Contagious Pneumococcal Disease Infections Pose High Health Risks for Hajj Travelers

Doctors advise precautionary measures that can be undertaken to safeguard against the disease  

• During Hajj, pneumonia accounts for one-third of the hospitalizations among hajj travelers in Saudi Arabia, with Streptococcus Pneumoniae being the leading cause  
• Studies conducted in UAE have shown the average age of a patient with community acquired pneumonia to be 58 years and the most common co-morbidities were diabetes mellitus (21%), malignancy (20%) and chronic obstructive pulmonary disease (COPD) (19%). 

Dubai, United Arab Emirates, 21 September 2015: The annual Hajj pilgrimage to Mecca in the Kingdom of Saudi Arabia is one of the largest mass gathering events in the world. It draws close to two million Muslims from more than 183 countries worldwide.   One of the major public health concerns in relation to mass gatherings is the importation or exportation of infectious diseases, and spread between attendees and to the local population.   To minimize risks, doctors have advised precautionary measures that can be undertaken while completing the pilgrimage, which can safeguard against the disease.

Hajj travelers need to be aware of the health risks associated with contracting pneumonia, meningitis and respiratory infection. Some of the most common respiratory diseases during Hajj include: common cold, seasonal flu, and bronchitis. These diseases are transmitted by droplets from coughing, sneezing or talking.  

Pneumonia accounts for 39% of all hospital admissions during Hajj and is also a leading cause of ICU admission.   Data also suggests that the decreased immunity due to overcrowding, exhaustion and undernourishment can result in high incidence of the disease. 

Even though Meningococcal vaccination is compulsory for all pilgrims attending Hajj, compliance is not hundred percent, thereby putting healthy pilgrims at risk. Saudi Arabia does not send back pilgrims who are not vaccinated and the threat of acquiring an infectious disease continues. Unvaccinated pilgrims are administered prophylactic antibiotics and allowed to complete the Hajj. 

Preventive tips for pilgrims during Hajj:
•    Wear mask, especially in crowded places, and replace it every 6 hours.
•    Wash hands with soap and water or disinfectant, especially after coughing and sneezing
•    Use disposable tissues when sneezing or coughing and then dispose in the trash
•    Do not touch your eyes, nose or mouth without washing your hands well.
•    Avoid excessive contact, use handshakes to greet others
•    Do not drink ice water or very cold water
•    Avoid direct exposure to the air conditioning when sweating
•    Visit a doctor if you experience severe symptoms
       -    Dubai Health Authority

•    Ensure the cleanliness of your accommodation
•    Don’t share personal hygiene products
•    Take any required medications on your doctor’s advice as per your health condition
•    Carry a first aid kit that includes sterile gauze pads, adhesive tape, antiseptic wipes and hand sanitizer
      -    Health Authority of Abu Dhabi

“At least one third of Hajj pilgrims are at risk of pneumococcal disease either by virtue of age or pre-existing medical conditions, consideration should be given to vaccinating high risk pilgrims against pneumococcal disease . The uptake of immunization recommendations vary greatly across countries. Studies indicate that Streptococcus pneumoniae is a frequently identified pathogen, found in about 10% of respiratory tract samples of symptomatic Hajj pilgrims.  It is necessary for Hajj pilgrims to be extra cautious about their health. Other preventive measures include smoking cessation, pollution reduction and following proper medical advice.” said Dr. Ashraf El Houfi, Consultant ICU Dubai Hospital, Head of Infection Control Office 

Health ministries and local authorities in UAE and KSA have established facilities in each country to ensure travelers and pilgrims can avail of medical care if required.

“Along with vaccination, maintaining proper hygiene is very important to prevent the spread of pneumococcal disease infections. Acute respiratory tract infections are very common during Hajj, primarily as a result of close contact among pilgrims, intense congestion, shared accommodation and air pollution. Pilgrims should adopt day-to-day precautions throughout their stay at Mecca to keep their immunity strong and prevent infectious diseases. Eating healthy food and drinking plenty of fluids to stay hydrated is essential as well. People with low immunity should wear masks in crowded places to minimize the risk of catching a respiratory infection and we also advise that they carry a first aid kit with them at all times.” added Dr. Fatma Al Attar, Head International Health Regulation, Ministry of Health, UAE 

Historically, outbreaks of the meningitis have been recorded during Hajj, the largest spate occurred in the year 1987.   Further, since there are various strains of Meningococcal disease causing bacteria, during the years 2000-2002 there was a shift in the pattern of meningococcal disease during Hajj  . An effective vaccination program ensured that no outbreaks occurred during Hajj in 2002. 

Through undertaking proper prevention measures by travelers, health costs associated with community acquired infections during Hajj can be easily avoided.