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CORD-19:065892aec9d2eeb8c5e4dea4966197d722a2670a JSONTXT 8 Projects

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Id Subject Object Predicate Lexical cue
T1 2-10 Sentence denotes Abstract
T2 13-19 Sentence denotes Mecca.
T3 20-365 Sentence denotes 7 In 1987, after a large outbreak of meningococcal disease serogroup A in pilgrims, Saudi Arabian health authorities implemented three preventive strategies: (1) compulsory vaccination with bivalent A and C vaccine for all pilgrims; (2) annual vaccination campaigns for all living in high-risk areas (pilgrimage sites) or among high-risk groups;
T4 366-436 Sentence denotes (3) compulsory oral ciprofloxacin to pilgrims from sub-Saharan Africa.
T5 437-621 Sentence denotes 2, 8, 9 By February 1999, with no evidence of ongoing epidemic meningococcal disease in Saudi Arabia, the US Centers for Disease Control and Prevention (CDC) lifted these requirements.
T6 622-751 Sentence denotes 10, 11 But in the subsequent Hajj seasons of 2000 and 2001, outbreaks of the disease affected 1300 and 1109 people, respectively.
T7 752-835 Sentence denotes More than 50% of these cases were confirmed to be of N meningitides serogroup W135.
T8 836-1093 Sentence denotes 2, 12 The rapidly changing pattern of meningococcal disease prompted the Saudi ministry of health to make recommendations (in 2001, in preparation for the 2002 Hajj season) for the prevention of meningococcal disease and other communicable diseases (table).
T9 1094-1257 Sentence denotes 4, 6 All pilgrims and local at-risk populations must now be given the quadrivalent polysaccharide vaccine-Hajj visas cannot be issued without proof of vaccination.
T10 1258-1649 Sentence denotes 4 Concerns over the immunogenicity of the vaccine in children younger than 5 years, the lack of effect on carrier status, and the need for booster doses after 3 years limit the efficacy of existing preparations. [13] [14] [15] [16] A conjugated quadrivalent meningococcal vaccine (Menactra) was only licensed recently in the USA in January, 2005, and should be more widely available by 2007.
T11 1650-1896 Sentence denotes Because it elicits a T-cell dependent immune response it is expected to offer immunity for more than 8 years, and eliminate the threat of the disease in all ages during the Hajj because it prevents transmission of infection from person to person.
T12 1897-1903 Sentence denotes 17, 18
T13 1905-2147 Sentence denotes Researchers undertaking a prospective study in two hospitals during the Hajj identified respiratory disease as the most common cause (57%) of admission to hospital, with pneumonia being the leading reason for admission in 39% of all patients.
T14 2148-2352 Sentence denotes 19 Researchers investigating the The immune response to tuberculosis antigens with a whole blood assay (QuantiFERON TB assay) has been measured in Singaporean pilgrims before, and 3 months after the Hajj.
T15 2353-2426 Sentence denotes 23 Of 357-paired assays, 149 pilgrims had negative tests before the Hajj.
T16 2427-2523 Sentence denotes But 15 (10%) of these had a substantial rise in immune response to the antigens during the Hajj.
T17 2524-2874 Sentence denotes This rise indicates that pilgrims from low tuberculosis-endemicity should be screened with a two-step purified protein derivative or QuantiFERON-TB before the Hajj and 3 months after, to detect new conversions. [24] [25] [26] [27] The prevalence of resistant tuberculosis is up to three times greater in Mecca and Medina than Saudi national averages.
T18 2875-2981 Sentence denotes 28, 29 This difference is due to the annual influx of pilgrims from areas of high tuberculosis-endemicity.
T19 2982-3070 Sentence denotes 30 The bulk of pilgrims now enter the region by air, often after long airplane journeys.
T20 3071-3197 Sentence denotes 31, 32 Despite several documented cases of tuberculosis acquired during air travel, the risk of such transmission remains low.
T21 3198-3258 Sentence denotes 33, 34 Specific data pertaining to Hajj travel do not exist.
T22 3259-3346 Sentence denotes Viral respiratory tract infections, particularly influenza, are common during the Hajj.
T23 3347-3531 Sentence denotes 20, 35, 36 Throat swabs from 761 patients with upper respiratory tract infections were positive for viral pathogens in 152 (20%), with influenza A and adenovirus being the most common.
T24 3532-3665 Sentence denotes 20 In another study, 35 500 pilgrims with upper respiratory tract infection symptoms were screened by throat swabs for viral culture.
T25 3666-3699 Sentence denotes 54 (10·8%) had positive cultures.
T26 3700-3884 Sentence denotes Of these, 27 (50%) had influenza B, 13 (24·1%) had herpes simplex virus, seven (12·9%) had respiratory syncytial virus, four (7·4%) had parainfluenza, and three (5·6%) had influenza A.
T27 3885-3974 Sentence denotes No enteroviruses or adenoviruses were detected, and no multiple infections were detected.
T28 3975-4025 Sentence denotes Only 22 (4·7%) had received the influenza vaccine.
