Hajj) for t=
he
year 1431H/2010” is available online at: http://dpownload.journals.elsevierhealth.com/pdfs/jpurnals/1876-0341/P=
IIS1876034110000717.pdf
Both of these papers provide succinct a=
nd
clear guidance for what is one of the largest mass gatherings of persons
worldwide.
The 30 September Eurosurveillance paper is divided into five main
sections: (1) Introduction; (2) Preventive measures during Hajj in Saudi Arabia;
(30 Communicable disease at the Hajj; (4) Non-communicable hazards at the H=
ajj;
and (5) Pre-and post-Hajj travel advice.
In the “Introduction” s=
ection
it is noted that combining the Umra and Hajj pilgrimage season the Kingdom =
of
Saudi Arabia (KSA) “hos=
ts
more than four million people from around 160 countries worldwide…From
the European Union close to 45,000 pilgrims arrive to KSA each year…O=
ne
of the major contributors to the planning and strategizing for the well-bei=
ng
of the guests is the Ministry of Health (MoH), whose Infection Control and
Preventive Medicine Policies are established every year, based on knowledge=
of
current global outbreaks, epidemiology of infectious diseases, and establis=
hed
effective preventive medicine strategies.”
In the “Preventive measures during
Hajj in Saudi Arabia=
”
a synopsis is given of the extensive and remarkable efforts to anticipate a
surge in medical needs and a highly interconnected electronic disease
surveillance system. For example, “In 2009, the KSA MoH prepared 24
hospitals with a total bed capacity of 4,964, of which 547 were critical ca=
re
beds. Moreover 136 healthcare centers in the vicinity of the Hajj were equi=
pped
with the latest emergency management medical systems and staffed with 17,60=
9 specialized
personnel to provide state of the art healthcare to all pilgrims free of ch=
arge…39
public health teams are distributed around where the Hajj takes place. These
include 18 stationary teams located in healthcare facilities and 21 mobile
teams which rotate through the different pilgrim camps. <=
/p>
At the Hajj terminal based at King Abdulaziz
International Airport
in Jeddah, the key port of entry for the majority of pilgrims, an independe=
nt,
newly renovated Hajj terminal now accommodates 80,000 pilgrims at any one t=
ime.
At each of its 18 hubs receiving pilgrim flights there are two clinical
examination rooms and a large holding area to assess arriving pilgrims and
check their immunization status and administer any recommended prophylactic
medicines. Any pilgrim with a suspected communicable disease requiring
isolation will be escorted back through the airport grounds by ambulance to=
a
nearby dedicated 200 bed hospital. The public health teams (stationary and
mobile) as well as the ports of entry teams report directly to the command
center on nine communicable diseases using an electronic surveillance form
based on an updated disease case definition submitted via mobile phones. Th=
ese
diseases include influenza, influenza-like illness, meningococcal disease, =
food
poisoning, viral hemorrhage fevers, yellow fever, cholera, polio, and plagu=
e.”
The section on “Communicable dise=
ase
at the Hajj” has four subsections: (1) Meningococcal disease; (2)
Respiratory tract infection; (3) Blood-borne diseases; and (4) Diarrhea and
food poisoning.
Included in the respiratory infections =
are
discussions about viral diseases, TB, and pertussis. Of the many viruses th=
at
can cause upper respiratory tract infection it is reported that “at t=
he
Hajj the main culprits are respiratory syncytial virus (RSV), parainfluenza,
influenza and adenovirus”.
Of note, it is stated that “In an
attempt to reduce the risk of respiratory tract infections during the Hajj,=
the
Saudi MoH encourages pilgrims to wear surgical face mask when in crowded
places. In addition the MoH recommends that international pilgrims be
vaccinated against seasonal influenza before arrival into the kingdom of Sa=
udi
Arabia…”In KSA seasonal influenza vaccine is recommended for
internal pilgrims particularly those with pre-existing conditions and all
healthcare workers working in the Hajj premises.”
In the section on diarrhea specific
guidance on polio prevention and use of oral polio vaccine (OPV) is provide=
d.
For example, all pilgrims from the four countries where transmission of wild
polio virus has never been completely interrupted (Afghanistan,
India, Nigeria, and Pakistan) “should recei=
ve one
dose of oral polio vaccine (OPV. Proof of OPV vaccination at least six weeks
prior departure is required to apply for an entry visa for Saudi Arabia.
These travelers will also receive a dose of OPV at border points when arriv=
ing
in Saudi Arabia.
All visitors age under the age of 15 travelling to Saudi Arabia from countries
reinfected with poliomyelitis should be vaccinated against poliomyelitis wi=
th
OPV. Proof of OPV vaccination is required six weeks prior to the application
for an entry visa. Irrespective of previous immunization history, all visit=
ors under 15 arriving in <=
st1:place
w:st=3D"on">Saudi Arabia will also receiv=
e a
dose of OPV at border points.”
In the final paragraph Dr. Memish
emphasizes that “Planning and supporting Hajj has become a forum for
collaboration crossing any political considerations. The Saudi MoH every ye=
ar
publishes the Hajj requirements for the upcoming Hajj season which is a good
guide to all needed precautions to ensure safe Hajj for all pilgrims.”=
;
In my opinion, much can be learned by o=
ther
countries, including the USA,
from these yearly preparedness and response efforts by the MoH in the
KSA related to the Hajj. In particular, practical lessons could be learned
regarding specific surge issues for healthcare facilities, healthcare worke=
rs,
and healthcare resources (including rapid large scale vaccination and
antimicrobial distribution), as well as the electronic surveillance system =
with
highly-coordinated real-time reporting by both stationary and mobile teams.=
Daniel R. Lucey, MD, MPH
Adjunct Professor of Microbiology and
Immunology
Georgetown University Medical<=
/st1:PlaceName>
Center
EROne Institutes, Washington Hospital=
Center, =
Washington, DC
website for this posting: www.BePast.org
email: DRL23@Georgetown.edu