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EMHJ 19 Supp2 2013.Pdf (‎1.481Mb) Eastern Mediterranean La Revue de Santé de Health Journal la Méditerranée orientale Vol. 19 Supplement 2 r r ½:nüÐØ{_UÐPL HnUÐ{dCÐ Supplement on Mass Gatherings Contents Preface ...........................................................................................................................................................................................................................................................................................................................................................................Si Editorials Hajj and the public health significance of mass gatherings Ziad A. Memish ...........................................................................................................................................................................................................................................................................................................................................S5 Health preparedness and legacy planning at mass gatherings in the EMR: a WHO perspective Nicolas Isla and Isabelle Nuttall .......................................................................................................................................................................................................................................................................................................S7 Research articles 6TJOHIFBMUIFEVDBUPSTUPJNQSPWFLOPXMFEHFPGIFBMUIZCFIBWJPVSBNPOH)BKK QJMHSJNT A. Turkestani, M. Balahmar, A. Ibrahem, E. Moqbel and Z.A. Memish................................................................................................................................................................................................................S9 1BĨFSOPGNPSCJEJUZBOENPSUBMJUZJO,BSCBMBIPTQJUBMTEVSJOH"TIVSBNBTTHBUIFSJOHBU,BSCBMB *SBR F. Al-Lami, A. Al-Fatlawi, P. Bloland, A. Nawwar, A. Jetheer, H. Hantoosh, F. Radhi, B. Mohan, M. Abbas, A. Kamil, I. Khayatt nda H. Baqir ..............................................S13 Preparedness and health risks associated with Moulay Abdellah Amghar moussem .PSPDDP m M. Youbi, N. Dghoughi, M. Akrim, A. Essolbi, A. Barkia, A.I. Azami, A.T. Fleischauer, D. Schneider and A. Maaroufi ........................................................................................................S19 Public health surveillance at a mass gathering: ursPG#BCB'BSJE 1BLQBĨBOEJTUSJDU 1VOKBC 1BLJTUBO %FDFNCFS S. Hassan, R. Imtiaz, N. Ikram, M.A. Baig, R. Safdar, M. Salman and R.J. Asghar ..................................................................................................................................................................................S24 .BTTHBUIFSJOHJO"RBCB +PSEBO EVSJOH&JE"M"EIB S. Abdullah, G. Sharkas N. Sabri, I. Iblan, M. Abdallat, S. Jriesat, B. Hijawi, R. Khanfar and M. Al-Nsour .................................................................................................................................S29 Patterns of diseases and preventive measures among domestic hajjis from Central, Saudi Arabia [complete republication] Fahad S. Al-Jasser, Ibrahim A. Kabbash, Mohammad A. AlMazroa, Ziad A. Memish .............................................................................................................................................................................S34 Review 1VCMJDIFBMUIDPOTJEFSBUJPOTGPSNBTTHBUIFSJOHTJOUIF.JEEMF&BTUBOE/PSUI"GSJDB .&/" SFHJPO M. AlNsour and A. Fleischauer .......................................................................................................................................................................................................................................................................................................S42 PL HnUÐ{dCÐ HCÐçPUph[UÐpdCÐ 2:nüÐØ{_UÐ Editorial Hajj and the public health significance of mass gatherings Ziad A. Memish 1 Mass gatherings (MG) refer to groups localized in their geographical distribu- countries, pushing the Hajj congrega- of people measured in the thousands, tion. Research has shown that emerging tion towards the 3 million mark. The some definitions suggest 25 000 and infectious diseases have roughly quad- sheer dimensions of Hajj demand above [1,2]. MG present unique health rupled over the past 50 years, and extraordinary imagination and agility challenges distinct from the average pathogens that originate in wild animals from planners. population cohort of the same size. (wildlife zoonoses) account for the ma- Because of the wide global attend- Within the context of an exploding jority of such diseases. Further, the fre- ance, international partnerships and global population, widely accessible air quency of infectious disease emergence collaborations in this