In compliance with the Directives of the Custodian of the two Holy Mosques, King Abdullah bin Abdul Aziz, the Ministry of Health (MOH) of the Kingdom of Saudi Arabia (KSA) held an international consultative workshop on preventive measures against infectious disease for Hajj and Umra, with a special emphasis on A (H1N1) influenza.

Traditionally, the Kingdom of Saudi Arabia, its leadership and its people have committed to serving the guests of the Holy places in Makkah and Medinah, sparing no efforts or resources to provide the best possible services, ensuring that guests can perform their rituals with ease and dignity.

Health care to the guests of the Holy places has always been a top priority for the government of KSA. Because of concerns about the ongoing influenza A(H1N1) pandemic, and the potential for transmission in the crowded setting of the Hajj, the Custodian of the Two Holy mosques invited a panel of renowned international experts from various parts of the world to discuss related issues. This panel included Muslims, Arabs and others, and was tasked with working closely with national experts and officials to identify the best possible recommendations to ensure the safety and health of pilgrims and all residents of KSA, as well as global health security.

These experts came from the World Health Organization (WHO), the US Centers for Disease Control and Prevention, the European Centre for Disease Prevention and Control, and other institutions in Europe, Australia and China. They took into consideration available scientific evidence regarding mass gatherings, and the special settings of Hajj and Umra and their implications for local and global health, and reviewed KSA’s national health preparedness plans for Hajj and Umra.

In going about this work, the expert panel visited points of entry into KSA and reference laboratories in Jeddah, and reviewed what the KSA MOH has already implemented with regards to preventive measures for infectious disease.

The experts made the following conclusions and recommendations:

• As of time of writing, A (H1N1) influenza remains of moderate severity when compared to seasonal influenza

• The Saudi national preparedness plan for pandemic influenza was commended for its comprehensiveness, systematic approach, and up to date status

• The KSA was also commended for its transparency, accuracy and timeliness of information sharing with the public and international organizations

• Adequate screening for A (H1N1) at ports of entry into KSA should be maintained in order to limit its spread, using current measures (such as thermal cameras and temporary quarantine) and others, knowing that this will not completely stop the increase in number of cases currently under way around the world

• The panel supported the KSA recommendation for all Hajjis, Umra visitors, residents of KSA and healthcare providers during the Hajj and Umra to receive seasonal influenza vaccine, at least two weeks prior to travel to the Holy places

• The panel recommended using the A (H1N1) vaccine, in the event of it becoming available and licensed by appropriate regulatory authorities, for all Hajjis and Umra visitors, and healthcare providers during the Hajj and Umra

• The panel recommended adherence by Hajjis and Umra visitors to good personal hygiene measures, including cough etiquette, use of antiseptic hand gels, and frequent hand washing with soap and water

• The panel recommended that the KSA MOH, as well as the country medical missions accompanying Hajjis, provide appropriate amounts of antiviral drugs for H1N1 treatment and prophylaxis for Hajjis

• The panel recommended ensuring that KSA reference laboratories are adequately supplied with the human and technical capacity necessary to cope with possible increased numbers of cases during the high seasons of Umra and Hajj

• The panel recommended providing an adequate facility for quarantine and isolation

• The panel recommended that, in order better to ensure their health and well being, the following high risk groups for severe disease postpone their participation in Hajj and Umra for this year: the elderly; pregnant women; people with chronic diseases; and children

• The panel recommended strengthening surveillance and reporting systems in KSA. The use of electronic data reporting was further recommended, through establishing a comprehensive, advanced network of telecommunications in KSA to monitor the spread of infectious diseases – including A (H1N1) – to ensure timely response

• The WHO is requested to share this information with all its Member countries, and to ask them to adhere to the health conditions and recommendations set by the Saudi MOH. WHO is also requested to underline the importance of (1) Member States educating and increasing the awareness of their Hajjis and Umra visitors concerning prevention measures for A(H1N1), through various media, and in multiple languages; and (2) standardizing these health education messages to protect all visitors

• The panel recommended adherence to all other health regulations issued by the Saudi MOH

• The panel recommended wide distribution of these recommendations, in various languages and through various media, and underlined how important it is that countries participating in Hajj and Umra facilitate their implementation.

Please note: these recommendations are based on knowledge at time of writing concerning the status and spread of A (H1N1), and will be regularly updated as the global situation progresses.