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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.

The hajj, which lasts four to five days, is one of Islam’s five pillars, required of all physically and financially able Muslims. Each country is assigned a quota of hajj visas that it receives from the Saudis.

Al Marghalani said the government also highly recommends prospective pilgrims get seasonal flu shots. And if a country has received swine flu vaccine in enough time to inoculate pilgrims before they depart for Mecca, the Saudis may require they be vaccinated prior to getting a visa.

However, few countries are in that position. An article in Science magazine on hajj preparations written by Memish and CDC staff noted that because of manufacturing delays, as of Oct. 22, only four countries had indicated they planned to vaccinate their pilgrims.

The kingdom has received an initial shipment of swine flu vaccine, and next week will start vaccinating health workers and local residents who plan to attend this year’s hajj, Agence France Presse reported Monday.

The Science article also said that arriving pilgrims will be given kits containing masks, hand sanitizers and informational materials explaining how the virus is spread by airborne particles and physical contact.

Thermal sensors at airports will detect arrivals with a high fever. The Saudi health ministry “has recommended that each receiving airport have the holding capacity for 200 to 300 pilgrims to evaluate those who are symptomatic with influenza-like illness,” said the June workshop report.

But officials are avoiding any mention of “quarantine,” the report added, partly because of fears it would discourage ill pilgrims from coming forward, and partly because of the “risk of politicizing Hajj negatively as people may feel discriminated if quarantined.”

If tests confirm an arriving pilgrim has the flu, they will be treated with anti-viral medicine — at Saudi expense.

Meanwhile, 76 clinics and 7 hospitals in and around Mecca will be fully staffed during the pilgrimage. And for the first time, spokesman Al Marghalani said, field medics will be equipped with hand-held web-linked devices to instantly alert a central medical command when they find a sick pilgrim. This will give a real-time, geographic picture of where outbreaks may be starting, allowing a rapid response to contain them.

While the prevention effort this year will be more intense, it is not unprecedented. “We have had experience with communicable and non-communicable diseases during the hajj for more than 50 years, so we’ve got a lot of experience,” Al Marghalani said.

Every year, Saudi health officials monitor epidemics around the world and require prior vaccination for visitors from affected areas, he said. Meningitis, polio, dengue fever and yellow fever are top concerns.

Also, the government issues a yearly report summing up the major health issues of the last pilgrimage. “They are very transparent,” said Awad Abu Zeid Mukhtaar, WHO’s representative in Riyadh. “Whenever they have cases, they report it.”

Saudi officials were encouraged when a wave of almost 2 million visitors to Mecca during the holy month of Ramadan in mid-September passed with only 26 cases of swine flu and no deaths.

However, the upcoming hajj will be more unpredictable. It will bring many more pilgrims from developing countries with weak health systems, as well as visitors from the northern hemisphere when its flu season will be in full swing.