The Hajj pilgrimage and surveillance for Middle East Respiratory syndrome coronavirus in pilgrims from African countries.

Abstract

It is well documented that mass gatherings attracting people from all over the world create an ideal environment for rapid transmission and spread of viral and bacterial respiratory infections (Abubakar et al. 2012). Africa has a large Muslim population estimated at over 250 million (Government 2011). Every year, more than 1 million pilgrims from African countries travel to Makkah and Madinah, Kingdom of Saudi Arabia (KSA) to join 10 million other pilgrims from around the globe to perform either the annual Hajj pilgrimage (Figure 1) or the Umrah, which can be performed at any time of the year (Memish et al. 2014a). One of the major public health concerns related to these journeys is the importation on arrival, or exportation on departure, of a range of infectious diseases, some of which may have epidemic potential (Al Rabeeah et al. 2012; Al-Tawfiq & Memish 2012). For example, Rift Valley fever from East Africa caused outbreaks in KSA and Yemen (Fagbo 2002), and there have been two important meningococcal disease outbreaks in KSA related to the Hajj (al-Gahtani et al. 1995; Aguilera et al. 2002).