Heat, crowds and viruses: What Hajj pilgrims need to know about health

‘People think the Hajj is an overseas trip. But it’s like going on a trek. It’s major.’
 
Travel medicine specialist and GP Dr Penny Burns is talking about the pilgrimage to the holy city of Mecca in Saudi Arabia that every Muslim with the financial and physical ability must complete once in a lifetime.
 
Every year, around two million pilgrims descend on Mecca for the Hajj, with around 3000 Australian Muslims expected to go. This year’s pilgrimage is from August 9–14.
 
Dr Burns told newsGP that with so many people packed into a tight space during the Middle Eastern summer, there are very real health concerns.
 
One potential threat that worries the Department of Health (DoH) is the ongoing risk of Middle East Respiratory Syndrome (MERS) – a rare disease linked to a zoonotic coronavirus spread by camels.
 
The virus has a fatality rate of up to 35% in people affected. There is no vaccine, and people susceptible to respiratory disease are at a higher risk of death.
 
‘Contracting MERS during Hajj is not common but it’s possible and can have severe consequences,’ Dr Burns said.
 
‘It exists in Saudi Arabia, so people should be alert to the fact they might be exposed and be very careful about avoiding contact with camels, drinking raw camel milk or eating undercooked camel meat.’
 
Dr Burns added pilgrims should ensure their other vaccinations are up to date, given the close proximity to many other people.
 
‘It’s a very dense, crowded environment with two million people all in one spot. That makes the risk of infectious diseases such as respiratory illness and diarrhoea very high,’ she said.
 
Meningococcal meningitis is also a concern, with the Saudi Arabian Government requiring pilgrims to ensure they have been vaccinated no less than 10 days before arriving with a quadrivalent (ACWY) vaccine, and to bring a valid vaccination certificate. Flu vaccination is recommended but not mandatory.        
 
‘We would recommend that pilgrims have all their routine vaccinations up to date,’ Dr Burns said.
 
‘Men in particular should ensure their hepatitis B vaccinations are up to date, as part of the Hajj can involve men shaving off their hair. There are designated barbers who do that, but if razors are unclean or shared, there’s a risk of transmission of blood-borne viruses.’
 
Dr Burns said it is easy to underestimate the task.
 
‘People walk many kilometres. Almost half will walk over 23 kilometres over the five-day pilgrimage,’ she said.
 
‘You’ve got young healthy pilgrims, but also many with chronic health conditions. It’s summer there, and temperatures can get very high, with an average daytime peak of 43⁰C. There’s quite a risk of heatstroke and heat exhaustion, as well as bacterial infections from chafing or blisters on the feet.’
 
She recommends that pilgrims stay well hydrated, use sunscreen, seek shade, and wear light coloured clothing. People using diuretics have to be especially careful of dehydration.
 
‘It’s really crucial doctors are supporting their patients with chronic conditions for this, by helping them with a travel pack with enough of their usual medications, emergency kits for people with diabetes, and so on,’ Dr Burns said.
 
Another threat to be alert to is the danger of crushing, following the deaths of up to 2000 pilgrims during a crowd surge in 2015.
 
Dr Burns said some Muslim women also might request assistance with managing their menstrual cycles ahead of the Hajj, as taking part in one specific ritual is not possible when menstruating.
 
The DoH has issued an information sheet on MERS and is also calling for GPs to remain vigilant for signs of possible MERS – a nationally notifiable disease – in the months following the pilgrimage. No cases have so far been detected in Australia.
 
The virus is not present in Australia’s enormous feral camel population.

Coronavirus Immunisation MERS Travel medicine Vaccinations