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 Hajj and Swine Flu 
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Post Hajj and Swine Flu
Chinese Mecca-bound pilgrims get swine flu shots

BEIJING -- China will give swine flu vaccinations to thousands of Muslims about to make the annual pilgrimage to Saudi Arabia, state media said, as authorities reported the mainland's third death from the illness.

Concerns over the hajj, which attracts about 3 million Muslims every year to the holy cities of Mecca and Medina, have led several countries to impose travel bans over fears the mass gathering could speed the spread of swine flu. Arab health ministers in July banned children, the elderly and those with chronic illnesses from attending this year.

All of China's 12,700 Muslims making the pilgrimage this year will be inoculated against swine flu, the official Xinhua News Agency said, citing an earlier announcement by the China Islamic Association.

China has acted aggressively to detect and contain swine flu cases after being accused of failing to move quickly enough to stop the 2003 outbreak of SARS. Despite earlier measures such as strict quarantines, authorities say the swine flu virus is spreading from cities into the countryside.

A patient died from swine flu on Sunday in the far western region of Xinjiang, the Health Ministry said Monday in a regular update, without providing details. The previous two deaths also occurred in the west, in Qinghai province and Tibet.

The ministry said a total of 35,664 swine flu cases had been reported on the mainland by Monday, with 2,600 new cases since Friday. It said it was training health workers to respond to the surge in swine flu cases in autumn and the coming winter.

The government has licensed eight manufacturers in China to produce swine flu vaccines. Health authorities say they are expected to produce enough to inoculate 5 percent of China's population of 1.3 billion by the end of the year. Priority groups include students, health workers and people suffering chronic respiratory and cardiovascular diseases.

In northwestern Ningxia, home to China's largest community of the Hui Muslim minority group, more than 2,000 Muslim pilgrims were vaccinated against swine flu, Xinhua said.

Each paid 5 yuan ($0.73) to cover "equipment cost," the report said, citing Ma Shouyu, head of religious affairs of Haiyuan, a county in southern Ningxia.

The pilgrims were scheduled to depart on chartered flights from Saturday to Nov. 12 for Mecca, the report said.

The hajj is a duty for all able-bodied Muslims in their lifetime, and many Muslims save up their whole lives to make the journey.

http://www.bellinghamherald.com/bizwire/story/1131320.html

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Tue Oct 27, 2009 7:39 am
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Post Re: Hajj and Swine Flu
Fears of swine flu mutation at Haj
DONALD MCNEIL
October 31, 2009

EVERY year, the single largest gathering in the world is the annual pilgrimage to Mecca: 2.5 million people from 160 countries packed into a small city in Saudi Arabia for five days.

This year, some will bring swine flu.

The Saudi authorities, fearing that the pilgrimage, or Haj, could turn their holy city into a petri dish for viral mutations and a hub for spreading a new pandemic wave around the world, are working hard to head that off. They have asked some worshippers, including pregnant women and the elderly, not to make this year's trip during the last week of November.

Although the Saudis turned to the World Health Organisation and other health agencies for help in previous public health threats to the Haj, this year the US Centres for Disease Control and Prevention is more deeply involved.

Consultants for the centres have travelled to Riyadh, flu experts at US medical schools have been called in and the US Navy's medical laboratory in Cairo is preparing to help with any complex flu testing that is beyond Saudi capabilities.

The Haj offers many opportunities to a virus that spreads through the air and lingers on surfaces, with pilgrims crowded into planes, boats, buses and tent cities.

Opportunities are increased by the ranks of the faithful praying shoulder to shoulder and touching hands to the floors around the Kaaba, to handrails as they run between the hills of Safa and Marwah, or to cups of water from the Zamzam Well.

The Saudis are concerned because this new strain is the first pandemic flu since 1968. Any new flu carries the risk of gene-swapping that can form mutant viruses, and this one has some swine and avian genes that, before this April, had never been seen in humans. Both the new strain and seasonal flu strains will be circulating in the world, increasing the risk of flu strains mixing in Mecca.

Also, although the flu infects younger people, the ones most likely to need hospitalisation, or die if they do get infected are the very young, pregnant women, the sick and the aged.

http://www.theage.com.au/world/fears-of-swine-flu-mutation-at-haj-20091030-hpto.html

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Fri Oct 30, 2009 7:28 am
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Post Re: Hajj and Swine Flu
Gearing up for prevention: The Hajj meets H1N1
By Jill Dougherty, CNN

(CNN) -- For many Muslims it's the journey of a lifetime: making the Hajj pilgrimage. Almost 3 million faithful, together, in the city of Mecca, Saudi Arabia. But this year, the Hajj could become an incubator for the H1N1 virus.

At a Muslim community center in Duluth, Georgia, American Muslims pray and prepare for the Hajj. Lateefa Khan is here with her husband, Zakerullah. She has mixed emotions. They are leaving their children behind but say they look forward to the worship.

"It is very exciting. An amazing experience," Khan says. "I am looking forward to worshipping, focusing all my time on worshipping."

