THE PHENOMENON OF HAJJ DEPARTURE CANCELLATION AMONG MANDAILING NATAL SOCIETY AMIDST COVID-19 PANDEMIC: BETWEEN ALLAH'S CALL AND HUMANITY'S CALL

Hajj is the fifth pillar of Islam which is obligatory to accomplish for those who are capable in terms of physic, economy, and health. The number of Indonesian hajj pilgrims as the world's most Muslim populous country elevates continuously year by year. The Government of Saudi Arabia cooperates with all Muslim populated countries to make regulations and understandings regarding the quota arrangement on the number of hajj and umrah pilgrims that are allowed to visit the two holy lands every year. In consequence, those regulations and understandings influence the waiting list for the hajj pilgrimage much longer, notably in these past two years amidst the Covid-19 pandemic. In response to that condition, the Indonesian government has decided to cancel all hajj departures for life safety. It is unavoidable that some hajj pilgrims may feel disadvantaged by governments' decision about the cancellation of hajj departure due to covid-19 pandemic situation. This study applies a qualitative descriptive method that aims to discover and provide constructive input regarding the regulations of the hajj pilgrimage during the pandemic and its position viewed through maqashid al-Syariah (the objective of Islamic law). The result of this study reveals that the Indonesian government has certainly considered all aspects to decide on the cancellation of the hajj departures during these two consecutive years. The main purpose of hajj departure cancellation by the Indonesian government is crucially beneficial because saving lives and maintains human safety and it is following one of five main objectives of Islamic sharia implementation (ad-dharuriyat al-Khamsa). Moreover, the Indonesian government and the community, in this context the hajj pilgrims, should build a positive relationship and work together to disseminate the policy regarding the hajj cancellation so that it removes misunderstanding and pro contra response in the community. © 2023 Otjivanda Presse.Essen. All rights reserved.

Worldwide poliomyelitis outbreaks: should mass gathering organizers be concerned?

The polio is the longest PHEIC and the continued occurrence of outbreaks of cVDPV would put further risks globally. The binary nature of PHEIC declarations would not support the continued polio PHEIC due to the requirement of tiered or graded strategies to combat such diseases.

Molecular Characterization of Influenza A/H3N2 Virus Isolated from Indonesian Hajj and Umrah Pilgrims 2013 to 2014.

The Hajj and Umrah are the annual mass gatherings of Muslims in Saudi Arabia and increase the transmission risk of acute respiratory infection. This study describes influenza infection among pilgrims upon arrival in Indonesia and the genetic characterization of imported influenza A/H3N2 virus. In total, 251 swab samples with influenza-like illness were tested using real-time RT-PCR for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and influenza viruses. Complete sequences of influenza A/H3N2 HA and NA genes were obtained using DNA sequencing and plotted to amino acid and antigenicity changes. Phylogenetic analysis was performed using a neighbour-joining method including the WHO vaccine strains and influenza A/H3N2 as references. The real-time RT-PCR test detected 100 (39.5%) samples positive with influenza with no positivity of MERS-CoV. Mutations in the HA gene were mainly located within the antigenic sites A, B, and D, while for the NA gene, no mutations related to oseltamivir resistance were observed. Phylogenetic analysis revealed that these viruses grouped together with clades 3C.2 and 3C.3; however, they were not closely grouped with the WHO-recommended vaccine (clades 3C.1). Sequences obtained from Hajj and Umrah pilgrims were also not grouped together with viruses from Middle East countries but clustered according to years of collection. This implies that the influenza A/H3N2 virus mutates continually across time.

