Hajj: infectious disease surveillance and control

Abstract

Religious festivals attract a large number of pilgrims from worldwide and are a potential risk for the transmission of infectious diseases between pilgrims, and to the indigenous population. The gathering of a large number of pilgrims could compromise the health system of the host country. The threat to global health security posed by infectious diseases with epidemic potential shows the importance of advanced planning of public health surveillance and response at these religious events. Saudi Arabia has extensive experience of providing health care at mass gatherings acquired through decades of managing millions of pilgrims at the Hajj. In this report, we describe the extensive public health planning, surveillance systems used to monitor public health risks, and health services provided and accessed during Hajj 2012 and Hajj 2013 that together attracted more than 5 million pilgrims from 184 countries. We also describe the recent establishment of the Global Center for Mass Gathering Medicine, a Saudi Government partnership with the WHO Collaborating Centre for Mass Gatherings Medicine, Gulf Co-operation Council states, UK universities, and public health institutions globally.

Figure 1

Stages of the Hajj For the Hajj, pilgrims wear simple garments (white for male pilgrims), do prayers, and undertake a series of rituals and rites together as an expression of unity, equality, and solidarity irrespective of nationality, ethnic origin, sex, and social class. Pilgrims fulfil each of the required prayer rituals by visiting and doing prayers in a particular order at several of the holy sites in Makkah, commencing at the Ka'aba. Although most pilgrims walk during the Hajj, some may use transport (eg, bus or trains) and those who have a disability or are elderly are pushed along in wheelchairs or carried on the shoulders of other pilgrims.

Figure 2

Number of pilgrims attending the Hajj from 2003 to 2013 Data are from the Saudi Ministry of Hajj and Central Department of Statistics and Information.

Figure 3

Web-based health-care surveillance network

Figure 4

Number of cases of invasive meningococcal disease linked to Hajj from 1995 to 2013