Khan will take precautions to avoid H1N1, also known as swine flu, at the Hajj. They'll carry hand sanitizer and will be "frequently washing our hands, trying to stay as clean as possible."

The Khans, along with a number of people at the center who are going on the Hajj, also are getting H1N1 inoculations.

Dr. Asif Saberi gives them a short lecture on how to prepare and encourages everyone to have their shots at least seven days before traveling. He says the Saudi government is doing a lot to protect pilgrims, but "the magnitude of the problem is the magnitude of the numbers of people who attend the Hajj."

When it comes to using hand sanitizer and wearing masks, Saberi says he encounters confusion about religious dictates and flu prevention. According to Muslim beliefs, for example, men in a state of pilgrimage should not wear any stitched items or touch alcohol. So what about wearing face masks or using alcohol-based sanitizers?

"One of the basic principles on which shariah (Islamic law) is based is the protection of the health," he says. "So if protection of the health is of such paramount importance, then the ritualistic significance of not wearing stitched clothes on your body is subservient to the need to maintain good health. And therefore wearing a mask is important. Using the sanitizer, which prevents this disease from spreading to others, is important."

Saudi Arabia has been preparing for the influx of millions of pilgrims. It won't turn away anyone who wants to come to the Hajj, but it is urging other countries not to let children younger than 12, people older than 65 or pregnant women make the pilgrimage.

The Saudi health minister went on television with his daughters, publicly getting their H1N1 flu shots, part of a campaign to alleviate fears about the vaccine.

The kingdom also is using sophisticated technology -- thermal screening equipment at entry points and mobile devices to document suspected cases of the flu.

Dr. Ziad Memish, assistant deputy to the Saudi health minister and co-author of a paper on Hajj and H1N1 published in Science magazine, said the government consulted 25 international experts, who joined with 25 Saudi experts, to discuss how to prepare.

"We had the team inspect the airport, the seaport, the regional lab that tests for the influenza," he said. "And then we had a review of all the evidence regarding the different strategies that should be used to prevent the spread of the disease during the mass gathering of the Hajj.

"We have relied on a collaborative program with the U.S. Centers for Disease Control and Prevention, where they are helping us setting up a system that was used in the Hurricane Katrina disaster, and I think the system has already been tested and it is working perfectly well."

In Washington, Louise Gresham, director of health security and epidemiology at the Nuclear Threat Initiative -- which also works to reduce global biological threats -- looks at a report tracking the spread of H1N1 in the Middle East. Gresham describes the risks:

"Picture, if you can, that 1 million people will come together in a single mosque at any given time during the Hajj. Picture that crowding over an extended period of time, and that's a test. A test not just for each individual pilgrim, but it is a real test for disease detection."

The Nuclear Threat Initiative supports a groundbreaking surveillance system in the Middle East, called the Middle East Consortium on Infectious Disease Surveillance. It brings together public health leaders and representatives from academic institutions and private health care facilities in Jordan, Israel and the Palestinian Authority. It was started seven years ago, during the height of the Israeli-Palestinian conflict.

"They actually started writing a plan for food-borne disease outbreaks, but they started a pandemic preparedness plan," Gresham says. "When H1N1 came along, this put them in a perfect position, because they were practiced, they were rehearsed and they had built great, great trust."

As part of this cooperation, Israel is supplying Gaza and the West Bank with H1N1 vaccinations for those who make the religious journey.

That trust, plus international cooperation, will be crucial in protecting pilgrims.

For those like Fayzah Abu Ayadah, faith outweighs fear.

"Even if we die there, it is not important," the Palestinian says. "The important thing is to go for the Hajj."

http://www.cnn.com/2009/HEALTH/11/16/hajj.H1N1/index.html

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Tue Nov 17, 2009 7:17 am
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Post Re: Hajj and Swine Flu
"Hajj devil stoning ritual biggest swine flu risk"
http://www.google.com/hostednews/ap/art ... QD9C8J6IG1

" Millions of Muslim pilgrims, many wearing surgical masks, jostled together shoulder-to-shoulder furiously casting pebbles at stone walls representing the devil Saturday — the hajj ritual of highest concern to world health authorities watching for an outbreak of swine flu."...

.."So far, only around 60 flu cases have been uncovered, but health officials warn it is likely spreading silently among pilgrims — and the true extent of the push that hajj has given to the virus won't be known until later, after the faithful have returned to their home countries around the world.

Saudi officials, along with American and international health experts, have geared up here to try to limit any outbreak.
But they also are using the pilgrimage as a test case to build a database, watch for mutations
and look for lessons on controlling the flu at other large gatherings like the 2010 soccer World Cup in South Africa.

The stoning of the devil ritual, performed on Friday, Saturday and Sunday, is when the crowds of pilgrims at the five-day hajj are at their height and contact between them is closest.
Under a hot sun Saturday, hundreds of thousands of sweaty bodies pressed against each other toward the stoning walls.
The majority did not wear masks, and many sneezed, coughed and spat and looked visibly exhausted."...

