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Will the hajj be an incubator for swine flu?

Millions walk, pray and eat together during the hajj. How Saudi Arabia is trying to minimize the swine flu risks.

A Muslim pilgrim prays on Mount Mercy on the plains of Arafat outside the holy city of Mecca, Dec. 7, 2008. Saudi health officials are working to minimize the swine flu risks for this year's hajj. (Ahmed Jadallah/Reuters)

RIYADH, Saudi Arabia — As millions of Muslims begin arriving in Mecca for this year’s pilgrimage, Saudi officials face a unique challenge: how to prevent this sacred rite from becoming an inadvertent incubator and global transmitter of swine flu.

The conditions that will arise during the pilgrimage, or hajj, which officially begins in the last week of November, are the exact opposite of what health officials like to see.

An estimated 2.5 million people from up to 160 countries — including perhaps 15,000 from North America — will walk, pray and eat in close proximity to each other for several days. They will touch the same religious objects and sleep in crowded tent cities. Some, inevitably, will arrive carrying the new virus strain, H1N1.

Unable to alter these conditions, Saudi health officials have been working feverishly for months to minimize the risks. It has been a delicate balance between maintaining unrestricted movement for one of Islam’s holiest rites, and imposing measures to retard rampant transmission of the virus.

In June the World Health Organization declared swine flu, first detected in April, to be pandemic, meaning it had reached much of the world. As of Oct. 17, the WHO reported more than 414,000 cases and nearly 5,000 deaths from the disease.

By Nov. 2, Saudi Arabia had 62 deaths and about 5,000 cases of confirmed or suspected swine flu, according to Khaled Al Marghalani, spokesman for the Ministry of Health.

Epidemiologists are watching swine flu carefully to detect if it blends with other strains or mutates into an even newer, more resilient strain that could produce more deadly outbreaks.

Large, dense concentrations of people such as the pilgrimage create conditions for such mutations. And pilgrims who become infected during the hajj could bring it home, triggering new outbreaks.

Al Marghalani said in an interview that ministry officials “feel very confident” that they have done as much as they can to prepare for the hajj.

He said the Saudis invited international epidemiological experts, including staff from the U.S. Centers for Disease Control and Prevention, to a June meeting in Jeddah. The participants inspected airports and seaports that will receive the pilgrims and made recommendations on preventing, spotting and containing flu outbreaks.

One recommendation, which the Saudis adopted and Arab health ministers endorsed, was for high-risk people to avoid this year’s pilgrimage. That group includes those younger than 12, older than 65, pregnant women and those suffering from diabetes and chronic diseases of the heart, kidney, lungs or nervous system.

The Saudis stress this is advisory only. “We will not prevent anybody from coming in if they get approval from their country,” said Dr. Ziad A. Memish, assistant deputy minister for preventive medicine, in a recorded interview posted at the website of Science magazine.