T29 4026-4232 Sentence denotes When extrapolating their results to the total number of pilgrims in 2003, the researchers estimated there were 400 000 pilgrims with respiratory symptoms and 24 000 possible cases of influenza in that Hajj.
T30 4233-4347 Sentence denotes The benefit of influenza vaccination was assessed in an unmatched case-control study on pilgrims of the 2000 Hajj.
T31 4348-4606 Sentence denotes 37 In 820 patients and 600 controls, the adjusted vaccine efficacy against clinic visits for influenza-like illness was 77% (95% CI [69] [70] [71] [72] [73] [74] [75] [76] [77] [78] [79] [80] [81] [82] [83] , and that against receipt of antibiotics was 66% .
T32 4607-4822 Sentence denotes The Saudi ministry of health recommends influenza vaccination to pilgrims, especially those with underlying comorbidities (table), and the vaccine is mandatory for all healthcare workers working in Mecca and Medina.
T33 4823-4937 Sentence denotes The ministry also recommends the use of facemasks during the Hajj, to reduce the airborne transmission of disease.
T34 4938-5048 Sentence denotes Compliance with this recommendation has been poor: during the 1999 Hajj, only 24% of pilgrims wore face masks.
T35 5049-5234 Sentence denotes 38 Although there are few data for the effectiveness of facemask use in prevention of respiratory tract infections at the Hajj, it is a simple and inexpensive infection control measure.
T36 5235-5295 Sentence denotes Pertussis is another respiratory tract infection of concern.
T37 5296-5396 Sentence denotes A prospective seroepidemiological study determined the incidence of pertussis in 358 adult pilgrims.
T38 5397-5567 Sentence denotes 39 Five (1·4%) had acquired pertussis (defined as prolonged cough and a greater than four-fold increase in the level of immunoglobulin G to whole-cell pertussis antigen).
T39 5568-5662 Sentence denotes Of the 40 pilgrims who had no pre-Hajj immunity to pertussis, three (7·5%) acquired pertussis.
T40 5663-5753 Sentence denotes The investigators suggested the administration of acellular pertussis vaccine to pilgrims.
T41 5754-5875 Sentence denotes Results of further large-scale studies will be needed before making the vaccine a general recommendation to all pilgrims.
T42 5877-5991 Sentence denotes Traveller's diarrhoea is common during the Hajj, although few studies have documented its incidence and aetiology.
T43 5992-6144 Sentence denotes In the 1986 Hajj, the most common cause of hospital admissions for pilgrims was gastroenteritis (n=381, 76·6%) with an incidence rate of 4·4 per 10 000.
T44 6145-6198 Sentence denotes 41% (156) of these patients were older than 60 years.
T45 6199-6373 Sentence denotes 40 In a 2002 study, gastrointestinal disease ranked third (n=10, 6·3%) after respiratory system (n=91, 57%) and cardiovascular disease (n=31, 19·4%) as reasons for admission.
T46 6374-6504 Sentence denotes 19 Cholera, an acute bacterial enteric disease caused by Vibrio cholera accounted for several outbreaks after the Hajj in 1984-86.
T47 6505-6636 Sentence denotes 41, 42 According to the Saudi ministry of health, cholera has reached Hajj areas and caused epidemics recorded as far back as 1846.
T48 6637-6748 Sentence denotes The last epidemic at the Hajj in 1989 affected 102 pilgrims (Saudi ministry of health, personal communication).
T49 6749-6835 Sentence denotes Improved water supply and sewage systems have eliminated cholera outbreaks since then.
T50 6836-6913 Sentence denotes However, sporadic cases of cholera have still been diagnosed in Saudi Arabia.
T51 6914-7050 Sentence denotes 43, 44 Hepatitis A is also common in Saudi Arabia, 45, 46 and is the most frequent vaccine-preventable illness contracted by travellers.
T52 7051-7122 Sentence denotes It is probably common during the Hajj, but, there are no data for this.
T53 7123-7207 Sentence denotes Food poisoning is another important cause of diarrhoea and vomiting during the Hajj.
T54 7208-7330 Sentence denotes 47 During the past 12 years, the number of reported cases of food poisoning has ranged from 44 to 132 in each Hajj season.
T55 7331-7517 Sentence denotes Prevention of diarrhoeal diseases includes education of the pilgrims regarding hand hygiene, avoidance of street vendor food (including ice), and avoidance of foods made with fresh eggs.
T56 7518-7614 Sentence denotes Authorities do not allow pilgrims to carry food, except for canned food sufficient for 24 hours.
T57 7615-7754 Sentence denotes 6 The ministry of health mandates the surveillance of pilgrims arriving from cholera-affected countries (identified in weekly WHO reports).
T58 7755-7822 Sentence denotes If suspected, samples are taken and those infected are quarantined.
T59 7823-7848 Sentence denotes Contacts are also tested.
T60 7849-8058 Sentence denotes 6 Hepatitis A virus vaccine is recommended for pilgrims from developed countries-it is probably unnecessary for those from developing countries since they are likely to be immune because of childhood exposure.
