Religious Mass Gathering Research Articles

IT-based health event surveillance in mass gathering - Kumbh Mela 2021, Haridwar, Uttarakhand

The Kumbh Mela is a large religious mass gathering event organised in India. During April 01 to April 30, 2021, Kumbh Mela was organized in Haridwar, Uttarakhand, India in the amid of COVID-19 pandemic. To detect and respond to unusual health events, a special surveillance model was established during Kumbh Mela-2021, Haridwar. The Kumbh module of Integrated Health Information Platform (IHIP) is utilized for real time data capturing. An Emergency Operations Centre (EOC) established to monitor COVID-19 and other disease situations through IHIP. Capacity building of Rapid Response Teams (RRT) was conducted. The special surveillance monitored 24 diseases/ syndromes. Kumbh mela area was divided into 4 zones with total 75 health facilities. A total of 31021 cases were reported on IHIP, including 86% communicable diseases (CDs), 8% non-communicable diseases (NCDs) and 6% unusual syndrome. Among total CDs, 27% acute febrile illness (AFI), 25.3% acute respiratory illness (ARI), 19% water borne diseases (WBDs), 15% COVID-19 and 14% others encountered. Out of total NCDs, 67% trauma, 25% dog bite, 8% others. A total of 36 early warning signals generated and responded, of which 22% WBDs, 22% ARI, 17% COVID-19, 14% AFI, 11% unusual syndrome and 14% others. The special disease surveillance helped monitoring health event alerts and health condition alerts. EOC monitored early warning signals and facilitated early detection and quick response to public health threats. Acute febrile illnesses emerged as a leading cause of morbidity. Future Mass Gathering events like Kumbh Mela should include disease surveillance as part of planning and augment capacity to diagnose and management of acute febrile illness.

Sacred journeys and pilgrimages: health risks associated with travels for religious purposes.

Pilgrimages and travel to religious Mass Gatherings (MGs) are part of all major religions. This narrative review aims to describe some characteristics, including health risks, of the more well known and frequently undertaken ones. A literature search was conducted using keywords related to the characteristics (frequency of occurrence, duration, calendar period, reasons behind their undertaking and the common health risks) of Christian, Muslim, Hindu, Buddhist and Jewish religious MGs. About 600 million trips are undertaken to religious sites annually. The characteristics varies between religions and between pilgrimages. However, religious MGs share common health risks, but these are reported in a heterogenous manner. European Christian pilgrimages reported both communicable diseases, such as norovirus outbreaks linked to the Marian Shrine of Lourdes in France, and noncommunicable diseases (NCD). NCD predominated at the Catholic pilgrimage to the Basilica of Our Lady of Guadalupe in Mexico, which documented 11 million attendees in one week. The Zion Christian Church Easter gathering in South Africa, attended by about 10 million pilgrims, reported mostly motor vehicles accidents. Muslim pilgrimages, such as the Arbaeen (20 million pilgrims) and Hajj documented a high incidence of respiratory tract infections, up to 80% during Hajj. Heat injuries and stampedes have been associated with Hajj. The Hindu Kumbh Mela pilgrimage, which attracted 100 million pilgrims in 2013, documented respiratory conditions in 70% of consultations. A deadly stampede occurred at the 2021 Jewish Lag BaOmer MG. Communicable and NCD differ among the different religious MGs. Gaps exists in the surveillance, reporting, and data accessibility of health risks associated with religious MGs. A need exists for the uniform implementation of a system of real-time monitoring of diseases and morbidity patterns, utilising standardised modern information-sharing platforms. The health needs of pilgrims can then be prioritised by developing specific and appropriate guidelines.

Managing risk of infectious disease transmission at religious mass gatherings.

Managing risk of infectious disease transmission at religious mass gatherings.

