Pilgrimage and flu
Muslim pilgrims attending the Hajj from countries plagued by avian
influenza notably Indonesia, Turkey, Iraq and Egypt may introduce the
deadly virus to the congregation leading to its global outburst.
Additionally, reports of the three latest bird flu clusters in Indonesia,1
a country that sends the maximum number of pilgrims to the Hajj, warn us
that we are probably at the brink of the long-waited pandemic influenza
and it is very likely that Hajj will play a pivotal role in accelerating
its global spread. Simultaneous out break of Meningococcus W135 in several
countries following Hajj in recent years is a good lesson we must not
forget too quickly.2 Furthermore, the risk of emergence of a variant
strain due to amalgamation of different flu viruses at the Hajj should not
British pilgrims will not spare if an outbreak results; 38% returning UK
Hajjis had influenza,3 yet in the last two years the overall influenza
vaccine uptake among high risk pilgrims was lower than the national
average particularly among the Londoners.4 Legal implementation, e.g.
obtaining mandatory influenza vaccination certificate before applying for
Hajj visa, may be required in order to increase uptakes. Targeting only
‘at risk’ group will make the scheme tricky; a compulsory universal rather
than an optional selective vaccination policy will be needed to improve
influenza vaccine coverage and consequently the risk of pandemic flu among
British pilgrims. Universal requirement for quadrivalent meningitis (ACWY)
vaccination before going on Hajj has already revealed successful results.5
Offering vaccination and health education in makeshift travel clinics at
the meeting places of Muslims, e.g. in mosques and community centres, in
large cities including London would be a novel step to improve vaccination
as well as health awareness.
Mohammad S. Jamal
Department of Pharmaceutical Sciences,
Greenwich University, Medway, Kent, ME4 5TB
Islam specialist registrar
Infection and Immunity ,
Bart’s and The London NHS Trust,
London E 1 1BB
1 Kandun IN, Wibisono H, Sedyaningsih ER, Yusharmen, Hadisoedarsuno
W, Purba W, et al. Three Indonesian clusters of H5N1 virus infection in
2005.N Engl J Med 2006;355:2186-94.
2 Hahne SJM, Gray SJ, Aguilera J, Crowcroft NS, Nichols T, Kaczmarski EB,
et al. W135 meningococcal disease in England and Wales associated with
Hajj 2000 and 2001. Lancet 2002;359:582-83.
3 Bashir H, Haworth E, Zambon M, Shafi S, Zuckerman J, Booy R. Influenza
among UK pilgrims to Hajj, 2003. Emerg Infect Dis 2004;10:882-3.
4 Shafi S, Rashid H, Ali K El-Bashir H, Haworth E, Memish ZA, et al.
Influenza vaccine uptake among British Muslims attending Hajj, 2005 and
2006. BMJ 2006;333:1220
5 Shafi S, Memish ZA, Gatrad AR, Sheikh A. Hajj 2006: communicable disease
and other health risks and current official guidance for pilgrims. Euro
Competing interests: No competing interests