Health news

Swine flu hits Hajj

16^th November 2009 - 150,000 British Muslims travel to Saudi Arabia each year for the Hajj, but this year those in at-risk groups for swine flu, children and older people are being advised to stay away.

The Saudi Arabian Health Ministry is recommending children under 12, over 65s and people with chronic diseases such as heart disease, kidney disease, respiratory diseases, neurological diseases, diabetes and patients with compromised immune systems should not travel to perform the Hajj this year.

The same advice is being given to pregnant women.

It has also added a travel requirement that everyone must have a valid certificate of vaccination against seasonal flu when applying for their Hajj visa. Travellers need to have had the jabs at least two weeks before arriving in Saudi Arabia with no exceptions allowed.  

The Hajj is expected to begin around November 25^th.

Added risks in dense crowds

Muslims should perform at least one Hajj in their lifetime.

Around 2.5 million people from more than 160 countries converging in one place increases public health risks such as food borne diseases, meningococcal outbreaks, heat exhaustion, accidents and respiratory illnesses.

There can be as many as seven people per square metre and under those circumstances experts say flu and swine flu could spread faster. This could also mean travellers bringing flu home with them.

The issues are discussed in a paper online ahead of a forthcoming edition of The Lancet, written by Dr Ziad A Memish, from the Saudi Arabian Ministry of Health in Riyadh, and colleagues.

New rules followed detailed planning

The swine flu pandemic was already underway when, in June, the Saudi Arabian Ministry of Health began a special discussion with consultants from global public health agencies.

The aim was to pool and share public health knowledge about mass gatherings and review the country’s emergency plans, focusing on the prevention and control of swine flu.

In the article the authors say, “These preparedness plans should ensure the optimum provision of health services for pilgrims to Saudi Arabia, and minimum disease transmission on their return home. Review of the implementation of these recommendations and their effect will not only inform future mass gatherings in Saudi Arabia, but will also strengthen preparedness efforts in other settings.”

They conclude, “After action reviews should be done to improve future performance on the basis of real-time experience. Noteworthy is that the recommendations generated during this meeting were based on the current status of the pandemic and therefore might need revision, dependent on the changes in virus characteristics and epidemiology of infections with the 2009 pandemic influenza A H1N1 virus.”

Isolation for pilgrims with flu

An editorial in the Lancet says “Because Hajj is one of the five pillars of Islam and should be done at least once in a Muslim’s lifetime, individuals will probably not want to postpone after they have spent much time saving money and planning for this purpose.

Some of the other recommendations, such as isolation of pilgrims with influenza-like illness, might not only deter individuals from reporting their illness but will undoubtedly also cause them distress and difficulty reuniting with their companions. Improvement of hand hygiene for infection control might be more acceptable than some of the other recommendations because pilgrims should wash before they pray.”

As the flu jabs are only needed for travel abroad, the Royal College of General Practitioners says GPs are allowed to charge for the vaccination, or may refer patients to private clinics to preserve their stocks of vaccine.

The Muslim Council of Britain’s advice online urges people attending the Hajj to stick to "good personal hygiene measures, including cough etiquette, use of antiseptic hand gels, and frequent hand washing with soap and water".