Patterns of disease presentation and outcome during the 2024 Al-Sha’abania mass gathering event in Karbala, Iraq

IntroductionMass gatherings can be defined as spontaneous or planned gatherings of many individuals that lead to an increased burden on local healthcare services. This study was conducted to estimate the prevalence of common disease presentations to temporary healthcare outlets during Al-Sha’abania mass gathering events to improve public health preparedness for future events. MethodA cross-sectional study was conducted during the Al-Sha’abania religious mass gathering in Karbala between February 24 and February 26, 2024, including seven healthcare outlets distributed around Imam Hussein and Imam Abbas Holy Shrines. ResultWe retrieved the records of 6799 patients who attended the temporary healthcare outlets during the data collection period; 3919 (57.6 %) were males. Females (62.0 %) and individuals above the age of 50 (52.7 %) constituted a higher proportion of emergency presentations. The most common cause of attendance was non-communicable conditions in both cold (66.7 %) and emergency cases (49.4 %). However, accidents/injuries were more common in emergency presentations (18.8 % vs. 2.7 %). The highest overall cause of attendance across all categories was joint/bone conditions (1192, 19.26 %) for cold cases and hypertension for emergency cases (84, 13.75 %). Out of the 611 patients with emergency presentation, only 8 (1.3 %) required referral to secondary and tertiary healthcare centers. ConclusionDifferences in the number of cases presented to different healthcare outlets require careful resource allocation during future mass gathering events in Karbala. Additionally, the importance of managing chronic conditions should be emphasized to reduce the burden of non-communicable conditions during mass gathering events.

Pattern of morbidity and mortality amongst Iraqi Hajj pilgrims: Experience of Iraqi Hajj medical mission 2023

IntroductionHajj is one of the largest global religious mass gatherings that takes place in Saudi Arabia and involves around three million Muslims from all over the world. It carries potential health risks both for Saudi Arabia and pilgrims’ home countries. Like all countries, the Iraq Ministry of Health is part of the Hajj coordinating committee and has developed a plan to prepare and respond to Iraqi pilgrims’ health needs during the Hajj season. This study aimed to demonstrate Iraqi pilgrims' leading health complaints before, during, and after the Hajj time in 2023. MethodWe conducted a retrospective cross-sectional study analyzing the data from electronic records of the main clinical presentations from the 38 clinics established in Al-Madeena Almunawara, Makka, Mina, Arafat, and Muzdalifah, KSA, during the three phases: the pre-Hajj (6th-26th June), the Hajj (27th-30 June), and the post-Hajj (1st-9th July). Result89,973 patients attended the clinics; 46,457 (51.6 %) were females. The highest daily attendance was 3429 during the pre-Hajj phase. The most frequent cause of attendance was rheumatologic/orthopedic diseases (18.8 %), HT (18 %), DM (11.4 %), influenza (9.7 %), other respiratory infections (8.3 %), ENT conditions (6.3 %); with similar distributions between the pre-Hajj, the Hajj, and the Post-Hajj phases, except for rheumatologic/orthopedic diseases, which contributed the highest during the Hajj phase (25.4 %), and influenza, which accounted for 21.1 % in the post-Hajj phase. Eight hundred-eleven referrals to secondary and tertiary care were reported, and 29 deaths were recorded among the pilgrims. ConclusionNon-communicable conditions exerted the highest burden on health services, as many pilgrims are elderly with preexisting chronic medical conditions. Respiratory infections were common, considering the overcrowding during Hajj. Raising pilgrims’ knowledge of potential health risks encountered during Hajj and following the preventive measures can help mitigate pilgrims’ health risks during the Hajj. Data availability statementData used for this study will be available upon request

Managing risk of infectious disease transmission at religious mass gatherings: Insights from survey, COVID-19 PCR, and antibody tests from Arbaeen walkers in 2020.

