Mass Gatherings and Hazard Control: Agenda for Education and Implementation

Abstract

The Hajj is an annual pilgrimage to Mecca, Saudi Arabia, attended by approximately two million Muslims. To promote a healthy pilgrimage, travelers should proactively look to recognize, prevent, and control those health or environmental stressors, arising in or from the Hajj. A hierarchy of controls to hazards has been employed as a means of determining how to implement meaningful control solutions. The Centers of Disease Control (CDC) and the National Institute for Occupational Safety and Health (NIOSH) lists ordered hazard control measures as: (1) Elimination, (2) Substitution, (3) Engineering Controls, (4) Administrative Controls, and (5) Personal Protective Equipment (PPE). Elimination, substitution, engineering, and administrative controls are favored over the use of PPE; however, specifically in the case of mass gatherings, those controls are not always feasible. Administrative controls, such as behavioral personal hygiene interventions, which include hand hygiene, proper cough etiquette, social distancing, and contact avoidance, can be effective at mitigating respiratory illness and other infectious diseases (Brunette and Centers for Disease Control and Prevention [CDC], CDC health information for international travel 2016: the yellow book. Oxford University Press, New York, 2016). Immunizations, as an engineering control, are designed to remove the hazard at the source, before it comes in contact with an individual (American Chemical Society [ACS], Control measures. Retrieved from https://www.acs.org/content/acs/en/about/governance/committees/chemicalsafety/hazard-assessment/fundamentals/control-measures.html, 2015). The initial cost of immunizations can be higher than the cost of personal protective equipment; however, over time, they can produce a cost saving in terms of reduced further medical care. For personal protective equipment to be effective, PPE should be properly worn and maintained in a clean and reliable fashion before, during, and after use (Occupational Safety and Health Administration [OSHA] 2016). The Kingdom of Saudi Arabia Ministry of Health established health guidelines, disseminated electronically through the MOH portal, specific to the health education of Hajj pilgrims addressing: (1) During Hajj, (2) Chronic Diseases, (3) Woman and Child, and (4) After Hajj (Saudi Ministry of Health, Media center. Retrieved from https://www.moh.gov.sa/en/Pages/Default.aspx, 2018a).