process are in- travel and unprecedented frequency correlates highly with human popula- creasingly necessary, as countries send- of MG, health issues relating to MG tion density, the density of mammalian ing pilgrims ensure their fitness for medicine are more commonly encoun- species and human population growth. travel and, later, continue to monitor tered. Safeguarding individual and mass Some data exist indicating that emerg- the impact of the returning pilgrims to health at such gatherings is termed ing diseases (specifically zoonoses) are their countries of origin. The scale and public health security [3]. more likely to be seen in tandem with diversity of Hajj presents an enormous MG-related infection is an emerg- progressive global warming [6]. public health security challenge to Saudi ing subspecialty in global epidemiol- The role played by travel, migra- Arabian authorities who, as functionar- ogy and while an extensive body of tion, trade and human exchanges in the ies to the Custodians of the two holy information and experiences now propagation of epidemic infectious dis- sites (Makkah Al Mukarramah and exists, not all are published and acces- ease is well known. Almost one billion Medina Al Munnawarah) must provide sible to MG planners and public health people cross international borders each extensive, multi-faceted programmes to administrators,and vital information year. In 2008, there were 924 million serve the “Guests of God” [8]. awaits dissemination [4]. Infectious dis- international arrivals, 16 million more Because of this remarkable scale, eases have long played a substantial part than 2007 [7]. Travel-related infection and its annual occurrence, preparations in shaping human history and continue is reaching previously uncharted di- for the public health safety and security to be an issue of pressing concern. In mensions of scale and complexity and of this event are extraordinarily challeng- this era of the “flat world”, globaliza- it is the Hajj experience that provides ing, requiring an intensely collaborative tion facilitates the spread of numerous invaluable insights in predicting travel- approach. Multiple domestic agencies infectious agents to all corners of the related health challenges. must work together to prepare for Hajj planet. No locale is too remote for a Hajj is the largest and most long- within a matter of months. While most threatening pathogen, be West Nile standing annual MG event on earth. It MG of this scale have the greater part of Virus arriving in the United States or is the site of some of the greatest crowd a decade to prepare, Saudi Arabia read- Rift Valley Fever reaching the Arabian densities known to man. Following an ies itself for the massive influx within a Peninsula [5]. exponential rise in the past decade, Hajj mere 11-month lead time demanding Public health risks focus on infec- is now the most internationally, ethni- precision in organization and the surge tious agents both specific to humans cally, demographically and clinically deployment of massive semi-perma- (which are broadly and uniformly diverse assembly today. The numbers nent infrastructures and manpower. distributed) and zoonoses (infectious of non-Saudi pilgrims attending the Such efforts are accomplished agents transmitted from animals to Hajj routinely exceed 2 million people, through intense inter-Ministry col- humans) which tend to be far more travelling to Makkah from over 180 laboration. Saudi authorities, including 1Deputy Minister of Health for Public Health, Director of the World Health Organization Collaborating Centre for Mass Gathering Medicine & Professor, College of Medicine, Al Faisal University, Riyadh, Kingdom of Saudi Arabia (Correspondence to: [email protected]). S5 EMHJ r 7PM 4VQQMFNFOU &BTUFSO.FEJUFSSBOFBO)FBMUI+PVSOBM -B3FWVFEF4BOUÊEFMB.ÊEJUFSSBOÊFPSJFOUBMF the Ministry of Health (MOH), the authorities must safeguard Hajj for mil- health security for such a massive gath- Ministry of Hajj, the Ministry of Inte- lions annually while at the same time ering [9]. rior (MOI), the Saudi Red Crescent carefully controlling its access to main- Given the complex, multi-factorial and other government health sectors, tain public health safety and security. elements that comprise the prepara- including the Saudi Arabian National Note must be made of the im- tion for Hajj, Hajj medicine clearly falls Guard Health Affairs, the Ministry of portant work facilitated by the Saudi within the realm of public health secu- Defence and Aviation (MODA) and immigration authorities which safe- rity and must be recognized as such. the Security forces, come together guards public health, possibly one of Further, because of the Kingdom’s with a common focus of public health the largest public health interventions ability
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