Arbaeen in Iraq has been one of the largest mass gatherings during the COVID-19 pandemic with 14.5 million attendees in 2020. We set out to assess the prevalence of current or past COVID-19 among 2020 Arbaeen participants, and establish associations between COVID-19 test results, symptoms, and known recent exposure. This was a cross-sectional study involving participants who joined Arbaeen walk in Iraq in October 2020. COVID-19 PCR and/or rapid antibody test were conducted among consented participants. A short questionnaire was administered. Rapid antibody testing was done onsite. Nasal and throat swab samples were transferred to the laboratory for PCR testing. A total of 835 (88.3% male; 11.7% female) participants were recruited. The most common symptom overall was cough (9.6%) followed by sore throat, fever, and loss of taste/smell (6.6%, 5.5%, and 5.0%, respectively). One in five (20.3%) participants reported close contact with a confirmed COVID-19 case in the past 14 days. Of the 237 participants with a PCR test, 18 (7.6%) were positive. Of the 765 participants with rapid antibody test, 19.3% tested positive for IgM, 39.3% for IgG, and 16.4% for both. Approximately 40% of the participants had evidence of current or past COVID-19 infection based on antibody and PCR. The almost 1 in 10 COVID-19 cases within such a multimillion person gathering, illustrates the difficulty in limiting the participation of infectious individuals in religious mass gatherings. There is a pressing need to explore measures to reduce the risk of transmission of infectious diseases at major mass gathering events.

Complaints and Advices of Alternative Medicine among Pilgrimages Visitors in Vivahpanchami at Janakpurdham, Nepal

Background & Objectives: Potential health related risks and spread of communicable disease is one of the challenges of religious mass gatherings. With the rise of globalization, parts of Ayurveda are now popularized as a form of alternative medicine. In Nepal, Ayurveda medicine faces lots of challenges, and is under threat due to inadequate funding, ignorance of modern diagnostic technologies, and insufficient quality research. It is vitally important to continually monitor and promote Ayurveda in the modern era of allopathic medicine. Thus, this study aimed to identify the main complaints and advices on Ayurvedic medicine among pilgrims visiting Vivahpanchmi in Janakpurdham, Madhesh Province, Nepal. Materials and Methods: The information was gathered from the registration book of pilgrims who attended an Ayurveda health camp at Rangbhumi Maidan (Barahbigha) in December 2023, organized by the Ayurveda and Alternative Medicine center, Janakpurdham Sub Metropolitan office, Dhanusha, Madhesh Province. The extracted data were imported into MS Excel and SPSS 20 was used for analysis. Data were expressed in frequencies and percentage. Results: Of the 707 pilgrims, 97.7% were from India and 2.3% were from Nepal; 68.9% of the visitors were women and 31.1% were men. Out of all visitors, less than 10% were over 60, and more than half were between the ages of 41 and 60. Gastritis accounted for the highest percentage (45.9%), followed by joint pain, weakness, back pain (31.3%), and coughing (17.1%). Only 4.4% of people reported being constipated. Conclusion: The most common complaints from Pilgrims were related to gastritis (Amlapitta), which was followed by joint discomfort, weakness, and back pain (Vata). The possible ayurvedic advices and medications were provided and distributed among the pilgrims during Vivahpanchmi.

Emerging pneumococcal serotypes in Iraq: scope for improved vaccine development.

Pneumococcal disease is a global public health concern as it affects the young, aged and the immunocompromised. The development of pneumococcal vaccines and their incorporation in the immunization programs has helped to reduce the global burden of disease. However, serotype replacement and the emergence of non-vaccine serotypes as well as the persistence of a few vaccine serotypes underscores the need for development of new and effective vaccines against such pneumococcal serotypes. In the Middle East, places of religious mass gatherings are a hotspot for disease transmission in addition to the global risk factors. Therefore, the periodic surveillance of pneumococcal serotypes circulating in the region to determine the effectiveness of existing prevention strategies and develop improved vaccines is warranted. Currently, there is a lack of serotype prevalence data for Iraq due to inadequate surveillance in the region. Thus, this review aims to determine the pneumococcal serotypes circulating in Iraq which may help in the development and introduction of improved pneumococcal vaccines in the country.

