Flu vaccination should be mandatory for all Hajj pilgrims to minimise the risk of a global pandemic, say doctors in this weeks BMJ.

At the end of next month Saudi Arabia will again host the Hajj the largest annual gathering in the world which attracts more than two million pilgrims from almost every country on earth.

For the individual pilgrim this is a deeply spiritual journey, but from a public health perspective, such a gathering makes the possible rampant spread of the influenza virus and a global pandemic a potentially devastating prospect that has been inadequately prepared for, write Professor Aziz Sheikh and colleagues.

Overcrowding is considerable throughout Hajj and it has been estimated that more than one in three pilgrims will experience respiratory symptoms during their stay.

Although the Saudi authorities recommend flu vaccination for pilgrims with chronic illnesses, data show that many high risk pilgrims remain unimmunised. For example, in a letter to this weeks BMJ, researchers found worryingly low rates of vaccination among British Muslims attending Hajj in 2005 and 2006.

And the situation is probably far worse among the large numbers of people coming from the economically developing world, add the authors.

Given this fact and the risks of a pandemic originating from the Hajj, mandatory influenza vaccination for all pilgrims should be considered, they write. Meningococcal vaccination for Hajj is already mandatory, so this extra vaccination should not be too inconvenient and should be readily acceptable.

Virus surveillance to identify newly emerging strains is also urgently needed, they say.

The World Health Organisation must work with the Saudi authorities to minimise the risk of the influenza virus spreading among pilgrims (and the rest of us). A coherent international response will be needed to ensure that the resources and logistics are in place so that these s
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Contact: Emma Dickinson
edickinson@bmj.com
44-020-738-36529
BMJ-British Medical Journal
7-Dec-2006