Viral Etiology of severe acute respiratory illness among admitted patients during the 2022 peri-Hajj season

Introduction Severe acute respiratory illness (SARI) among pilgrims continues to be an important healthcare issue. The aim of the study is to describe the viral etiology of admitted patients during the 2022 peri-Hajj season in the Holly citifies of Makkah and Madinah. Methods This is a retrospective analysis of admitted patients with SARI and those patients were tested with multi-plex PCR for most common viral etiologies. Results A total of 179 cases of SARI were identified during the study period. Of the cases, 101 (56.4%) were males, 78 (43.6%) were females, and 78 (43.6%) were Saudi. The mean age (± SD) was 58.60 years (± 20.5) years. Those who were 65 years of age were the most common group (n=68;36%), followed by the age group 55-59 years (37 cases, 19%). The most frequent comorbidities were diabetes mellitus (n=67, 36%), hypertension (n=65, 35%), and chronic lung disease (34;18%). Of the included patients, 85 (47.5%) tested negative and 94 (42.5%) tested positive for various viral etiologies. The most frequently detected viruses were SARS-CoV-2 (n=28 cases;15%), influenza viruses (n=22 cases;12%) and influenza A (n=16) of which 43% were H3N2 and 6 cases for influenza B. The only MERS-CoV case was among a citizen and none of the visitors or residents had MERS-CoV. Of the total cases, 27 (14%) died during the follow up period. In a binary regression analysis, only age was associated with mortality (P=0.002). Conclusion The most frequently detected viruses among admitted patients with SARI were SARS-CoV-2 and influenza viruses. It is important to continue surveillance of admitted and non-admitted patients in different Hajj seasons to identify any shift in the etiologic agents.

MERS-CoV seroconversion amongst Malaysian Hajj pilgrims returning from the Middle East, 2016-2018: results from the MERCURIAL multiyear prospective cohort study.

Prospective cohort study to investigate the potential exposure to the Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) following Hajj pilgrims is still very limited. Here, we report the antibody seroconversion study results obtained from successive three years cohort studies (2016-2018) involving the Malaysian Hajj pilgrims returning from the Middle East. A cohort study of Hajj pilgrims from Malaysia enrolled 2,863 participants from 2016-2018, all of whom consented to provide paired blood samples for both pre- and post-Hajj travel to the Middle East. ELISAs and micro-neutralization assays were performed to detect the presence of MERS-CoV IgG antibodies. Sociodemographic data, symptoms experienced during Hajj, and history of exposure to camels or camel products were recorded using structured pre- and post-Hajj questionnaires. A 4-fold increase in anti-MERS-CoV IgG between paired pre-Hajj and post-Hajj serum samples in twelve participants was observed. None of the twelve ELISA-positive sera had detectable levels of virus-neutralizing antibodies. All reportedly had mild symptoms of respiratory symptoms at a certain point during the pilgrimage, implying mild or asymptomatic infections. No association between post-Hajj serum positivity and a history of exposure to camels or camel products was obtained. Findings from the study suggest that serologic conversion to MERS-CoV occurred in at least 0.6% of the Hajj pilgrims returning from the Middle East. Since all the seroconvertants had mild to no symptoms during the sampling period, it highlights the likelihood of occurrence of only low infectivity spillover infections among the Hajj pilgrims.

Respiratory viral infections during Hajj seasons.

Respiratory viral infections pose a public health concern during mass gathering (MG) events. Sustainable and continuous surveillance of respiratory viruses remains a priority to early identify and prevent potential outbreaks. This article reviews recent literature addressed the prevalence and diversity of circulating respiratory viruses during Hajj pilgrimage, one of the largest planned religious MG events held annually in Saudi Arabia. The variation between studies with respect to study design, sample size, time of sample collection (pre-, during, and pos-Hajj), type of participants (e.g., symptomatic vs. a symptomatic pilgrims), and laboratory procedure was highlighted. The majority of these studies were conducted on the 2019 Hajj season or earlier, prior to the emergence of COVID-19 which had significant impact on the past three Hajj seasons (2020, 2021, and 2022). A summary about key aspects related to organization of Hajj during COVID-19 pandemic and the implementation of exceptional infection control strategies is provided.