Evaluating the gap choice decisions of pedestrians in conflict situations in mass religious gatherings and controlled experimental setup – A pilot study

Previous studies on modelling the microscopic behaviour of pedestrians have focused on conflict resolution among pedestrians in pedestrian-pedestrian interactions. Many of these models propose alternate mechanisms to avoid conflicts by introducing repulsive forces between pedestrians or a set of predefined rules stating the precedence of movements to sidestep obstacles and other pedestrians. However, the possibility of formulating the decision-making mechanism pedestrians use to overcome conflicts as a gap-seeking behaviour has not been explored. In this study, resolving conflicts between opposing pedestrians is modelled as gap choice decisions made by individuals. Pedestrians looking for gaps or spaces in a crowd to facilitate their movement form the basis for such an analysis. The study compares pedestrians' gap acceptance behaviour across two scenarios: pedestrian movement in a field setup (Kumbh Mela) and a controlled experiment. Multiple gap choice decisions of individuals are modelled to understand the effect of individual-level heterogeneity on gap choices. Apart from the gap duration, spacing, position of gap, linear density, age, and presence of luggage significantly influenced the gap choices. Model validation is done using appropriate methods for both field and experimental data. The bootstrap method of internal validation and holdout validation is used to assess the performance of the estimated model on field data and experimental data, respectively. It is seen that the models have reasonable predictive and discriminative abilities. The analysis results also indicate that pedestrians tend to force gaps to facilitate movement in their natural state. Consequently, controlled experiments might have limitations in reproducing or motivating the participants to behave like a crowd.

Knowledge, Attitude, and Self-reported Practices on Prevention of Respiratory Infections among Two Groups of Islamic Pilgrims, Thailand, 2021

Religious mass gatherings can foster contagious disease transmission in the home countries of pilgrims. Thailand has two major Muslim pilgrims: the Hajj and the Dawah. This study aimed to compare their knowledge (K), attitude (A), and self-reported practice (P), and qualitatively evaluate their perceptions regarding the prevention of respiratory infections. A cross-sectional mixed methods study was conducted. Multistage sampling was conducted in Hajj participants, while convenience sampling was used with the Dawah participants at two gathering places. Pearson’s chi-square test was used to compare KAP scores between the two groups. We conducted qualitative interviews with 13 purposively chosen participants. There were 111 Hajj and 228 Dawah participants. Most Hajj respondents were in the age group of ≥50 years, while most Dawah respondents were between 30–49 years. Overall, the Hajj group had a significantly higher proportion of good knowledge scores than the Dawah group, with 76.6 and 56.1, as well as the positive attitude score of 97.3 and 87.7. The Hajj group was more receptive to receive health education about respiratory infections before their pilgrimage. Preparatory education classes should be initiated for Dawah Muslims before they attend a foreign gathering event.

Public Health Challenges in Saudi Arabia during the COVID-19 Pandemic: A Literature Review.

Similar to most countries, Saudi Arabia faced several challenges during the novel coronavirus disease 2019 (COVID-19) pandemic, some of which were related to the religious position of the country. The main challenges included deficits in knowledge, attitudes, and practices toward COVID-19, the negative psychological impacts of the pandemic on the general population and healthcare workers, vaccine hesitancy, the management of religious mass gatherings (e.g., Hajj and Umrah), and the imposition of travel regulations. In this article, we discuss these challenges based on evidence from studies involving Saudi Arabian populations. We outline the measures through which the Saudi authorities managed to minimize the negative impacts of these challenges in the context of international health regulations and recommendations.

