[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]
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Hajj, Umrah, and the neglected tropical diseases
Mashal M. Almutairi , Waleed Saleh Alsalem, Mazen Hassanain, Peter J. Hotez
Published: August 16, 2018 / DOI: https://doi.org/10.1371/journal.pntd.0006539
Citation: Almutairi MM, Alsalem WS, Hassanain M, Hotez PJ (2018) Hajj, Umrah, and the neglected tropical diseases. PLoS Negl Trop Dis 12(8): e0006539. https://doi.org/10.1371/journal.pntd.0006539
Editor: Samuel V. Scarpino, Northeastern University, UNITED STATES
Published: August 16, 2018
Copyright: © 2018 Almutairi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The authors received no specific funding for this work.
Competing interests: PJH is investigator and patent holder on several vaccines in development, including vaccines for diseases discussed in the article.
Together, the Hajj and Umrah rank among the leading global venues that host annual mass human migrations. The Hajj is an annual pilgrimage to the Islamic holy city of Makkah in Saudi Arabia (Fig 1). It is considered a religious obligation for all adult Muslims worldwide who have the physical and financial ability and draws an estimated 2–3 million people annually . Umrah is an Islamic pilgrimage to Makkah, which occurs at times other than the period of the Hajj—the period of Ramadan (fasting month) is considered the peak period . In 2018, the Hajj is scheduled to take place in August, while Ramadan will occur between May and June .
Through the Hajj and Umrah, it is estimated that visitors to Saudi Arabia arrive from almost every country, based on a ratio of “one pilgrim per 1,000 Muslims from that country” . Currently, the largest countries in terms of Muslim populations are Asian nations located in tropical disease–endemic areas, led by Indonesia, Pakistan, India, and Bangladesh, followed by Nigeria and Egypt in Africa, where neglected tropical diseases (NTDs) are also widespread (Table 1) . Together, these nations account for almost 700,000 Hajj pilgrims, and according to the Global Burden of Disease Study, they account for some of the largest numbers of people living with NTDs .
The largest numbers of Hajj immigrants are from South and Southeast Asian tropical countries where globally the largest numbers of cases of dengue, lymphatic filariasis (LF), soil-transmitted helminth infections, leprosy, and kala-azar are also endemic . Similarly, Nigeria is the most highly endemic country in Africa for the major NTDs, especially schistosomiasis, soil-transmitted helminth infections, LF, onchocerciasis, and rabies. Each of these diseases has the potential of being either introduced or reintroduced in the Middle East and North Africa (MENA) region due to Hajj and Umrah activities.
Previously reported major Hajj-associated infectious diseases included respiratory tract infections like seasonal influenza, meningococcal disease, lower respiratory infections due to pneumococcus, and tuberculosis; water-borne and blood-borne infections including hepatitis A, B, and C were discussed elsewhere [5, 6]. In this report, we focus on the major NTDs that have either been introduced into the Middle East through Hajj and Umrah pilgrimages from tropical disease–endemic countries of Asia and Africa or where importation from Saudi Arabia to other parts of the world are possible. In some cases, these diseases have now become endemic in Saudi Arabia and elsewhere in the MENA region. Our report emphasizes the recent scientific literature published within the last five years.
Keywords: Mass Gathering Events; The Hajj; Middle East Region; Saudi Arabia; Infectious Diseases; Emerging Diseases.