Saudi residents planning to perform the upcoming Haj should get vaccinated against swine flu by November 22, the Saudi government says, the latest step in a months-long federal campaign to ensure that this year's pilgrimage does not amplify the global spread of the new pandemic influenza. Saudi health officials have been preparing since June for the arrival of about 2.5 million pilgrims from up to 160 countries with an eye to minimising outbreaks of the influenza, which has already caused 6,250 deaths across the globe, including at least 62 in the kingdom.
Conditions during the pilgrimage, set to begin on November 25, are exactly what health officials advise against when seeking to contain infectious diseases. Pilgrims will walk, pray and eat in close proximity to each other, touch the same religious objects, and sleep in crowded tent cities. Inevitably, some will arrive with the new virus strain, formally known as H1N1. Saudi health officials, in a move endorsed by Arab health authorities, have advised high-risk people to avoid the Haj this year. That group includes those younger than 12 or older than 65, pregnant women and those suffering from diabetes and chronic diseases of the heart, kidney, lungs or nervous system.
However, no one will be prevented from entering the kingdom to participate in the Haj, a once-in-a-lifetime religious obligation for all Muslims who are financially and physically able to undertake the trip. "We've said we won't turn away anyone who arrives at our borders. But we are recommending to other countries whom they should let come," Dr Ziad Memish, the assistant deputy minister for preventive medicine, was quoted as saying by the Saudi Gazette.
Epidemiologists are watching H1N1 carefully because it could blend with other flu virus strains, or mutate into an even more resilient strain that could produce deadlier outbreaks. Dense concentrations of people on such a pilgrimage facilitate such mutations. And unsuspecting pilgrims who become infected could spread it in their native lands. Saudi health authorities began their readiness campaign in June with a workshop in Jeddah attended by international experts on infection control, including staff from the US Centers for Disease Control and Prevention.
"Central to - the kingdom's commitment as the custodian to the two holy sites in Islam is the safeguarding of these pilgrims from every hazard," a report from the workshop stated. "Public health security at the Haj is therefore a matter of national security." Precautions undertaken by the Saudis include providing arriving pilgrims with kits containing masks, hand sanitisers and informational materials explaining how the virus is spread by airborne particles and physical contact.
Saudi airports have been equipped with thermal sensors to detect arriving passengers with high fever. The Saudi health ministry also asked each airport to have "holding capacity for 200 to 300 pilgrims to evaluate those who are symptomatic with influenza-like illness", the June workshop report said. If tests confirm an arrival has the flu, the person will be treated with antiviral medicine - at Saudi expense. But they will not be put under the strict conditions of a quarantine as Saudi officials want to avoid any suggestion of discrimination towards visiting pilgrims, the report added.
Meanwhile, 76 clinics and seven hospitals in and around Mecca will be fully staffed with about 1,200 Saudi doctors, nurses and technicians to deal with health emergencies during the Haj, officials have said. For the first time, a Saudi health ministry spokesman, Khaled al Marghalani said medics in the field will be able to instantly alert a central medical command when they find a sick pilgrim. Their reports, transmitted via hand-held, web-linked devices, will allow rapid response teams to quickly contain potential outbreaks, he said.
In an interview, Mr al Marghalani said the ministry early on created "a national scientific committee [comprised of] experts in influenza from all over the kingdom" and that "each decision [of the ministry] must be with their approval". Also, Mr al Marghalani pointed out that Saudi health officials have had "a lot of experience - more than 50 years" in dealing with medical issues during the Haj. Each year, the ministry issues a report summing up the major health events at the last pilgrimage. Although there have been outbreaks of such diseases as polio and meningitis among pilgrims, there has never been an epidemic, he added.
One bright spot is that during Ramadan when almost two million visitors went to Mecca, there were only 26 cases of swine flu and no deaths. But the Haj will be more unpredictable, as a second global wave of swine flu cases has already begun, world health officials have said. Saudi officials are not requiring visiting pilgrims to be vaccinated against swine flu because so few countries have the vaccine in stock. But it is asking all prospective pilgrims living in the kingdom to go to a health ministry facility to get their swine flu shots. The government is giving priority in vaccinations to health workers and residents of Mecca and Medina.
The local press has reported a lukewarm public response to the offer of free vaccination. The Arab News reported yesterday that "few people" have turned up at ministry-operated centres just opened in Mecca and Riyadh. "It is thought that claims on the internet and in the media about the vaccine having harmful side effects kept many people at bay," the article stated. Moulavi Mohammed Basheer, who is leading 100 pilgrims from Riyadh, told Arab News that members of his group had shown no interest in getting vaccinated. "Since the vaccination is not mandatory, we cannot force pilgrims to take it," Mr Basheer was quoted as saying.
This lackadaisical public attitude has caused some exasperation among health officials. "We haven't seen any scientific article saying this vaccine is not safe," Mr al Marghalani said. firstname.lastname@example.org