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Hajj 2016: How are the Saudis trying to combat communicable diseases and protect the pilgrims?As the annual Hajj approaches, JOL examined what the Saudi government is doing in order to combat the communicable diseases that threaten the Muslim pilgrims as they perform one of the five pillars of Islam.
On Sunday, JOL examined what communicable diseases threaten the Muslim pilgrims in Saudi Arabia. In this article, JOL reviews what measures the Saudi government has put in place in order to ensure the Muslim pilgrims’ health and safety during the annual pilgrimage.
Upper respiratory tract infections (URIs)
There are also a variety of techniques to prevent these infections, which include pharmaceutical and non-pharmaceutical methods. The most common pharmaceutical method is vaccination. As part of an extensive effort to decrease the prevalence of URIs during the Hajj pilgrimage, the Saudi Health Ministry recommends that all visitors receive a seasonal flu vaccination. However, this is not a requirement but simply a recommendation especially for people who have been identified as belonging to an increased risk group such as pregnant women, young children, the elderly and people suffering from certain diseases such as diabetes, AIDS, asthma and heart or lung diseases.
In regards to non-pharmaceutical methods, the importance of personal hygiene is stressed. The Saudi Health Ministry recommends that pilgrims wash their hands thoroughly with soap and water, use hand sanitizers and disposable tissues while coughing or sneezing. Another non-pharmaceutical method is wearing a face-mask, which is also advised by the Saudi Health Ministry. However, this method is unpopular.
An additional method practiced by the Saudi Health Ministry to prevent the spread of URIs is to recommend that people who belong to high-risk populations (such as the people identified earlier under the recommendations of the influenza vaccine) postpone their Hajj pilgrimage during outbreaks of respiratory epidemics and pandemics. Such recommendations were published by the Ministry during the influenza A/H1N1 pandemic in 2009 which coincided with the Hajj season that year and the Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic in 2013. However, epidemiological studies regarding both these outbreaks during the Hajj show that this recommendation was rarely followed and therefore not effective as some pilgrims might not have the luxury of waiting another year or two for the epidemic to subside. One of the possible reasons for the low compliance rate with this recommendation is due to the financial planning done years earlier. Also, due to the advanced age of the majority of the pilgrims, the voluntary deference of their planned Hajj could mean that they will not be able to complete this religious duty in their lifetime.
In preparation for the 2002 Hajj pilgrimage, the Saudi Health Ministry updated its vaccination policy, requiring all pilgrims to receive the Quadrivalent Meningococcal Conjugate Vaccine (MCV4) that protects against the A, C, Y and W135 strands of N meningitides. Before 2002, pilgrims were only required to receive the vaccination against the A and C strands.
The MCV4 vaccination has a suspected lifespan of three years, therefore, all pilgrims must receive the vaccination within this time period and at least ten days before their planned trip to Saudi Arabia. The vaccination is required of all pilgrims, those who are coming from abroad and locally as well as for all workers in the Hajj region and in the ports of entry, where the foreign pilgrims enter and leave Saudi Arabia. In addition, since 2002, ciprofloxacin tablets have been a requirement for pilgrims from the African meningitis belt, an African sub-Saharan region consisting of 16 countries that are prone to meningitis cases. The Saudi government requires that, upon entering Saudi Arabia, all pilgrims from these countries receive one dose of 500 mg of ciprofloxacin, administered at the port of entry, in order to lower the chances of a meningitis outbreak during the Hajj.
Diarrhoeal disease and gastrointestinal infections
The Saudi Health Ministry advises pilgrims to maintain good hygiene and avoid consuming food and water of unknown or questionable origin. This includes food and even ice cubes sold by street vendors. In order to lower the risk of diarrhoeal diseases, the Saudi government does not allow pilgrims to bring food into Saudi Arabia unless it is canned and can be consumed within 24 hours of their arrival. A strict surveillance program is also undertaken by the Saudi authorities in order to monitor and prevent the outbreak of diarrhoeal diseases. The surveillance program is headed by the Saudi Command and Control Center. The center tracks pilgrims who come from cholera-infected countries, an infectious diarrhoeal disease that infected many Hajj pilgrims in the late 20th century. If a pilgrim is suspected of carrying the disease, he is quarantined and samples from him are taken and tested. Also, all of his known contacts are tracked down and tested.
A similar procedure is undertaken if a pilgrim, regardless of his country of origin, complains of having diarrhea. In a case like this, the pilgrim and all the people he shared his living quarters with during the Hajj are quarantined. All of the contacts of these people are then also located by the Saudi Command and Control Center.
Despite the high prevalence of skin infections, most of them are easy to treat and prevent. In order to prevent skin infections, pilgrims are advised by the Saudi government to use deodorants and antifungal ointments in order to reduce the risk of frictional dermatoses. Pilgrims are also advised to be aware of pain or irritation on their skin, which can easily be caused by clothes. Upon discovering areas of pain or irritation, pilgrims should seek medical assistance from a dermatologist immediately. Also, preexisting skin problems should be protected as well as any exposed skin especially among pilgrims from cooler climates who are not used to so much sun exposure.
By banning the employment of unlicensed barbers during the Hajj, the Saudi Health Ministry has attempted to hinder this phenomenon and decrease the risk of blood-borne disease transmission. The ban by the Saudi government on unlicensed barbers is not the only method used to decrease the risk of blood-borne diseases by unlicensed barbers. The Saudi authorities also bring licensed barbers from around the country to provide their sterilized services to the Hajj pilgrims. In addition, the Saudi government displays posters, distributes flyers and broadcasts commercials on radio and television stations in an attempt to educate the pilgrims about the risk of blood-borne diseases through the use of unlicensed barbers.
This article is part 2 of a 5-part series regarding the Hajj and health risks. To find out what non-communicable health issues threaten the Muslim pilgrims, look for the next article in the series.
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