USAGE AND USABILITY OF HEALTH MOBILE APPLICATIONS DURING COVID-19 IN SAUDI ARABIA-A CASE OF TAWAKKALNA AND SEHATY APPLICATION

The purpose of this study was to evaluate the usability and usage statistics of the Tawakkalna and Sehaty programs. The study employed a cross-sectional methodology to collect statistics on usability and utilization. A random sample was used to collect data, and an online survey was given to the research population. A Likert scale with a range of 1 (strongly disagree) to 5 (strongly agree) was utilized. The results indicated that 147 individuals participated in the survey. More than half were female (85.1%), and more than half were citizens (66%). Tawakkalna was installed on the mobile devices of 97.9% of the population, while 89.4% had Sehaty installed. 38.3% utilize Tawakkalna twice daily, 34.0% utilize it once daily, whereas 61.7% utilize the Sehaty application monthly. The acceptance of Tawakkalna's usability and the interface is 61.7%, while Sehaty's is 57.0%. Information on Tawakkalna is helpful, updated, and accurate to 55.3%, 66%, and 61.7%, respectively. 36.2% of respondents indicated that it is tough to recover from any error, while 34% indicated that it is simple to recover in Tawakalna. 87.2% of the population utilized Tawakkalna's health services. In the instance of Sehaty, the usefulness, frequency of notification updates, rate of recovery, and accuracy of information are 40.4%, 38.3%, 38.3%, and 48.9%, respectively. Tawakkalna was developed in response to the COVID-19 pandemic, while 89.4% of the population has been vaccinated with Sehaty. It serves multiple purposes, including health, educational, and tourism application aspects. Before the pandemic, a Sehaty application was utilized to give immunizations. The Mean and Standard Deviation indicate that, except for its usefulness, the Tawakkalna has superior experience in all respects. People use Sehaty to schedule covid-19 immunization sessions © 2022, International Journal of eBusiness and eGovernment Studies.All Rights Reserved.

Deep Learning Based Face Mask Detection in Religious Mass Gathering During COVID-19 Pandemic

Notwithstanding the religious intention of billions of devotees, the religious mass gathering increased major public health concerns since it likely became a huge super spreading event for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most attendees ignored preventive measures, namely maintaining physical distance, practising hand hygiene, and wearing facemasks. Wearing a face mask in public areas protects people from spreading COVID-19. Artificial intelligence (AI) based on deep learning (DL) and machine learning (ML) could assist in fighting covid-19 in several ways. This study introduces a new deep learning-based Face Mask Detection in Religious Mass Gathering (DLFMD-RMG) technique during the COVID-19 pandemic. The DLFMD-RMG technique focuses mainly on detecting face masks in a religious mass gathering. To accomplish this, the presented DLFMD-RMG technique undergoes two pre-processing levels: Bilateral Filtering (BF) and Contrast Enhancement. For face detection, the DLFMD-RMG technique uses YOLOv5 with a ResNet-50 detector. In addition, the face detection performance can be improved by the seeker optimization algorithm (SOA) for tuning the hyperparameter of the ResNet-50 module, showing the novelty of the work. At last, the faces with and without masks are classified using the Fuzzy Neural Network (FNN) model. The stimulation study of the DLFMD-RMG algorithm is examined on a benchmark dataset. The results highlighted the remarkable performance of the DLFMD-RMG model algorithm in other recent approaches. © 2023 CRL Publishing. All rights reserved.

Hygiene and Health Coaching for Community Readiness to Perform the Hajj during an Ongoing COVID-19 Pandemic.

In March 2020, WHO declared Coronavirus Disease 2019 (COVID-19) as a global pandemic, which had a major impact on all mass gatherings (MG), including the Hajj. This has an impact for the government, as the party organizing the pilgrimage can make more mature preparations for a more optimal implementation of the pilgrimage. This study aimed to evaluate hygiene and health coaching for community readiness to perform the Hajj during an ongoing COVID-19 pandemic in Indonesia. We used a mixed qualitative and quantitative method, in which the quantitative component used an analytic cross-sectional design with a questionnaire given to 2425 pilgrims, while the qualitative component was carried out through Focus Group Discussion. During the pandemic, all hygiene and health coaching, including guidance, was carried out in three types of distance learning, called "online", "offline (face-to-face)", and "combination". This study shows that face-to-face health coaching is low (50.5%), while online coaching is high (70.0%). The total fraction of pilgrims who participated in blended coaching sessions was 55.1%, and the highest frequency of coaching was under four times (38.7%). However, in its implementation, there is still no integration between programs. There is quite a lot of health information given to pilgrims, but the material still varies between regions. Information on guidelines for preventing and transmitting COVID-19 for officers and pilgrims has not been fully socialized. There exists an urgent need to establish messages that are clear, meaningful, empathetic, consistent, and in context in order to achieve health improvement of pilgrims.

