JEDDAH — Many in Saudi Arabia often suffer from illnesses during Haj and Umrah seasons, when millions of pilgrims gathering in Makkah and Madinah make the spread of infections all too easy. One of the most common diseases is pneumococcal, which is an infection caused by a type of bacteria called streptococcus pneumonia. The incidence rate of pneumococcal disease (PD) in Saudi Arabia is estimated to be 17.4 per 100 people, with a fatality rate of 12.2 percent. Pneumonia is a major threat to health in Haj. It accounts for 39 percent of all hospital admissions during Haj and is the second leading cause of hospital admissions. Saudi Gazette spoke with Dr. Nezar Bahray, an American and Canadian Boards certified doctor of internal medicine and infectious diseases, to find out more about this issue. Bahray is also the director of academic and training affairs at Soliman Fakeeh Hospital in Jeddah. “A retrospective analysis in the Kingdom on community acquired pneumonia put the average age of the patients at 43 years. The clinical histories indicated that 25 percent had type 2 diabetes mellitus, and 54 percent had one or more co-morbidity [other conditions],” Bahray said. According to Bahray, there are more than 90 known pneumococcal strains that can cause disease, and a previous pneumococcal infection will not protect a person from future infection. Therefore, pneumococcal vaccines are recommended for children and adults even if they have had pneumococcal disease in the past. Before Haj or Umrah pilgrims can receive their visas, they must undertake several mandatory tests and have some check-ups, such as a tuberculosis test and a chest x-ray. One possible solution to reduce the prevalence of the disease is to have pilgrims receive vaccines at least two weeks prior to coming to the Kingdom and preferably up to a month before. “There is regulation for mandatory vaccination against meningococcal meningitis, and yellow fever,” Bahray said. “We also wish to see the other vaccines for pneumococcal to become mandated. Also they should take the meningococcal vaccine, which is already mandatory, and also they should get a vaccination for influenza.” He explained that, along with vaccinations, it is vital to maintain a healthy diet high in nutrition, as this helps maintaining a strong immune system. He also suggested several preventive measures during Umrah, such as wearing masks, especially in crowded places. The masks must be replaced every six hours if possible. Washing hands with soap and water, or disinfectant, especially after coughing and sneezing, is also vital, as is using disposable tissues when sneezing or coughing. Bahray said it was important to dispose of used tissues and masks in the trash so as to reduce the chances of infection. If there are no tissues, Bahray said, it is preferable to use your upper arm, not your hands, and not to touch your eyes, nose or mouth if you have not washed your hands well. It is also preferable to greet others with handshakes alone. People should not drink ice water or very cold water, and they should avoid direct exposure to air-conditioning when sweating. He added, “The best place to convey the message to people is hospitals. Some hospitals have adopted smart tactics such as popups, which appear on screens of doctors to remind them to inform patients about diseases prevalent during the Umrah season. Many health awareness campaigns are run on airplanes and in airports in the country and abroad throughout the year, with increased frequency during Umrah and Haj seasons. But according to Bahray, there isn't enough awareness around pneumococcal diseases, such as lung infections. He said the potential of the vaccine to prevent infection is neglected in Gulf states, because there is little awareness of the burden caused by the disease in adults. Bahray argues that several vaccines should be provided for certain groups of people more at risk of infection during and after the campaigns in Umrah and Haj seasons. “Pneumococcal disease is a leading cause of vaccine-preventable death. This is why the vaccine is a great measure to avoid lung infection for people over 50, pregnant women, diabetics or people affected by renal failure and children under the age of 10,” he added. To minimize the health risks for pilgrims and to prevent the spread of communicable diseases during travel, the Ministry of Health issues its own set of health regulations that are updated each year.
