There have been cases in the past when overcrowding has resulted in stampedes with people getting trampled or crushed, according to reports. It is this overcrowding that becomes a breeding ground for various infectious diseases. Some such infectious diseases are endemic in certain countries and they tend to be with the people traveling for Haj.

The Kingdom offers many preventive measures and health care facilities in the interest of pilgrims, according to the Ministry of Haj. They offer free health care to all pilgrims. Like in the past, dozens of hospitals with several thousand beds have been prepared fully staffed with medical personnel to treat sick or injured pilgrims.

In addition, all of the Kingdom’s entry points, whether land, port or airport, have teams of public health personnel to check that arriving Haj pilgrims have met with immunization and other medical requirements.

There are infectious diseases that have the potential to infect people in overcrowded conditions, a specialist at King Abdul Aziz Hospital says. There were many such cases at Haj in the past. Due to the intense overcrowding and high humidity, the deadly meningococcal meningitis disease can spread among pilgrims. The history of meningococcal meningitis and Haj has demonstrated numerous large outbreaks throughout the years, especially in studies conducted since 1987.

As a preventive measure, the Kingdom specifies that pilgrims must be immunized against this form of meningitis. The Saudi requirements are as follows:

All pilgrims over two years old must get a vaccine to protect against meningococcal disease. This means that you need to have your vaccine no more than three years and no less than ten days before you arrive in Saudi Arabia, must show proof of meningococcal vaccination on a valid certificate of vaccination (International Certificate of Vaccination or Prophylaxis) before you can enter the holy cities of Makkah and Madinah to perform the pilgrimage. In addition, the pilgrim’s routine vaccinations should be up to date to include measles/mumps/rubella, tetanus, diphtheria and polio. Those arriving from a country where yellow fever is endemic such as those from the continents of Africa and South America, proof of yellow fever vaccination should be furnished. In addition to meningococcal meningitis vaccine, the Kingdom also requires vaccination against H1N1 influenza.

There are numerous acute respiratory infections that are common during the Haj season. Overcrowding and close sleeping quarters contribute to the spread of viral infections to include respiratory syncytial virus (RSV), parainfluenza, influenza and adenovirus, doctors say. The combination of crowding and people coming from countries, which are endemic for tuberculosis, make it a potential serious problem among pilgrims.

The Ministry of Health encourages pilgrims to wear surgical facemasks when they are in crowded areas.

A ritual among Muslim men at the end of Haj is shaving their heads. However, because some barbers who operate around the Haj reuse shaving equipment on multiple men, the risk of blood borne infections like hepatitis is a risk. Male pilgrims should ensure only using licensed barbers at the Haj. Avoid sharing razors with others.

Besides respiratory infections, overcrowding is associated with diarrheal diseases, according to a specialist in internal medicine at United Doctors. Diseases such as cholera have been implicated in outbreaks in the past and even with much improved water and sewage systems, the concern about imported cholera and other enteric diseases are always a concern.
 

 
In addition to the numerous infections possible in such a crowded environment, pilgrims should also protect themselves from non-communicable illness and injury such as protecting themselves from the sun and heat, and keep themselves properly hydrated.

Overcrowding provides the ideal condition for the transmission of infections like typhoid, cholera and invasive meningococcal meningitis. Outbreaks of typhoid and cholera have also been recorded during Haj in the past. Although most early cases of meningitis were reported in pilgrims, the outbreaks quickly spread to their immediate contacts and then to those with no pilgrim contact. Cases continued to be identified even three to four months after Haj most likely as a result of pilgrims assimilating in the community and dispersing bacteria. There have been several epidemics of invasive meningococcal infection throughout the world in the past 15 years, which have been clearly linked to the annual pilgrimage, according to a study.

Aside from acute respiratory diseases, a pilgrim should be careful about viral conjunctivitis as well. Conjunctivitis is inflammation of the conjunctiva. The conjunctiva is the clear membrane that lines the inside of the eyelids and covers the white of the eye, explains an eye specialist at Magrabi Hospitals and Centers.

Many things including infection by viruses or bacteria cause conjunctivitis. Allergic conjunctivitis is elicited by ocular exposure to allergens (pollen, weeds, molds, grasses, animal dander, dust mites, cockroaches and pollution).

Viral forms of conjunctivitis (often called pink eye) can be spread easily to other people. The same viruses that cause the common cold can cause viral conjunctivitis. Viruses can be spread by coughing or sneezing and can get in your eyes through contact with infected hands, washcloths or towels, cosmetics, false eyelashes, soft contact lenses, etc. Symptoms include redness, watery discharge, and itching and sensitivity to light. Usually one eye is affected at first.

Like a cold, viral conjunctivitis is a self-limited disease and usually goes away on its own without treatment. However, eye drops prescribed by doctor could help control some of the symptoms. Antihistamine pills may also relieve the itching and redness. Topical antibiotics are used as prophylaxis.

Those wearing contact lenses should stop wearing them until the eyes become infection-free. The combination of contacts and conjunctivitis could damage the cornea (the clear outer layer on the front of the eye) and cause severe vision problems.

Other forms of viral conjunctivitis are viral conjunctivitis caused by recurrent herpes simplex virus (HSV), which can be vision threatening. They include epidemic keratoconjunctivitis, resulting in loss of visual acuity due to corneal affection and hemorrhagic conjunctivitis caused by enterovirus.