Virtual hajj as a response to demographic and geopolitical pressures

Hajj is the most important one of the Five Pillars in Islam. Islam makes the Kaaba as the orientation of daily prayers (salat), and hajj as the linkage to maintain the global Muslim faith community. The sanctity of hajj rituals is of positive significance for global pilgrims to transcend the boundaries of countries and ethnic groups. In the era of globalization, hajj quota has long been a scarce resource. It is difficult for most Muslims to obtain hajj permits from Saudi Arabia in a short term. Even non-Muslims are full of concern about Islam, especially the hajj. Then, the "virtual hajj," which is similar to the real hajj in the sacred city Mecca, came into being. It is mainly divided into several types: (1) building the real scenes of Kaaba and other hajj sites, and Muslims participating in the "virtual hajj" through role-playing;(2) the "virtual hajj" apps developed through 3D digital technology and their upgraded versions;(3) the "virtual hajj" live broadcasting the real hajj to non-pilgrims through the pilgrim's smartphone with the 5G network technology;and (4) the "virtual hajj" software developed by VR and AR technology in the Metaverse era. The main functions of "virtual hajj" are embodied in four aspects: protest against Saudi Arabia, Islamic education, universal effect, and the COVID-19 fighting. All types of "virtual hajj" have positive effects on both the Muslims and non-Muslims. However, there are different voices from religious circles on how to treat "virtual hajj."

Are Mass Gathering Events Hot Spot for Spreading of Infectious Diseases: The Kumbh Mela Experience

Kumbh Mela, the largest spiritual mass gathering, witnessed around 240 million pilgrims in 2019 at Prayagraj. The huge gathering poses challenges of different kinds including easy transmission of infectious diseases. This research aims to identify the types and causes of infectious diseases and discuss the government's efforts for health and sanitation management. Secondary data from various reports have been used to support the study for which related websites, Prayagraj Mela Authority reports, peer-reviewed articles, and related literatures were studied. Qualitative and quantitative analyses have been done to find trends and have comparative studies among various Kumbh and Ardh Kumbh Melas. The study finds that there is spread of infectious diseases like Acute respiratory infections, fever, skin disease, dysentery etc. during the Kumbh Mela due to the huge population, restricted space, pressure on sanitation infrastructure, unhygienic living conditions, solid and liquid wastes generated during Mela, and pilgrims' social and religious psychologies. The number of pilgrims of the occasion has increased heavily with time. Based on the anticipated number various efforts and initiatives of the government and management such as advance disease surveillance system, HEAT map, ensuring safe drinking water, better sanitation and healthcare facilities has increased over the years to reduce its impact. Mass gathering events always draw attention to health hazards and in fact the outbreak of the COVID-19 pandemic forced to think about the organization of mass gathering events in future. The mega tent city that accommodates nearly millions of pilgrims in the river bed is significant not only for India but also for mass gathering research at the international level to draw policy and provide the opportunity to generate the evidence and document base for risk prevention, mitigation, and management planning of infectious diseases and disasters.