Respiratory viral infections during Hajj seasons

Respiratory viral infections pose a public health concern during mass gathering (MG) events. Sustainable and continuous surveillance of respiratory viruses remains a priority to early identify and prevent potential outbreaks. This article reviews recent literature addressed the prevalence and diversity of circulating respiratory viruses during Hajj pilgrimage, one of the largest planned religious MG events held annually in Saudi Arabia. The variation between studies with respect to study design, sample size, time of sample collection (pre-, during, and pos-Hajj), type of participants (e.g., symptomatic vs. a symptomatic pilgrims), and laboratory procedure was highlighted. The majority of these studies were conducted on the 2019 Hajj season or earlier, prior to the emergence of COVID-19 which had significant impact on the past three Hajj seasons (2020, 2021, and 2022). A summary about key aspects related to organization of Hajj during COVID-19 pandemic and the implementation of exceptional infection control strategies is provided.

The Association of Acute Watery Diarrhea in Iranian Pilgrims of Iraq with Cholera Cases in Iranians.

Despite the advances in the control of infectious diseases like cholera, they can potentially cause epidemics, especially in mass gathering events. One of the most important countries on the walking way of the Arbaeen religious event is Iran, which requires health system preparedness. The aim of this study was to predict the cholera epidemic in Iran by using the syndromic surveillance system of Iranian pilgrims in Iraq. The data of the Iranian pilgrims with acute watery diarrhea in Iraq during the Arbaeen religious event and the confirmed cholera cases of pilgrims after returning to Iran were analyzed. We used the Poisson regression model of the relationship between the numbers of cases to evaluate acute watery diarrhea and cholera. Spatial statistics and hot spot analysis were used to identify the provinces with the highest incidence. SPSS software Version 24 was used for statistical analysis. The frequency of acute watery diarrhea cases was 2232 and the frequency of cholera in pilgrims after returning to Iran was 641. The results of spatial analysis for acute watery diarrhea cases showed a high number of acute watery diarrhea cases in the Khuzestan and Isfahan provinces, located in hot spots. Using Poisson regression, the relationship between the number of acute watery diarrhea reported in the syndromic surveillance system and the number of cholera cases was confirmed. The syndromic surveillance system is useful to predict the outbreak of infectious diseases in large religious mass gatherings.

Healthcare Research in Mass Religious Gatherings and Emergency Management: A Comprehensive Narrative Review.

Religious mass gatherings, especially pilgrimages of various faiths, involve overcrowding and the international movement of people, exposing individuals to significant health risks, such as the spread of infectious diseases, crowds, exposure to bad weather, physical stress, or risks due to pre-existing medical conditions. This paper aims to review the literature related to health care research on religious mass gatherings, with special reference to the role of awareness creation, training, and risk awareness for individuals during Hajj. The results indicated that the research on health risks associated with large-scale gatherings showed that some countries (which witness religious gatherings) follow effective preventive measures to reduce health risks, while some countries did not (and linked this to its poor infrastructure and the low standard of living in it, such as India). It also showed that most studies overlooked identifying the causes of infectious diseases and determining the perceptions of participants in mass gatherings. While it showed that environmental factors strongly influence the emergence of infectious diseases among individuals, the results also showed the scarcity of research that revolves around the awareness of community members, the health risks of mass gatherings, preventive measures against diseases, and the main effects on individuals' perceptions of risks. The results also showed a lack of research evidence on how pilgrims perceive risks, adopt information, and interact with their willingness to be trained in preventive measures.

Deep Learning Based Face Mask Detection in Religious Mass Gathering During COVID-19 Pandemic

