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Hajj pilgrims should get flu jab to avoid pandemic

December 08, 2006

Hajj and the risk of influenza BMJ Volume 333, pp 1182-3

Flu vaccination should be mandatory for all Hajj pilgrims to minimise the risk of a global pandemic, say doctors in this week's BMJ.

At the end of next month Saudi Arabia will again host the Hajj - the largest annual gathering in the world - which attracts more than two million pilgrims from almost every country on earth.

For the individual pilgrim this is a deeply spiritual journey, but from a public health perspective, such a gathering makes the possible rampant spread of the influenza virus and a global pandemic a potentially devastating prospect that has been inadequately prepared for, write Professor Aziz Sheikh and colleagues.

Overcrowding is considerable throughout Hajj and it has been estimated that more than one in three pilgrims will experience respiratory symptoms during their stay.

Although the Saudi authorities recommend flu vaccination for pilgrims with chronic illnesses, data show that many high risk pilgrims remain unimmunised. For example, in a letter to this week's BMJ, researchers found worryingly low rates of vaccination among British Muslims attending Hajj in 2005 and 2006.

And the situation is probably far worse among the large numbers of people coming from the economically developing world, add the authors.

Given this fact and the risks of a pandemic originating from the Hajj, mandatory influenza vaccination for all pilgrims should be considered, they write. Meningococcal vaccination for Hajj is already mandatory, so this extra vaccination should not be too inconvenient and should be readily acceptable.

Virus surveillance to identify newly emerging strains is also urgently needed, they say.

The World Health Organisation must work with the Saudi authorities to minimise the risk of the influenza virus spreading among pilgrims (and the rest of us). A coherent international response will be needed to ensure that the resources and logistics are in place so that these strategies can be implemented, they conclude.

BMJ-British Medical Journal

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Muslims travelling to Saudi Arabia for the annual Hajj religious festival are a high priority for enhanced meningococcal vaccination this year. Thirty-three cases and nine fatalities were reported in England and Wales, a similar number to that reported in 2000, despite the recommendation to use a different vaccine in 2001. Better implementation of control policies are needed to prevent an outbreak of meningococcal disease among pilgrims and their contacts this year, conclude authors of a research letter in this week's issue of THE LANCET. An outbreak of a previously rare strain (W135) meningococcal disease was seen in 2000 and 2001 among pilgrims returning from Saudi Arabia and their contac

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