Coronavirus Impact on Human Feelings During 2021 Hajj Season via Deep Learning Critical Twitter Analysis

The COVID-19 pandemic had major impact on all worldwide traveling in 2020 and 2021, which also affected Muslims' ability to perform the ritual of Hajj and Umrah. Due to the pandemic, the Saudi government limited number of pilgrims to ensure their safety and prevent the spread of disease. This reduction of pilgrims affected residents of Makkah and Madinah holy cities, whom were often involved in a variety of activities during the Hajj seasons. Twitter was one of the channels that many people and government organizations utilized to communicate with each other regarding general issues as well as other topics related to the Corona epidemic and health measures during the 2021 Hajj season (1442AH). In this study, more than 22,000 tweets were collected from Makkah and Madinah during the Hajj season of 2021. The collected tweets were analyzed using convolutional neural network and long short-term memory network (CNN-LSTM) deep learning model. We extracted the basic features of tweets and classified them into three sentimental categories including positive, negative, and neutral. The findings indicated strange negative feelings towards the Corona pandemic differently within the tweets from the holy cities. The results also showed strong correlation value of 0.74 for the sentiment analysis rates of general tweets sent by Makkah and Madinah tweeters. Furthermore, considerable correlations have been observed between Makkah and Madinah tweeters' perceptions of several issues relevant to the Corona pandemic, revealing worthwhile remarking results.

Analyzing perceptions of a global event using CNN-LSTM deep learning approach: the case of Hajj 1442 (2021).

Hajj (pilgrimage) is a unique social and religious event in which many Muslims worldwide come to perform Hajj. More than two million people travel to Makkah, Saudi Arabia annually to perform various Hajj rituals for four to five days. However, given the recent outbreak of the coronavirus (COVID-19) and its variants, Hajj in the last 2 years 2020-2021 has been different because pilgrims were limited down to a few thousand to control and prevent the spread of COVID-19. This study employs a deep learning approach to investigate the impressions of pilgrims and others from within and outside the Makkah community during the 1442 AH Hajj season. Approximately 4,300 Hajj-related posts and interactions were collected from social media channels, such as Twitter and YouTube, during the Hajj season Dhul-Hijjah 1-13, 1442 (July 11-23, 2021). Convolutional neural networks (CNNs) and long short-term memory (LSTM) deep learning methods were utilized to investigate people's impressions from the collected data. The CNN-LSTM approach showed superior performance results compared with other widely used classification models in terms of F-score and accuracy. Findings revealed significantly positive sentiment rates for tweets collected from Mina and Arafa holy sites, with ratios exceeding 4 out of 5. Furthermore, the sentiment analysis (SA) rates for tweets about Hajj and pilgrims varied during the days of Hajj. Some were classified as positive tweets, such as describing joy at receiving the days of Hajj, and some were negative tweets, such as expressing the impression about the hot weather and the level of satisfaction for some services. Moreover, the SA of comments on several YouTube videos revealed positive classified comments, including praise and supplications, and negative classified comments, such as expressing regret that the Hajj was limited to a small number of pilgrims.

Respiratory pathogens among ill pilgrims and the potential benefit of using point-of-care rapid molecular diagnostic tools during the Hajj.

We investigated respiratory pathogens among ill Hajj pilgrims from Marseille. We also discuss the potential role of point-of-care (POC) rapid molecular diagnostic tools for this purpose. Clinical data were collected using a standardised questionnaire. Influenza A and B viruses, human rhinovirus and human coronaviruses, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae and Klebsiella pneumoniae were investigated using real-time PCR in respiratory samples obtained during travel, at the onset of symptoms. 207 participants were included. A cough, expectoration, rhinitis and a sore throat were the most frequent respiratory symptoms, followed by loss of voice and dyspnoea. 38.7% and 25.1% of pilgrims reported a fever and influenza-like symptoms, respectively. 59.4% pilgrims received antibiotics. Rhinovirus (40.6%) was the most frequent pathogen, followed by S. aureus (35.8%) and H. influenzae (30.4%). Virus and bacteria co-infections were identified in 28.5% of participants. 25.1% pilgrims who were positive for respiratory bacteria did not receive antibiotic treatment. In the context of the Hajj pilgrimage, it is important to detect infections that can be easily managed with appropriate treatment, and those that can affect prognosis, requiring hospitalisation. POC rapid molecular diagnostic tools could be used for patient management at small Hajj medical missions and to rationalise antibiotic consumption among Hajj pilgrims.