Notwithstanding the religious intention of billions of devotees, the religious mass gathering increased major public health concerns since it likely became a huge super spreading event for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most attendees ignored preventive measures, namely maintaining physical distance, practising hand hygiene, and wearing facemasks. Wearing a face mask in public areas protects people from spreading COVID-19. Artificial intelligence (AI) based on deep learning (DL) and machine learning (ML) could assist in fighting covid-19 in several ways. This study introduces a new deep learning-based Face Mask Detection in Religious Mass Gathering (DLFMD-RMG) technique during the COVID-19 pandemic. The DLFMD-RMG technique focuses mainly on detecting face masks in a religious mass gathering. To accomplish this, the presented DLFMD-RMG technique undergoes two pre-processing levels: Bilateral Filtering (BF) and Contrast Enhancement. For face detection, the DLFMD-RMG technique uses YOLOv5 with a ResNet-50 detector. In addition, the face detection performance can be improved by the seeker optimization algorithm (SOA) for tuning the hyperparameter of the ResNet-50 module, showing the novelty of the work. At last, the faces with and without masks are classified using the Fuzzy Neural Network (FNN) model. The stimulation study of the DLFMD-RMG algorithm is examined on a benchmark dataset. The results highlighted the remarkable performance of the DLFMD-RMG model algorithm in other recent approaches.

Reframing the Intersections of Pilgrimage, Religious Tourism, and Sustainability

Every year, hundreds of millions of people around the world travel to sacred places to worship and to learn. While the practice of pilgrimage has a long tradition and is an important part of many religious traditions and the spiritual development of individuals, some scholars have begun to question the sustainability of modern pilgrimage travel. Not only does pilgrimage, like other forms of mobility, contribute to the emission of greenhouse gases and waste accumulation, it also seems to be exempt from blame when it comes to the current environmental crisis. In addition, while mass religious gatherings have historically been tied to the transmission and spread of disease, the threat of pilgrims becoming infected while on pilgrimage has not historically been an inhibiter to religious mobility. Indeed, the demand for pilgrimage seems to increase during times of hardship and uncertainty. Given these inherent contradictions, the purpose of this conceptual paper is to question the notion of sustainability in the context of pilgrimage and religious tourism and discuss whether modern day pilgrimage and religious tourism can be structured and managed in a more sustainable manner. First, the authors discuss the existing academic literature on the positive and negative economics, socio-cultural, and environmental impacts of pilgrimage and religious tourism. The authors then question the validity of certain tourism-environment models, including the ‘Tourism Area Life Cycle’ and ‘Carrying Capacity’, in the context of pilgrimage and religious tourism, particularly as they apply to pilgrimage and religious tourism destinations that do not typically show a decline in their visitor numbers. The authors then expand upon a conceptual model that can help scholars analyze the impacts of pilgrimage and religious tourism on pilgrim-towns. The authors conclude by contending that future discussions regarding sustainability in the context of pilgrimage and religious tourism should include religious and cultural constructs of what constitutes the tangible and intangible forms of sacredness of a place.

Under Recognized Respiratory Tract Infections in Non-Neutropenic Fever Children with Cancer: Real-World Insights from Mass Religious Gatherings and Influenza Seasons

Background: No existing research has addressed respiratory tract infections (RTIs) in children with non-neutropenic fever (NNF) who are present during seasons of religious mass gatherings (Hajj, Ramadan), especially if this coincides with the influenza season. The treatment approach for RTI cases in NNF children during mass religious gatherings may not be applicable in the normal season.
 Methods: This study includes a retrospective analysis of RTI in NNF children who were present during mass religious gathering seasons and/or flu season, and who were being treated for malignancy at Princess Noorah Oncology Center from May 1, 2016 through December 2017.
 Results: A total of 4599 spikes in fever were identified in 124 non-neutropenic children in whom 455 spikes (9.9%, 455 out of 4599) were documented during mass religious gatherings and/or the flu season. NNF secondary to RTIs was documented in 59.7% of patients during the study seasons with a total of 245 fever spikes recorded. Ceftriaxone-based therapy was the main treatment approach for NNF including the RTI cases that were associated with 50% of subsequent hospitalization for further management. Among all the examined risk factors, a prolonged fever of more than three days was significantly associated with NNF secondary to RTI during mass religious gatherings if coincident with the flu season, OR=0.034 [95% CI, 0.013 - 0.09] P-value <0.001.
 Conclusions: The present study showed that the prevalence rate of NNF of RTI in NNF children increased during periods of mass gathering. There is need therefore for a national consensus to address NNF management during mass religious gatherings, particularly if coincident with the flu season.

