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Health Care Workers
Due to their direct contact with patients, health care workers usually have a heightened risk of been infected with contagious diseases. In light of this, it is important to understand ways that may be used to prevent these infections. Moreover, it is also essential to understand the underlying factors that lead to these infections and ways that may be used to prevent and stop infections. During the Hajj period, there is always a high concentration of individuals in Mecca, which provides a conducive environment for the outbreak of various contagious diseases.
Demographic Characterization
During the Hajj pilgrimage in Mecca, there is always a high concentration of faithful’s which reaches as high as 7 people per square meter. These more than two million individuals come from different countries in the world, are confined for two to six weeks in a small area as the do their religious activities. This crowding, fatigue, extremely hot and sunny weather, as well as fluid droplets from individuals with contagious diseases increases the chances of the spread of respiratory diseases (4). Noteworthy, a number of individuals have tested positive for viral and bacterial respiratory pathogens. Some of the notable contagious diseases that have been identified are all serotypes of meningococci, gram-negative organisms, atypical organisms, Streptococcus pneumonia, influenza A and B, Mycobacterium tuberculosis among others (5).
Vaccination Uptake and Associated Factors
During the Hajj period, the infection rates are as high as 25.6% among medical mission members in Saudi hospitals acute respiratory tract infection (ARI) (1). As a result, it is always prudent to ensure that patients are adequately protected from infections. Currently, the vaccination levels of HCW in Saudi Arabia are sub-optimal at 82.4% only been vaccinated. On the contrary, the vaccination levels are much higher. Generally, the main cause for the huge number of unvaccinated HCW is a false sense of security, low perceived likelihood of infection, fear, insufficient time and the lack of awareness on the importance of the vaccine. Transmission of disease from patients to HCW or staff to patient is common during outbreaks (3). Although most of these diseases are preventable through vaccination, there is still a large portion of individuals that is not vaccinated due to lack of proper education. To elaborate, Al-Ghamdi & Kabbash (2), observed that physicians had a better understanding of the importance of vaccinations than HCWs. Similarly, the knowledge of HCWs increased with an increase in experience (2). Turkestani, Ibrahim, and Menish (7) observed that education could be effectively used to increase the knowledge of pilgrims, which would minimize their risk of infection.
Concern of Disease
The level of risk perception depends on an individual’s level of knowledge. In light of this, physicians are more concerned the need for vaccination than HCW. Therefore, there is the need for creation of awareness in order to increase risk perception. One of the main reason for the lack of vaccination among most individuals who go for pilgrimage is the lack of concern in taking precautions against ARI. In order to ensure that individuals are safe from infection, individuals should be trained on the importance of vaccination. Generally, this method will raise their concern and interest on the importance of vaccination. In addition, pilgrims must be informed of the health requirement and whether of Saudi Arabia so that they make adequate plans for the trip (6).
Non-pharmaceutical Measures
The non-pharmaceutical approach in dealing with the spread of contagious disease is one of the most effective methods. In general, this method works by ensuring that all individuals who visit Mecca are vaccinated with meningococcal vaccination. This method ensures that pilgrims have low chances of getting infections, and in turn, they have low chances of infecting HCW.  Another popular non-pharmaceutical method is the use of facemasks to prevent infections. Alasmary et al (1), found that facemasks did not offer any protection against the spread of airborne diseases. Since facemasks are not designed to work as particulates respirators, they are unable to filter of small particulates in the air when users inhale (5). In addition, these masks have a higher rate of infection in the case of intermittent use. There was a 2.5 times increase in infection since these masks could become contaminated with infectious material and the touching of the outside of a used mask could result in transmission of infection when an individual rubs his/ her nose (1). Accordingly, preventative masks such as N95 should be encouraged since they are designed to filter particulates.
Facemasks and Niqabs
According to Al-Asmary et al. (1), facemasks and niqabs do not offer any protection against acute respiratory tract infection. In their analysis, intermittent use of surgical face masks, non-use of alcohol-based disinfectants, and direct contact with pilgrims increased the chances of infections. The study found that using facemasks intermittently had a risk of 2.7 of infection at the 95% confidence level. Constant use of facemasks had a risk of 1.4-5.0 at the 95% confidence level. Since a niqab is not designed to prevent the flow of particulate respirators, it cannot effectively prevent the spread of acute respiratory tract infections. Al-Amary et al (2007) concluded that the use of surgical masks should be discontinued and instead HCW should use N95 masks, which are designed to filter particulates.
References List

  1. Al-Asmary, S., Al-Shehri, A., Aboub-Zeid. A., Abdel-Fattah, M., Hifawy, T., El-Said, Y. Acute respiratory tract infections among Hajj medical mission personnel, Saudi Arabia. International Journal of Infectious Diseases. 2007; 11: 268—272.
  2. Al-Ghamdi, A., & Kabbash I. Awareness of healthcare workers regarding preventive measures of communicable diseases among Hajj pilgrims at the entry point in Western Saudi Arabia. Saudi Medical Journal. 2011; Vol. 32 (11): 1161-1167.
  3. Ghabrah, T., Madani, T., Albarrak, A., Alhazmi, M., Alazaraqi, T., Alhudaithi, M., Ishaq, A. Assessment of infection control knowledge, attitude and practice among healthcare workers during the Hajj period of the Islamic year 1423 (2003). Scandinavian Journal of Infectious Diseases. 2007; 39(11-12): 1018-1024.
  4. Madanin, T., & Ghabrah, T. Meningococcal, influenza virus, and hepatitis B virus vaccination coverage level among health care workers in Hajj. BMC Infectious Diseases. 2007; 1(1): 7-80.
  5. Memish, Z., Assiri, A., Alshehri, M., Hussain, R., & Almor, I. The prevalence of respiratory viruses among healthcare workers serving pilgrims in Makkah during the 2009 influenza A (H1N1) pandemic. Travel Medicine and Infectious Disease. 2012; 10: 18-24.
  6. Phrom-in. Surveillance for meningococcal carriage by Muslims returning from the Hajj to Hat Ai Airport, Thailand. Southeast Asian Journal of Tropical Medical in Public Health. 2002; 33(Suppl 3).
  7. Turkestani, A., Ibrahim, B., & Menish, M. (2013). Using health educators to improve knowledge of healthy behaviour among Hajj 1432 (2011) pilgrims. Eastern Mediterranean Health Journal. 2013; 19: 2-4.