Knowledge, Attitude, and Practice toward Prevention of COVID-19 Among Nursing and Midwifery Students: A cross-sectional Study in Gorgan, Northern Iran

Background: Healthcare providers are high-risk groups for the novel coronavirus disease (COVID-19) infection. Nursing students are an essential part of high-risk healthcare providers. The aim of this study was to evaluate the knowledge, attitude, and practice of nursing and midwifery students at Golestan University of Medical Sciences (GOUMS) toward the prevention of COVID-19.Methods: This cross-sectional study was conducted on 174 nursing and midwifery students of GOUMS (northeast of IRAN) in 2020. Data were gathered using an online questionnaire comprising three parts - Knowledge (8 questions), Attitude (10 questions), and Practice (8 questions) toward the prevention of COVID-19. The range of scores in each subscale (knowledge, attitude, and preventive practices) were 8-24, 10-50, and 8-24, respectively. Data were analyzed using the SPSS v.16 software. The Mann-Whitney and Kruskal-Wallis tests were used for the analysis.Results: Overall, in this study, nursing and midwifery students had a good knowledge (mean score: 23.19 +/- 2.56), a positive attitude (mean score: 45.48 +/- 4.21), and appropriate practice (mean score: 23.30 +/- 3.51) regarding COVID-19 prevention. Also, the results revealed a positive correlation between knowledge and attitude (r = 0.1, P = 0.18) and attitude and practice (r = 0.2, P = 0.01) among the students. Conclusion: The findings demonstrated a good preventive knowledge, attitude, and practice toward COVID-19 among nursing and midwifery students.

Hajj 2021: Role of mitigation measures for health security.

PURPOSE: After the impressive results of the 2020 Hajj management, Saudi authorities decided to expand the quota to 60,000 pilgrims in 2021, which resulted in a convenient and successful experience. PATIENTS AND METHODS: This was a retrospective pre and post-study study conducted on all pilgrims attending the 2021 Hajj using the polymerase chain reaction (PCR) test surveillance with paired-swab samples (pre-Hajj and post-Hajj) to evaluate the risk potential of COVID-19 among Hajj pilgrims, the effectiveness of preventive measures and the potential effect of the Hajj ritual as a huge mass gathering on the epidemiological situation of the Saudi Arabian population. RESULT: Forty-one cases had positive COVID-19 infections out of a total of 58,428 pilgrims who attended the 2021 Hajj season, as detected by nonmandatory pre- and post-Hajj PCR. Notably, the 2021 Hajj season achieved a decreasing leg of the COVID-19 pandemic curve. The adjusted incidence rate in KSA from July 11th to August 7th ranged from 19 to 24 cases per 100,000 population. In contrast, the incidence rate for the same duration in Hajj ranged from 3 to 7 cases per 100,000 pilgrims. CONCLUSION: The Saudi mitigation plan ensured the safety of pilgrims and healthcare workers for Hajj, successfully limited the risk of COVID-19 transmission inside and contributed to global health security. The success story of Hajj in 2020 and 2021 during the pandemic represents a successful model for planning, achieving and managing future mass gatherings by integrating technology with global and national health policies and public health measures.

Cross-sectional study of Middle East respiratory syndrome coronavirus in humans and dromedary camels in Diyala, Iraq.

