Common Health Hazards in French Pilgrims During the Hajj of 2007: a Prospective Cohort Study

Background: The majority of published studies on Hajj-related diseases were based on hospitalized patient cohorts.

Methods: A total of 545 Hajj pilgrims from Marseille were enrolled in a prospective epidemiological study to evaluate the incidence of common health hazards. They were administered a questionnaire before traveling addressing demographic factors and health status indicators and a post-travel questionnaire about travel-associated diseases.

Results: Respondents had a median age of 61 years and originated mainly from North Africa (81%). A significant proportion of individuals had chronic medical disorders such as walking disability (26%), diabetes mellitus (21%), and hypertension (21%). A total of 462 pilgrims were administered a questionnaire on returning home. A proportion of 59% of travelers presented at least one health problem during the pilgrimage and 44% of the cohort attended a doctor during travel; 3% were hospitalized. Cough was the main complaint among travelers (attack rate of 51%), followed by headache, heat stress, and fever. Few travelers suffered diarrhea and vomiting. Cardiovascular diseases, neurological disorders, trauma, skin and gastrointestinal problems were not frequently observed in our survey, suggesting that their prevalence among the causes of admission to Saudi hospitals reflects a bias of selection. Cough episodes were significantly more frequent in individuals >55 years. We also evidenced that women were more likely to present underlying chronic cardiovascular disorder and diabetes compared to men and that they more frequently suffered from cough episodes associated with fever during the Hajj.

Conclusions: Health risks associated with the Hajj in our experience are much more related to crowding conditions than to travel. Our work suggests that the studies performed in Saudi specialized units probably overestimate the part of certain diseases within the spectrum of Hajj-associated diseases. Our results also suggest that old female Hajjes should be considered as a high-risk population and that preventive measures should be reinforced before departing for Saudi Arabia.