Swine flu fears for hajj pilgrims
Posted: Wednesday, November 25, 2009 2:42 PM
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Cairo, Egypt
By Charlene Gubash, NBC News Producer
JIDDAH, Saudi Arabia – The road to Mecca for Islam’s annual hajj is littered with needles this year. Before you even leave your country of origin you have to get vaccinations for meningitis, seasonal flu, yellow fever, and for the lucky, the H1N1 vaccine.
Our trip started in Cairo, where Egyptian authorities are keen to prevent their residents from catching the H1N1 virus during the yearly pilgrimage and bringing it back home.
They insisted on a complete physical, including blood tests, chest x-rays and electrocardiograms to make sure we were healthy enough to travel before we were even allowed to get the H1N1 vaccine, which Egypt requires of all hajj pilgrims. China, Turkey, Bahrain, the United Arab Emirates, Jordan and others also are mandating the H1N1 vaccine.
Why are they so afraid? For at least five days, more than three million pilgrims from 160 countries are assembling in one place at one time, worshipping, eating and sleeping next to each other. For Muslims, it is the spiritual voyage of a lifetime; but for the H1N1 virus, it is the opportunity of a lifetime to hitch a ride on hosts that will deploy to the four corners of the earth.
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| Saudi Press Agency via EPA |
| Hajj pilgrims wear protective face masks ahead of the start of the hajj in Mina, Saudi Arabia, on Tuesday. |
That is why the Saudi government, in conjunction with the World Health Organization and the U.S. Centers for Disease Control and Prevention, has been hard at work for several months reviewing every possible step of the pilgrims’ journey – from pre-departure, arrival, pilgrimage, departure and post-departure – to limit the spread of the virus and its chance to mutate.
Precautions at the border
At the airport in Jeddah, where 65 percent of all pilgrims arrive, travelers have to pass a gamut of tests before going through passport control.
First, they file one-by-one past thermal sensing cameras, designed to set off an alarm if they sense a high body temperature. Feverish passengers are taken to an isolated area and then to a specially designed hospital to be tested for the H1N1 virus on state-of-the-art equipment that will deliver a result in three hours. If they have the virus, they are kept in hospital for seven to ten days and released to rejoin the hajj.
Those who succeed in passing the cameras then have their vaccination records checked. If they are missing common vaccines, they are taken to an airport health clinic for free vaccination. If they received their H1N1 vaccine less than 10 days prior to travel (the time required for the vaccine to be effective) they are given antibiotics as a protective measure.
While the H1N1 vaccine is highly recommended, it is not mandatory for entry into Saudi Arabia since it may not have been readily available in the traveler’s country of origin. Also, some travelers, and local Saudis, didn’t take the vaccine out of a fear of side effects.
An army of health workers — 450 at Jeddah airport alone – recommend further protective measures, such as protective masks and hand washing, before pilgrims are allowed to continue on their way. New arrivals run through the same series of tests at every port of entry in Saudi Arabia, and the government has deployed even more border security to prevent undocumented visitors from slipping in.
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| Saudi Press Agency via EPA |
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Packets with sanitizing hand gel and face masks being handed out by Saudi medical authorities in Mecca to fight the spread of the H1N1 swine flu at the hajj.
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Still, a sea of humanity However, once inside the holy city of Mecca, which is closed to non-Muslims, the scene is less controlled. Crowds fill the streets, with the vast majority of them unmasked. Saudi sanitation workers scrub the sidewalks and walls with disinfectant, but for many pilgrims, disease-prevention is not top of mind.
People sit on curbs eating greasy rice and meat off Styrofoam plates, sometimes with bare hands, and share soft drink cans with companions. Others cough or sneeze openly or spit on the ground. Many are well past the recommended age limit of 65 years and some appear frail. And despite the Saudi efforts to guard the country’s borders, there are still a few who have managed to sneak into the country and claim a patch of pavement for their living quarters.
One man from Nigeria said he got the H1N1 vaccine at home, but he was nervous anyway.
"I’m worried because it affects human beings. It can attack anybody and instantly you can die." Still he wasn’t wearing a mask or taking any other obvious precautions when our NBC crew spoke to him inside Mecca.
Another pilgrim, Osman, traveled all the way from Singapore for the Muslim rite of passage. He got the vaccine before coming, but was resigned to his fate one way or the other.
"I’m not very concerned about it because I have already decided to come to the hajj," he said. "And if my faith says [getting H1N1] is going to happen here, it doesn’t matter to me."
Shaky Shar, a pilgrim visiting from Turkey, said he refused to take the vaccine because he was nervous about possible side effects. "We are worried about [contracting the flu] but we protect ourselves like this," he said, indicating a mask he was wearing.
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| Hassan Ammar / AP |
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Muslim pilgrims circle the Kaaba inside the Grand Mosque in Mecca, Saudi Arabia, on Tuesday. |
Highly sophisticated monitoring
Inside Mecca’s crowded Grand Mosque, Islam’s holiest site, Saudi Arabia continues its fight against the unseen enemy.
Strategically placed thermal sensors monitor body temperatures. And for the first time ever, experts from Saudi Arabia and the CDC are working together in Mecca to monitor detected cases in real time, provide command and control, and collect data that is relayed to the CDC in Atlanta. Random blood samples are taken from infected pilgrims to make sure the virus has not mutated.
The challenge is enormous. Previous studies done on returning pilgrims show that anywhere from 40 to 60 percent of them brought upper respiratory infections contracted during the hajj home with them. And a separate British study demonstrated a spike in flu cases in the country at large weeks after pilgrims returned from the annual rite.
But the resources assembled to fight the potential threat to global health are equally impressive: 17,609 health care workers, 240 health care centers (at all holy sites and within the Grand Mosque itself), 26 well equipped hospitals and 170 mobile medical units each staffed by a doctor and nurse.
Dr. Ziad Memish, Saudi Arabia’s executive director of infection prevention and control, was confident that they were well prepared.
"We do have a very active preventive medicine team that has experts in infectious disease who are actually manning each of the health care facilities that we have in the hajj premises, Mecca, Medina and Arafat," he said. "We have a team of infection experts that are circulating in the community and also the hospitals to make sure that there is no cross-transmission of infectious disease during the hajj time."
And it doesn’t end there. Many returning pilgrims will be met by more doctors and thermal sensors when they return to their own countries. Those who are healthy will head home to celebrate with family. Those who manifest symptoms will be quarantined.
Meanwhile, world health organizations will sift through a treasure trove of data.
NBC News’ Tom Aspell and Mohamed Muslemany contributed to this report from Mecca.
