# 7477
Last month the Kingdom of Saudi Arabia announced an abrupt Limit to Umrah & Hajj Visitors this year, citing construction as the Grand Mosque as the primary reason behind a 20% cutback in Visas.
Many observers believed the recent surge in MERS-CoV cases were the real reason behind this decision - but until today - we’ve not seen any official acknowledgment of that from the MOH.
Today the MOH published (in Arabic) updated requirements and advice for Hajj and Umrah visitors this year (h/t Ironorehopper on FluTrackers).
The most notable change is they are now publically citing MERS-CoV as the reason why the elderly, those with chronic illnesses, immune dysfunctions, as well as pregnant women and children ought not to make a pilgrimage this year.
Here is a machine translation of today’s statement (bolding mine).
Hajj and Umrah requirements for the year 1434 AH
September 04, 1434 (July 12th, 2013)
Ministry of Health issued health requirements that must be met in coming for Umrah and Hajj 1434 H as part of precautionary measures for disease virus Koruna new (MERS-COV) and so out of the keenness of the Government of the Custodian of the Two Holy Mosques in maintaining the health of everyone and provide an atmosphere healthy and safe, God willing, for the pilgrims and pilgrims to perform This all rites smoothly and health and contentment.
I have included these requirements issued by the ministry's recommendation to postpone the performance of Umrah and Hajj this year for the elderly and people with chronic diseases as patients heart, kidney, respiratory and diabetes, as well as patients with immune deficiency congenital and acquired, in addition to ill tumors, as well as pregnant women and children.
It also included requirements set of tips and guidance health awareness for citizens, residents and pilgrims of them; pollutants to wash your hands thoroughly with soap and water or disinfectant other allocated to it, especially after coughing and sneezing, as well as the use of tissue when coughing or sneezing and dispose of the waste basket, in addition to not touch eyes, nose and mouth by hand, and the reduction of direct contact with the injured and non-participation tools personal, as well as the wearing of masks in crowded locations, and maintaining personal hygiene as a whole.
These requirements also included on the next to get a valid certificate of vaccination against meningitis before the advent of the Kingdom of not less than 10 days and not more than 3 years, as well as get a certificate of vaccination against polio-affected countries, according to specific requirements.
Also included stipulations importance of vaccination against seasonal flu vaccine, especially for people with chronic diseases such as heart, kidney, diabetes and respiratory and neurology as well as diseases of HIV congenital and acquired, and metabolic diseases, as well as pregnant women and children less than 5 years and those with obesity.
The advice to wear a facemask is not exactly new, as ARIs (Acute Respiratory Infections) have been common health complaints during the Hajj and Umrah, and calls for wearing masks have been made often over the years.
Last year, in The Hajj: communicable and non-communicable health hazards and current guidance for pilgrims masks were recommended to reduce the spread of TB and other respiratory illnesses, and similar calls have been made in the past, including in 2009 during the H1N1 pandemic.
The wearing masks is mentioned repeatedly on the KSA MOH web page on Health Tips to Be Followed During Hajj. A couple of examples include:
- Face-masks are recommended at crowded and congested places, especially during circumambulation of the Ka'ba (Tawaf), stoning (Rajm), and walking between Safa and Marwa (Sa'i). They should be changed regularly (every six hours), or when dirty, in accordance with the guidelines provided by the manufacturer, along with washing hands with water and soap when taking them off.
- Using face-masks, especially in overcrowded places, and changing them every now and then (in accordance with the manufacturer's instructions) helps protect you from the infectious diseases transmitted through coughing or sneezing.
Compliance with this advice is apparently difficult, as Islam teaches that women may not `cover their face’ while in Ihram (a sacred state which a Muslim must enter in order to perform the Hajj or Umrah).
During the 2009 Pandemic the Grand Mufti of Saudi Arabia permitted the use of masks while performing the Umrah, stating that it was not the same as `covering the face’, but stated `that it should not be used unless needed.’
In the November 2009 edition of the EID Journal, a report entitled Hajj Pilgrims’ Knowledge about Acute Respiratory Infections
Saudi health authorities recommend use of surgical face masks (5); however, data conflict about the protective effect of such masks during the pilgrimage (5,6). Use of face masks varies according to the origin of Hajj pilgrims; in 1 study, only 15% of pilgrims from the Middle East, 17% from Europe and the United States, and 45% from Southeast Asia used a mask (4). Promotion and distribution of free masks increased their use from 34% to 81% in another cohort of Saudi pilgrims (6).
National Health Service for England does not advise the use of masks, considering compliance with this advice unlikely because many Muslims believe that covering the face during the Hajj is prohibited and because masks need to be of high quality and changed at least every 6 hours to remain effective (7).
Recent studies demonstrated that surgical and N95 masks were equally effective in preventing spread of PCR-detectable influenza virus when used by infected patients. These masks also were potentially effective at preventing respiratory virus acquisition by household contacts of infected persons when worn by healthy persons. However, effectiveness depended largely on adherence to mask use (8,9).
And finally, I should point out that the World Health Organization has not (at this time) issued any advice for religious pilgrims to Saudi Arabia to wear masks (see WHO: MERS, Masks, And The Media).
