Pandemic H1N1 and the 2009 Hajj

The annual Hajj pilgrimage of more than 2.5 million pilgrims from more than 160 countries is held in the Kingdom of Saudi Arabia (KSA) ( 1 ) (see the figure). Hajj is a deeply spiritual journey undertaken by Muslims at least once in their lifetimes. Hajj-related infectious disease outbreaks in recent decades have focused attention on Hajj as a global public health security challenge of extraordinary dimensions ( 1 – 5 ). This past summer, a KSA–World Health Organization (WHO) consultation process developed the Jeddah recommendations on mitigation for the effects of the current pandemic influenza A (H1N1) virus during the 2009 Hajj, which is the last week of November ( 6 ). Here, we outline some of the realities associated with meeting those recommendations and the most recent plans to help mitigate the transmission burden.