.."Like many here, Mikail Ocasio, a 28-year-old pilgrim from Maryland, dismissed the swine flu worries. "No disease was going to stop me from making my hajj," ...

.."American and Saudi health officials circulated among the sprawling tent camp at Mina where the pilgrims live and gave the faithful cheek swabs for testing later.
Health authorities hung posters of correct hand washing, and hand sanitizer dispensers were placed on walls in the camps, near public bathrooms and at ritual sites. Pilgrims arriving at Saudi airports were also scanned using a thermal camera and were offered a free vaccine"...

.."since the flu's incubation period can be as long as a week, the number of cases from hajj won't be known until after pilgrims return home, starting Sunday. Then it will be up to their home countries to monitor new cases.
"We don't expect there to be a big number of cases in the next two days; it will be the week after hajj when you will see the escalation," said the WHO's el-Bushra.

Many pilgrims already infected may have such mild symptoms they don't even know they are infected. Others simply don't seek treatment.
"A guesstimate of 30 percent of sick people will not come in for treatment because they are afraid of missing some of the rituals," said Shahul Ebrahim, who is part of a team from the U.S. Centers for Disease Control who are at the hajj helping Saudi health officials deal with swine flu.

Saudi Arabia this year recommended that those highly susceptible to H1N1 — the very young and the very old — stay away this year, and that may have had some impact in limiting cases.
Still, some pilgrims were seen carrying newborn babies and dragging infants behind them as they circled the Kaaba. Many elderly pilgrims feebly slumped in wheelchairs as relatives pushed them through the motions of the rites. For the old in particular, it's hard to pass on the hajj, since many want to do it at least once in their lifetimes.

World health authorities are concerned about the H1N1 virus because it is a new strain to which the vast majority of the world's people have no immunity.
While it is mostly mild right now, the flu could mutate into a more dangerous form the more it circulates.

The same hajj petri dish that could help the disease spread gives epidemiologists a unique chance to study the virus.

Saudi and CDC experts are working to get cheek swabs from a representative sample of the population for later study.
Some pilgrims were swabbed upon entry at the airport and at exit, said Ebrahim.
Authorities have also begun taking samples from illegal pilgrims who sneak in by land or sea without hajj visas and have set up sprawling makeshift camps on the rugged mountains of Mina.

The samples will be tested for H1N1 and any new strains of the swine flu that may have developed.

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Sat Nov 28, 2009 6:21 pm
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Post Re: Hajj and Swine Flu
Saudi official: 5 dead from swine flu at hajj

MINA, Saudi Arabia (AP) - Five people died from the H1N1 flu virus during the hajj, the Saudi health minister said Sunday _ a relatively small number considering the event is the largest annual gathering of people in the world and is seen as an ideal incubator for the virus.

Speaking on the final day of the Islamic pilgrimage, Abdullah al-Rabeeah said authorities recorded 73 cases _ including the five deaths _ of H1N1, commonly known as swine flu, during the pilgrimage. He said only 10 percent of the some 3 million pilgrims were vaccinated against the virus.

``Our safety precautions have secured a very successful and safe hajj for pilgrims from around the world with no infectious disease outbreaks,'' al-Rabeeah said.

Saudi officials, along with American and international health experts, worked to curb any outbreak during the hajj. Health officials circulated among the sprawling tent camp at Mina where the pilgrims lived and gave the faithful cheek swabs for testing later. They also placed hand sanitizer dispensers on walls in the camps, near public bathrooms and at ritual sites, while pilgrims arriving at Saudi airports were scanned using a thermal camera and offered a free vaccine.

But authorities also are using the pilgrimage as a test case to build a database, watch for mutations and look for lessons on controlling the flu at other large gatherings like the 2010 soccer World Cup in South Africa.

Despite the relatively minor impact of the virus during the hajj, some experts warn it is likely spreading silently among pilgrims _ and the true extent of the push that hajj has given to the virus won't be known until later, after the faithful have returned to their home countries around the world.

Al-Rabeeah brushed aside such concerns Sunday, saying pilgrims have been in the country for almost a month, far longer than the weeklong incubation period.

``They've had enough time to show symptoms of swine flu, and that hasn't happened,'' he said.

But he also stressed Saudi authorities will continue to monitor pilgrims until they leave the country, and urged other countries monitor the pilgrims upon their return home.

On Sunday, Muslim pilgrims performed the hajj's final ritual at the cube-shaped Kaaba _ Islam's holiest shrine.

After three days of throwing stones at walls in the desert valley of Mina in a symbolic rejection of Satan's temptation, some 3 million pilgrims crammed into buses and trucks for the short trip back to Mecca to circle the Kaaba, marking the traditional end of the hajj.

Many of the men making the pilgrimage had shed their traditional white robes in favor of Western clothing. Many had shaved heads, done on the first day of stoning as a symbol of renewal.

The Muslims believe that they are cleared of all sins if they perform a sincere pilgrimage.

http://www.tri-parishtimes.com/articles/2009/11/30/ap/world/031_51_apw.txt

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Mon Nov 30, 2009 9:18 am
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