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In Saudi Arabia, religious tourism – most notably Umrah, which runs from December to the end of Ramadan (August 7th) - and the Hajj, which falls in mid October this year – are big business, accounting for roughly 3% of their Gross National Product.
According to a recent Arab News report, more than 7 million pilgrims visit Saudi Arabia each year, adding more than $16 billion dollars to the local economy.
Egypt, Turkey, Pakistan and Iran provide the most pilgrims, but devout Muslims come from nearly every nation on earth to take part in `lesser pilgrimages’, called (Umrah), and in the Hajj.
Yesterday we learned that a Tunisian tourist, recently returned from a trip to Qatar and Saudi Arabia, died from the novel coronavirus (and two of his relatives were infected) raising concerns that visitors to the Gulf States could spread the virus around the globe (see KUNA Report On Tunisian Coronavirus Case).
What little we do know about the progression of this disease suggests that it has a prolonged incubation period - estimated at 10 days – giving travelers plenty of time to become infected, and travel home, before they become symptomatic.
The Hajj this October will likely see 4 million pilgrims over a relatively short time span, while between now and the end of Ramadan, a couple of million tourists are expected to visit Saudi Arabia.
All of which means that public health officials must decide upon, and implement, prudent measures to minimize the risk of spreading this virus further.
This, as you might well guess, isn’t a new concern. And considerable thought has been devoted to it. So a brief review of the topic of mass gatherings and public health:
Last fall, just before the Hajj of 2012 - and just weeks after we learned of the first novel coronavirus cases in Saudi Arabia – we saw the following report in the ECDC’s journal Eurosurveillance.
Eurosurveillance, Volume 17, Issue 41, 11 October 2012
Rapid communications
The Hajj: updated health hazards and current recommendations for 2012
J A Al-Tawfiq1, Z A Memish
This year the Hajj will take place during 24–29 October. Recent outbreaks of Ebola haemorrhagic fever in Uganda and the Democratic Republic of the Congo, cholera in Sierra Leone, and infections associated with a novel coronavirus in Saudi Arabia and Qatar required review of the health recommendations of the 2012 Hajj. Current guidelines foresee mandatory vaccination with quadrivalent meningococcal vaccine for all pilgrims, and yellow fever and poliomyelitis vaccine for pilgrims from high-risk countries. Influenza vaccine is strongly recommended.
The annual Hajj is one of the greatest assemblies of humankind on earth. Each year, three million Muslims attend the Hajj in Mecca, Saudi Arabia. Of these, 1.8 million non-Saudi Arabians usually come from overseas countries and 89% (1.6 millions) of them arrive by air [1]. Pilgrims come from more than 180 countries worldwide and about 45,000 pilgrims each year arrive to Saudi Arabia from the European Union [2].<SNIP>
Pre- and post-Hajj travel advice
The Hajj is a unique event with possible impact on international public health. Healthcare practitioners around the world must be attentive to the potential risks of disease transmission during the Hajj. They must recommend appropriate strategies for the prevention and control of communicable diseases before, during and after the completion of the Hajj. The current international collaboration in planning vaccination campaigns, developing visa quotas, arranging rapid repatriation, and managing health hazards at the Hajj are crucial steps in this process. The Saudi Arabian Ministry of Health publishes the Hajj requirements for each Hajj season. This year’s Hajj recommendations have recently been published [3].
Recent outbreaks of Ebola haemorrhagic fever in Uganda and the Democratic Republic of the Congo (DRC), cholera in Sierra Leone, and infections associated with a novel coronavirus in Saudi Arabia and Qatar required review of the health recommendations of the 2012 Hajj. We present here the changes and additions made in the recommendations for these diseases. For completeness, we also summarise the existing recommendations [3,4].
Similarly, in January of last year, The Lancet ran a six-part series on mass gatherings and health issues, which becomes all the more relevant today.
Mass Gatherings Health
Published January 16, 2012
Executive summary
A six-part series describes the scope of the emerging specialty of mass-gatherings health. Mass gatherings are events such as religious occasions, music festivals, or sports events that attract enough people to exceed the capacity of routine health and public safety measures. Managing such events requires providing for all eventualities from infectious disease outbreaks to security against terrorist attacks. Thus mass gatherings health is a topic that goes beyond the scope of typical public health provision.
The first paper in the series describes the influence that the Hajj pilgrimage has had on the development of mass gatherings health. The second paper looks at the prevention of infectious diseases associated with mass gatherings. In the third paper, non-communicable disease risks associated with mass gatherings are reviewed. The fourth paper looks at crowd and environmental management during mass gatherings. Fifth is a review of infectious diseases surveillance and modelling. The final paper sets out a research agenda for the mass gatherings health specialty. This series is timely as London prepares to host the 2012 Olympic Games.
Series Comment
Mass gatherings health Series
John McConnell
Series Papers
Emergence of medicine for mass gatherings: lessons from the Hajj
Ziad A Memish, Gwen M Stephens, Robert Stephen, Qanta A Ahmed
Global perspectives for prevention of infectious diseases associated with mass gatherings
Ibrahim Abubakar, Philippe Gautret, Gary W Brunette, Lucille Blumberg, David Johnson, Gilles Poumerol, Ziad A Memish, Maurizio Barbeschi, Ali S Khan
Non-communicable health risks during mass gatherings
Robert Steffen, Abderrezak Bouchama, Anders Johansson, Jiri Dvorak, Nicolas Isla, Catherine Smallwood, Ziad A Memish
Crowd and environmental management during mass gatherings
Anders Johansson, Michael Batty, Konrad Hayashi, Osama Al Bar, David Marcozzi, Ziad A Memish
Infectious disease surveillance and modelling across geographic frontiers and scientific specialties
Kamran Khan, Scott J N McNabb, Ziad A Memish, Rose Eckhardt, Wei Hu, David Kossowsky, Jennifer Sears, Julien Arino, Anders Johansson, Maurizio Barbeschi, Brian McCloskey, Bonnie Henry, Martin Cetron, John S Brownstein
Research agenda for mass gatherings: a call to action
John S Tam, Maurizio Barbeschi, Natasha Shapovalova, Sylvie Briand, Ziad A Memish, Marie-Paule Kieny
Each year there are multiple mass gatherings which could conceivably facilitate disease transmission; including the Super bowl, Mardi Gras, and Carnival in Rio, and the Hajj.
The good news is, that while mass gatherings may provide greater opportunities for disease outbreaks, history has shown that major epidemic outbreaks have been a rarity (for an exception, see The Impact Of Mass Gatherings & Travel On Flu Epidemics).
Still, public health authorities must anticipate and prepare for the worst.
Because the old saying is true, `When public health works, nothing happens’.
