As the H1N1 flu continues to move around the globe infecting large numbers of people and causing deaths many of use are looking into the crystal ball of the fall and wondering what it will bring.  One way of dealing with the flu is to avoid large crowds…something that is  of course not possible at The Hajj. Every year, the single largest gathering on the planet is the annual pilgrimage to Mecca where approximately 2.5 million people from 160 countries will pack into a small city in Saudi Arabia for five days. No doubt, some of the pilgrims will be bringing the flu.

The Saudi authorities, fearing that The Hajj could turn their holy city into a petri dish for viral mutations and a hub for spreading a new pandemic wave around the world, are working hard to head that off. They have asked some worshipers, including pregnant women and the elderly, not to make the trip, which is scheduled for the last week of November.

“The Hajj is a central ritual of Islam, and our country tries to make it easy for everyone to come,” said Dr. Ziad A. Memish, the country’s assistant deputy minister for prevention “We’ve said we won’t turn away anyone who arrives at our borders. But we are recommending to other countries whom they should let come.” Although the Saudis have turned to the WHO and other health agencies for help in previous public health threats to The Hajj, this year the CDC is more deeply involved because it has so much experience with the new flu.

While religious pilgrimages feed the souls of those who attend, they have in the past endangered the health of those who attend. Diseases that have been an issue in the past include meningitis and polio.

The Hajj offers many opportunities to a virus that spreads through the air and lingers on surfaces: Pilgrims crowded into planes, boats, buses and tent cities; the endless ranks of the faithful praying shoulder to shoulder and touching their hands to the floors around the Kaaba, to handrails as they run between the hills Safa and Marwah, or to cups of water from the Zamzam Well.

The Journal of Science last week published a paper that describes the many the obstacles to fighting flu transmission at The Hajj. Dr. Memish, the Saudi official, is a co-author with several Centers for Disease Control experts. For example, pilgrims are advised to wash their hands frequently and bring their own surgical masks and hand sanitizers. The first is easy: Islamic law requires washing the hands and face five times a day before prayers. But male pilgrims may not wear anything with stitches in it; they wrap themselves in two lengths of unhemmed white cloth. And women on The Hajj — even those who wear chadors at home — are forbidden to cover their faces. Also, since Islam forbids alcohol, some believers reject most hand sanitizers.  Senior religious leaders have issued fatwas declaring that masks and sanitizers “are not a problem,” Dr. Memish said, but every religion has some conservatives who believe in keeping up standards.

The Saudi government has made many preparations, like buying stockpiles of generic Tamiflu. The country has 76 health facilities staffed for The Hajj, and intensive-care units have been expanded. For pilgrims, all medical care for problems they develop during their visit is free. “Saudi Arabia’s reputation rests on how The Hajj is conducted,” Dr. Shahul H. Ebrahim, a Centers for Disease Control epidemiologist who advises the Saudi government, said in the Science article. “It’s a rich country, they take a lot of national pride in it and the king is responsible. I don’t think anything is lacking here except vaccines.”

In countries with large Muslim populations, many applicants get one or two chances in a lifetime at the pilgrimage that every Muslim is supposed to make, and “some people save money for their whole lives to do it,” he said. More than half of all pilgrims are over 50. In a normal year, many of those desperate to come before they die are pushed in wheelchairs or carried around the Kaaba and through the other rituals.

Pandemic H1N1 and the 2009 Hajj

Pet Ferret Dies of H1N1

A news station in Hastings, Nebraska has reported that Stormy the ferret, one of four ferrets in a family of humans sick with the flu, has died from the H1N1 virus. Testing was done by the University of Nebraska Veterinary Diagnostic Lab where the ferret tested positive for H1N1. The state public health veterinarian said it is not unexpected, but it is rare.

This continues to point out the fact that when a human is sick in a household with pets that the pets should be kept apart from the sick individual and good hand and cough hygiene is important to prevent disease transmission – to any species!