Avian Flu Diary: Eurosurveillance: Hajj Health Hazards & Recommendations

Credit Wikipedia

# 6627

While no new cases of the novel coronavirus have been detected beyond the first two from Saudi Arabia & Qatar, Singapore had a brief scare yesterday when a woman - recently arrived from Kuwait - was hospitalized with a respiratory infection (see Woman tests negative for SARS-related bug).

This comes on the heels of a similar case last week in Hong Kong (also negative), and 5 people isolated in Denmark (again, negative) two weeks earlier.

Although there are no signs that this coronavirus is being spread from person-to-person, memories of the SARS epidemic of 2003 have prompted enhanced surveillance for anyone traveling from the Middle East showing respiratory symptoms.

Out of an abundance of caution, these cases are quickly isolated and tested - even though health officials know most will turn out to have something far less exotic than this new coronavirus.

With the Hajj only 10 days away - and influenza and other viruses in circulation – we shouldn’t be surprised to see this drill repeated around the world as pilgrims return home from Mecca at the end of the month.

Which brings us to this Rapid Communications from the ECDC journal Eurosurveillance, posted yesterday. I’ve only included excerpts, follow the link to read it in its entirety.

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].

(Continue . . . )

Whenever there is a mass gathering (or migration) of people, public health officials must plan on how to deal with, and hopefully contain, any disease outbreaks.

Earlier this year the ECDC, along with local public health officials, geared up for three very high profile and well attended public events; The London Olympics and Para-Olympics Games, and the UEFA EURO 2012 football championship.

You can see their preparations in How The ECDC Will Spend Your Summer Vacation.

Similarly, as this report details, Saudi Arabia is taking serious steps to prevent disease outbreaks.

Every 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.

And the granddaddy of all human migrations takes place every winter across Asia, with the celebration of the Lunar New Year. More than 2 billion passenger journeys – mostly by crowded train – are made in China alone over a six week period.

The good news is, that while mass gatherings and migrations provide greater opportunities for disease outbreaks, history has shown that serious outbreaks rarely occur.

Still, public health authorities must anticipate and prepare for the worst, even though it probably won’t happen. This is hardly wasted energy.

After all, we’ll never know the number of outbreaks that have been prevented by proactive measures over the years.

The old saying is true, `When public health works, nothing happens’.

For more on health planning for mass gatherings, you may wish to revisit: