Millions of pilgrims are heading for
Makkah for Haj. The number of people performing the annual
pilgrimage being huge, there are many occasions during the annual
pilgrimage when the pilgrims arriving from more than 140 countries
come in direct contact with others. Overcrowding, which is of
paramount importance to Haj management, thus becomes an issue both
from safety and infection-free points of view.
There have been cases in the past when overcrowding has resulted
in stampedes with people getting trampled or crushed, according to
reports. It is this overcrowding that becomes a breeding ground
for various infectious diseases. Some such infectious diseases are
endemic in certain countries and they tend to be with the people
traveling for Haj.
The Kingdom offers many preventive measures and health care
facilities in the interest of pilgrims, according to the Ministry
of Haj. They offer free health care to all pilgrims. Like in the
past, dozens of hospitals with several thousand beds have been
prepared fully staffed with medical personnel to treat sick or
In addition, all of the Kingdom’s entry points, whether land, port
or airport, have teams of public health personnel to check that
arriving Haj pilgrims have met with immunization and other medical
There are infectious diseases that have the potential to infect
people in overcrowded conditions, a specialist at King Abdul Aziz
Hospital says. There were many such cases at Haj in the past. Due
to the intense overcrowding and high humidity, the deadly
meningococcal meningitis disease can spread among pilgrims. The
history of meningococcal meningitis and Haj has demonstrated
numerous large outbreaks throughout the years, especially in
studies conducted since 1987.
As a preventive measure, the Kingdom specifies that pilgrims must
be immunized against this form of meningitis. The Saudi
requirements are as follows:
All pilgrims over two years old must get a vaccine to protect
against meningococcal disease. This means that you need to have
your vaccine no more than three years and no less than ten days
before you arrive in Saudi Arabia, must show proof of
meningococcal vaccination on a valid certificate of vaccination
(International Certificate of Vaccination or Prophylaxis) before
you can enter the holy cities of Makkah and Madinah to perform the
pilgrimage. In addition, the pilgrim’s routine vaccinations should
be up to date to include measles/mumps/rubella, tetanus,
diphtheria and polio. Those arriving from a country where yellow
fever is endemic such as those from the continents of Africa and
South America, proof of yellow fever vaccination should be
furnished. In addition to meningococcal meningitis vaccine, the
Kingdom also requires vaccination against H1N1 influenza.
There are numerous acute respiratory infections that are common
during the Haj season. Overcrowding and close sleeping quarters
contribute to the spread of viral infections to include
respiratory syncytial virus (RSV), parainfluenza, influenza and
adenovirus, doctors say. The combination of crowding and people
coming from countries, which are endemic for tuberculosis, make it
a potential serious problem among pilgrims.
The Ministry of Health encourages pilgrims to wear surgical
facemasks when they are in crowded areas.
A ritual among Muslim men at the end of Haj is shaving their
heads. However, because some barbers who operate around the Haj
reuse shaving equipment on multiple men, the risk of blood borne
infections like hepatitis is a risk. Male pilgrims should ensure
only using licensed barbers at the Haj. Avoid sharing razors with
Besides respiratory infections, overcrowding is associated with
diarrheal diseases, according to a specialist in internal medicine
at United Doctors. Diseases such as cholera have been implicated
in outbreaks in the past and even with much improved water and
sewage systems, the concern about imported cholera and other
enteric diseases are always a concern.
Diarrheal diseases can be prevented thus:
•Drink only beverages that have been bottled and sealed.
•Avoid tap water, fountain drinks, and ice cubes.
•Hand washing is a must not only for diarrheal disease prevention
but also for prevention of respiratory infections.
In addition to the numerous
infections possible in such a crowded environment, pilgrims should
also protect themselves from non-communicable illness and injury
such as protecting themselves from the sun and heat, and keep
themselves properly hydrated.
Overcrowding provides the ideal condition for the transmission of
infections like typhoid, cholera and invasive meningococcal
meningitis. Outbreaks of typhoid and cholera have also been
recorded during Haj in the past. Although most early cases of
meningitis were reported in pilgrims, the outbreaks quickly spread
to their immediate contacts and then to those with no pilgrim
contact. Cases continued to be identified even three to four
months after Haj most likely as a result of pilgrims assimilating
in the community and dispersing bacteria. There have been several
epidemics of invasive meningococcal infection throughout the world
in the past 15 years, which have been clearly linked to the annual
pilgrimage, according to a study.
Aside from acute respiratory diseases, a pilgrim should be careful
about viral conjunctivitis as well. Conjunctivitis is inflammation
of the conjunctiva. The conjunctiva is the clear membrane that
lines the inside of the eyelids and covers the white of the eye,
explains an eye specialist at Magrabi Hospitals and Centers.
Many things including infection by viruses or bacteria cause
conjunctivitis. Allergic conjunctivitis is elicited by ocular
exposure to allergens (pollen, weeds, molds, grasses, animal
dander, dust mites, cockroaches and pollution).
Viral forms of conjunctivitis (often called pink eye) can be
spread easily to other people. The same viruses that cause the
common cold can cause viral conjunctivitis. Viruses can be spread
by coughing or sneezing and can get in your eyes through contact
with infected hands, washcloths or towels, cosmetics, false
eyelashes, soft contact lenses, etc. Symptoms include redness,
watery discharge, and itching and sensitivity to light. Usually
one eye is affected at first.
Like a cold, viral conjunctivitis is a self-limited disease and
usually goes away on its own without treatment. However, eye drops
prescribed by doctor could help control some of the symptoms.
Antihistamine pills may also relieve the itching and redness.
Topical antibiotics are used as prophylaxis.
Those wearing contact lenses should stop wearing them until the
eyes become infection-free. The combination of contacts and
conjunctivitis could damage the cornea (the clear outer layer on
the front of the eye) and cause severe vision problems.
Other forms of viral conjunctivitis are viral conjunctivitis
caused by recurrent herpes simplex virus (HSV), which can be
vision threatening. They include epidemic keratoconjunctivitis,
resulting in loss of visual acuity due to corneal affection and
hemorrhagic conjunctivitis caused by enterovirus.
To keep away from getting conjunctivitis from someone who has
it, or to prevent spreading it to others, doctors recommend the
•Wash your hands often. Do not touch or rub your eyes.
•Never share eye makeup or cosmetics with anyone. When you have
conjunctivitis, throw out eye makeup you have been using.
•Never use eye medicine that has been prescribed for someone else.
•Do not share towels, washcloths, pillows, or sheets with anyone.
If one eye is affected but not the other, use a separate towel for
•Avoid swimming in swimming pools if you have conjunctivitis.
•Avoid close contact with people until the symptoms improve.