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Experts warn of Hajj flu threat

13th December 2006

13122006_muslims.jpgA group of international experts has warned of the possibility of the spread of influenza during the annual pilgrimage of Muslims to Mecca, which will be hosted by Saudi Arabia at the end of January.

"For the individual pilgrim [the Hajj] is a deeply spiritual journey that represents the culmination of months if not years of preparation," according to four doctors writing in a British Medical Journal editorial.

"From a public health perspective, however, such a gathering makes the possible rampant spread of the influenza virus and a global pandemic - which many experts believe is overdue - a potentially devastating prospect that has been inadequately prepared for," said the article, which was signed by Birmingham-based consultant paediatrician A Rashid Gatrad, Middlesex-based microbiologist Shuja Shafi, Saudi-based infectious diseases expert Ziad A Memish, and Edinburgh-based Aziz Sheikh, professor of primary care research and development.

The four call for internationally agreed strategies to minimise the risk of a pandemic, which they say should centre on ways to prevent transmission, as well as including facilities for prompt diagnosis and treatment of infected individuals. "No such comprehensive strategy currently exists," they write.

They said the tented accommodation provided for pilgrims in the desert plains near the sacred sites was conducive to the spread of influenza.

"It is not unusual for 50-100 people to share a tent overnight. Such overcrowding and continuous close contact greatly increases the spread of respiratory infections. It has been estimated that more than one in three pilgrims will experience respiratory symptoms during their stay," they said.

The Saudi Arabian Ministry of Health has recommended that masks be used to minimise droplet spread, but many Muslims consider covering the face during the Hajj to be prohibited. The experts said masks would need anyway to be of high quality and changed at least every six hours to remain effective.

Instead, frequent hand washing was recommended to reduce spread of the virus. Given the religious insistence on ritual purity before the five daily prayers and other acts of worship, this suggestion should be acceptable to most pilgrims and relatively easy to implement, they said.

"Given this fact and the risks of a pandemic originating from the Hajj, mandatory influenza vaccination for all pilgrims should be considered," they said, adding that this should not be too difficult to implement, given that meningococcal vaccinations are already mandatory among pilgrims.

They said virus surveillance studies to identify newly emerging strains were urgently needed, adding that Saudi Arabia was not currently implementing one, and called on the World Health Organisation (WHO) to work with the Saudi authorities to minimise the risk of the influenza virus spreading among pilgrims, and to the rest of the world.

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