Transmission of Antimicrobial Resistant Bacteria at the Hajj: A Scoping Review.

The Hajj is an annual religious mass gathering event held in Makkah, Saudi Arabia. With millions of participants from across the globe attending the Hajj, the risk of importation, transmission, and global spread of infectious diseases is high. The emergence of antimicrobial resistant (AMR) bacteria is of worldwide concern and the Hajj poses a serious risk to its dissemination. This review aims to synthesize published literature on AMR bacteria acquisition and transmission associated with the Hajj. We searched electronic databases to identify literature published between January 1990 and December 2021. The search strategy included medical subject headings and keyword terms related to AMR bacteria and the Hajj. After screening 2214 search results, 51 studies were included in the analysis. The review found 6455 AMR bacteria transmissions related to the Hajj. Thirty predominantly enteric or respiratory disease-causing AMR bacterial species were reported with isolates identified in cases on five continents. Most were male, aged above 50 years and were diagnosed in Makkah. Most cases were identified through hospital-based research; few cases were detected in community or primary health care settings. This review provides a contemporary account of knowledge related to AMR transmission at the Hajj. It emphasizes the need for the enhancement of surveillance for AMR bacteria globally.

Religious pilgrimage and COVID-19. An observational report in Italy from contact tracing activities

Abstract Issue/Problem Religious Mass Gathering (MG) represent one of public health challenges for Health Authorities due to potential spread of communicable diseases. This is much more true during a pandemic as COVID-19. Surveillance is crucial to prevent further spreading of infectious disease related to a religious MG. Description of the problem During international contact tracing activities an increase of reporting of COVID-cases with a travel history to a Catholic shrine in Europe was observed, despite travel restrictions put in place. In order to promote public health actions as risk communication, a risk evaluation was conducted. A descriptive analysis was carried out: personal and vaccination data were collected; for cases, date and type of positive tests, date of symptoms’ onset were collected; for high-risk contacts, date and type of negative tests at the end of follow-up were collected. Frequencies were calculated. Results Six journeys back from Medjugorje were identified, with at least one positive case. All trips took place between 18/09/2021 and 29/10/2021. 31 positive cases out of 160 travellers were identified, with number of cases per travel ranging from 1 to 11. Lessons Religious MG represent an important global health issue. Even though a specific surveillance was not activated, international contact tracing activities turned out a great source of epidemic intelligence and consequent surveillance and control activities led to risk assessment and communication actions. Key messages • In the pandemic context, where travel restrictions were put in place, surveillance for Religious MG should be always implemented. • Cooperation among all the stakeholders involved as Church, travel agency, Regional Health Systems and Government Bodies has to be promoted for specific surveillance in religious MG events.

A walk accessibility-based approach to assess crowd management in mass religious gatherings

The effectiveness of any crowd management plan is constrained by the behavior of individuals in the crowd. In mass religious gatherings, the strict time schedules to perform specific activities and the arrival and departure constraints force pilgrims to incorporate multiple stops in the same tour based on the proximity of these sub-destinations. This paper explores the role of accessibility of prime activity locations, possible trip chaining patterns, and the resultant shortest paths in the context of crowd management. The extracted mean speed of pedestrians from the video data of Kumbh Mela, Ujjain (2016) is used as an input to generate the spatial time-based accessibility map. Two methods – space syntax and accessibility considering travel time are used to understand the pilgrim's travel choices. The findings from the study confirm that both distance and directions are the major determinants of pedestrian route choice in mass religious gatherings. The study also evaluates the effect of temporary road closures on the route choices of pilgrims The methodology adopted, and insights derived from the analysis could be used to manage the crowd more effectively by ensuring that critical attention is given to the routes that are more likely to carry the diverted pedestrians during road closures.