BACKGROUND: Middle East respiratory syndrome (MERS) is a zoonotic viral disease transmitted from dromedaries to humans. To date, more than 1500 cases of MERS have been reported and 80% of all cases have occurred in the Kingdom of Saudi Arabia (KSA). This cross-sectional study was carried out to figure out the rate of infection among humans and dromedary camels and to explore the risk factors. METHODS: This study was conducted in Diyala Province, Iraq for the period from August 2017 to October 2018. Human subjects included 90 participants; 34 (37.8%) were females and 56 (62.2%) were males. Additionally, 90 dromedary camels were also included, 50 (55.6%) males and 40 (44.4%) females. Serum samples from subjects were collected and tested for the presence of anti-MERS-coronavirus (CoV) immunoglobulin g (IgG). RESULTS: The results revealed that 46 (51.1%) of human subjects were positive for anti-MERS-CoV IgG, (95% confidence interval (CI) for the prevalence rate 40.9-61.3) with a mean titer of anti-MERS-CoV IgG antibodies (Ab) of 81.2 U/mL. The anti-MERS-CoV IgG positivity rate was insignificantly higher, but the mean of anti-MERS-CoV IgG titer was significantly higher among females (p = 0.12 and p < 0.004, respectively). Furthermore, the anti-MERS-CoV IgG positivity rate and Ab titer were significantly higher among those people who visited KSA for Hajj or Umrah (p < 0.001 and p < 0.001, respectively). In camels, 81 (90.0%) were positive for anti-MERS-CoV IgG, (95% CI for the prevalence rate 82.5-94.9), with a mean titer of 99.8 U/mL. DISCUSSION: The MERS-CoV infection rate was high among both Iraqi humans and dromedary camels. Further confirmatory studies are needed, and setting up of national precaution program is essential.

Estimating social contacts in mass gatherings for disease outbreak prevention and management: case of Hajj pilgrimage.

BACKGROUND: Most mass gathering events have been suspended due to the SARS-CoV-2 pandemic. However, with vaccination rollout, whether and how to organize some of these mass gathering events arises as part of the pandemic recovery discussions, and this calls for decision support tools. The Hajj, one of the world's largest religious gatherings, was substantively scaled down in 2020 and 2021 and it is still unclear how it will take place in 2022 and subsequent years. Simulating disease transmission dynamics during the Hajj season under different conditions can provide some insights for better decision-making. Most disease risk assessment models require data on the number and nature of possible close contacts between individuals. METHODS: We sought to use integrated agent-based modeling and discrete events simulation techniques to capture risky contacts among the pilgrims and assess different scenarios in one of the Hajj major sites, namely Masjid-Al-Haram. RESULTS: The simulation results showed that a plethora of risky contacts may occur during the rituals. Also, as the total number of pilgrims increases at each site, the number of risky contacts increases, and physical distancing measures may be challenging to maintain beyond a certain number of pilgrims in the site. CONCLUSIONS: This study presented a simulation tool that can be relevant for the risk assessment of a variety of (respiratory) infectious diseases, in addition to COVID-19 in the Hajj season. This tool can be expanded to include other contributing elements of disease transmission to quantify the risk of the mass gathering events.

Low Prevalence of Syndromic Respiratory Tract Infections among Returning Hajj Pilgrims Amidst the COVID-19 Pandemic: A Post-Hajj Survey.

This study estimates the point prevalence of symptomatic respiratory tract infections (RTIs) among returned Hajj pilgrims and their contacts in 2021. Using the computer-assisted telephone interview (CATI) technique, domestic pilgrims were invited to participate in this cross-sectional survey two weeks after their home return from Hajj. Of 600 pilgrims approached, 79.3% agreed to participate and completed the survey. Syndromic definitions were used to clinically diagnose possible influenza-like illnesses (ILI) and COVID-19. Median with range was applied to summarise the continuous data, and frequencies and proportions were used to present the categorical variables. Simple logistic regression was carried out to assess the correlations of potential factors with the prevalence of RTIs. The majority of pilgrims (88.7%) reported receiving at least two doses of the COVID-19 vaccine before Hajj. Eleven (2.3%) pilgrims reported respiratory symptoms with the estimated prevalence of possible ILI being 0.2%, and of possible COVID-19 being 0.4%. Among those who were symptomatic, five (45.5%) reported that one or more of their close contacts had developed similar RTI symptoms after the pilgrims' home return. The prevalence of RTIs among pilgrims who returned home after attending the Hajj 2021 was lower compared with those reported in the pre-pandemic studies; however, the risk of spread of infection among contacts following Hajj is still a concern.