The Risk of a Cholera Outbreak during the Hajj

Millions of pilgrims attend the annual Hajj to the holy city of Mecca and because of the mass gatherings involved, there is often a high potential of public health challenges coming up. The large influx of people from across the globe and the considerable amount of time that they spend in close proximity to one another leads to a situation where there is a high risk of disease transmission (1). The transmission of such disease is not only a matter of concern for the pilgrims, but also for the local population. The introduction of such disease as cholera can end up putting the entire public health system of Saudi Arabia, as well as those of the home countries of the pilgrims at a compromise because they might bring back this disease with them on their return. It is therefore extremely pertinent to ensure that there is an effective understanding of the cholera epidemic and the manner through which it has affected the Hajj pilgrims in the past and its potential of return in future events.

Cholera epidemics in Mecca have been recorded since the nineteenth century with the first recorded case appearing in 1831 (2). However, these epidemics developed in the Hejaz region but since 1912, there have been no reported epidemics that have developed in Mecca and its environs. It is important to note that prior to the use of steam ships in 1866 to transport pilgrims, caravan transport was the most common means of transportation (3). Because of the latter, it was possible for epidemics to die out prior to the pilgrims’ arrival in Mecca because of the long duration of their journeys (4, 5). Steam navigation that was used to transport pilgrims from Egypt and India to the Hejaz not only led to considerable proximity, but also the increase in the likelihood of individuals carrying epidemics to Mecca and back to their home countries (6). It is important to note that despite epidemics arising from time to time in the subsequent years, the most recent cholera outbreak took place in the Hajj of 1989, which is an extremely important public health victory for the Saudi government. During the latter outbreak, about 102 pilgrims were affected, and the disease was contained (7).

Despite the precautions that have been taken by the Saudi government, it is important to note that the country is still at risk of a cholera epidemic. This is especially considering that there is currently a cholera epidemic in neighboring Yemen, which has affected more than 300,000 people (8). Thus, the potential of this epidemic spreading during the Hajj to Mecca is highly significant because it could end up spreading to the rest of the world as pilgrims return home. In recent years, the pilgrimage has drawn between 2 and 4 million individuals from all over the world. The outbreak of cholera in Yemen as well as in some African countries might end up presenting a serious risk to all pilgrims during the Hajj and after returning to their countries (9, 10). It is however noteworthy that because of the strict measures that it has taken; Saudi Arabia has not had a cholera outbreak in many years. This situation therefore means that the government has taken appropriate measures to counter the potential of the disease appearing in its borders, especially during the Hajj.

It is therefore important to consider the potential of cholera during the Hajj a serious threat. By putting such considerations at the forefront of public health policy, the government of Saudi Arabia can work hand in hand with its partners, especially the countries from which pilgrims originate, to ensure that threats are discovered early and eliminated prior to the Hajj (11). Furthermore, Saudi Arabia can make sure to reinforce its surveillance and rapid test system in order to detect cases early (12). The latter system has worked extremely well in recent years because outbreaks of cholera have not been recorded in decades. Also, the Saudi government should work hand in hand with the World Health Organization (WHO) in order to undertake a joint risk assessment of the situation so that they can develop recommendations to curb any potential outbreak in a manner that is clinically, operationally, and financially sustainable (13). Such measures, as well as the strict implementation of WHO guidelines to prevent cholera, and also undertaking campaigns to raise awareness about this disease during the Hajj could go a long way towards its prevention. Finally, Saudi Arabia should work towards enhancing its measures to protect both pilgrims and locals through regular screenings and testing from the potential of cholera outbreaks.

There is a threat of a #cholera epidemic in #Mariupol

Centralized water supply/sewerage is not working.the city is drowning in garbage and sewage.Almost every yard has mass burials and the summer heat has accelerated the decomposition of thousands of corpses under the rubble

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