Evaluations of communication efforts and preventive measures are important in developing evidence-based public health plans to prevent and mitigate disease outbreaks at the Hajj and other mass gatherings. Every year, millions of Muslims, including thousands in the United States, make a pilgrimage called the Hajj to the cities of Mecca and Medina in the Kingdom of Saudi Arabia
(KSA). An estimated 2,521,000 pilgrims attended the 2009 Hajj during November 25–29; of these, 1,613,000 were international pilgrims from 163 countries, including 11,066 US Hajj travelers.1,2 While all mass gatherings have the potential to place travelers at risk for infectious and noninfectious hazards, the Hajj presents some of the world’s most important public health and infection control challenges.3 Selleck PTC124 A variety of risk factors makes
the Hajj an environment where emerging infectious diseases can quickly spread and even evolve into epidemics, including extended stays at Hajj sites, crowded accommodations with other Hajj pilgrims, many of whom are from developing nations, and long periods of time spent in densely packed crowds (crowd densities at Hajj have been estimated to be as high as seven people per square meter).4 Any disease outbreak at the Hajj could potentially be spread globally by returning travelers though major airline hubs, which could become the settings for further dissemination of disease.5 The 2009 Hajj took place during the influenza A(H1N1) pandemic, DZNeP datasheet which led to increased emphasis on understanding ways to mitigate the potential spread of respiratory disease.6 In order to address these concerns KSA, with guidance from national and international
public health agencies such as the US Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO), issued recommendations on measures to mitigate the impact of influenza A(H1N1) among pilgrims performing the Hajj. The recommended behaviors included washing hands often (hand hygiene), use of hand sanitizers, wearing a face mask, covering one’s cough or sneeze (cough etiquette), staying away from sick people (social distancing), second and not touching objects touched by sick people (contact avoidance).7,8 At the time the survey was developed, CDC recommendations for high-risk people in crowded settings where influenza A(H1N1) was circulating were to avoid the setting, but if that was not possible, to consider wearing a face mask.9 The 2009 Hajj presented an opportunity to evaluate behavioral interventions for community mitigation of respiratory disease in the context of an extremely large and crowded mass gathering. Our survey collected self-report data on protective practices and respiratory illness among US travelers to the 2009 Hajj.