T61 8059-8198 Sentence denotes Travellers can be checked for hepatitis A virus immunoglobulin G (IgG) before administration of the vaccine, to avoid needless vaccination.
T62 8199-8271 Sentence denotes 48 Pilgrims must be educated about self-treatment of diarrhoeal disease.
T63 8272-8302 Sentence denotes Adequate rehydration is vital.
T64 8303-8477 Sentence denotes Selfadministered antibiotics with an extended spectrum macrolide, azithromycin, or oral quinolone are probably indicated for moderate to severe travellers' diarrhoea (table).
T65 8478-8484 Sentence denotes 49, 50
T66 8486-8678 Sentence denotes Lengthy rituals of standing and walking, chafing garments, heat and diaphoresis all promote skin infection at the Hajj, and bacterial skin infections have been well described in Hajj pilgrims.
T67 8679-8781 Sentence denotes One study included 1441 patients at an outpatient dermatology clinic in Mecca during two Hajj seasons.
T68 8782-8887 Sentence denotes 51, 52 Primary pyoderma (including impetigo), carbuncles, furuncles, and folliculitis were commonly seen.
T69 8888-8926 Sentence denotes Secondary pyoderma complicated eczema.
T70 8927-8993 Sentence denotes Other conditions included cutaneous leishmaniasis in two patients.
T71 8994-9035 Sentence denotes Pilgrims are barefoot in some holy areas.
T72 9036-9123 Sentence denotes Standing on scorching marble in the midday sun can severely burn the soles of the feet.
T73 9124-9232 Sentence denotes 53, 54 New marble surfaces that do not absorb heat to the same degree have now been installed at the mosque.
T74 9233-9327 Sentence denotes Pilgrims should keep their skin dry and use talcum powder to keep intertriginous areas intact.
T75 9328-9389 Sentence denotes They must be vigilant of pain or soreness caused by garments.
T76 9390-9423 Sentence denotes Exposed skin should be protected.
T77 9424-9618 Sentence denotes Any preexisting skin condition should be protected and medicated as appropriate and the pilgrim must travel with their usual medications and ointments, which are all permissible during the Hajj.
T78 9619-9690 Sentence denotes Orf is a viral disease of sheep and goats, caused by the parapox virus.
T79 9691-9742 Sentence denotes Seasonal orf has been reported in abattoir workers.
T80 9743-9833 Sentence denotes Human infection results from direct contact with infected animals, producing skin lesions.
T81 9834-9924 Sentence denotes 13 55 Since few pilgrims perform the sacrifice themselves, the risk of infection is small.
T82 9925-9977 Sentence denotes Muslim men complete the Hajj by shaving their heads.
T83 9978-10079 Sentence denotes Shaving can facilitate the transmission of blood-borne disease, including hepatitis B and C, and HIV.
T84 10080-10224 Sentence denotes 56 Official regulations mandate both testing of barbers for hepatitis B (HBV) and C (HCV), and HIV, and the use of disposable single-use blades.
T85 10225-10356 Sentence denotes 57 Unlicensed barbers operating at the Hajj, shave hair at the roadside with non-sterile blades that are re-used on several people.
T86 10357-10614 Sentence denotes Data from 1999 for hepatitis serology in 158 Hajj barbers showed that seven (4%) were positive for HBsAg (hepatitis B surface antigen), 16 (10%) were HCV-positive, and one (0·6%) was positive for HbeAg (hepatitis B "e" antigen), indicating high infectivity.
T87 10615-10747 Sentence denotes 58 Saudi authorities continue to take an aggressive legislative stance to prevent unlicensed barbers from operating during the Hajj.
T88 10748-10841 Sentence denotes All pilgrims need to be aware of these hazards and must be shaved only at designated centres.
T89 10842-11076 Sentence denotes Since there are no published data to document the significance of head shaving in HBV transmission to pilgrims, and since the HBV vaccine series takes 6 months to complete, it is difficult to recommend the HBV vaccine to all pilgrims.
T90 11077-11209 Sentence denotes Individuals who are counselled in sufficient time before the Hajj, and who can afford the vaccine cost, should take the HBV vaccine.
T91 11210-11330 Sentence denotes Emerging infectious diseases-such as viral haemorrhagic fever (VHF) syndromes-are a special concern in Hajj health care.
T92 11331-11539 Sentence denotes Rift Valley fever is a VHF that affects mainly livestock but also humans. [59] [60] [61] [62] [63] Reports in September, 2000, first documented cases of the fever outside of Africa, in Saudi Arabia and Yemen.
T93 11540-11595 Sentence denotes 63, 64 This epidemic was of major concern for the Hajj.
T94 11596-11825 Sentence denotes 65 The ministries of health and of agriculture collaborated to restrict the entry of sheep to the holy sites from regions in Saudi Arabia endemic with the virus, and by launching an educational program for Mecca abattoir workers.
T95 11826-11895 Sentence denotes No outbreaks of Rift Valley fever at the Hajj have yet been reported.
T96 11896-11995 Sentence denotes Another new VHF caused by a flavivirus was isolated in 1995 from six patients from south of Jeddah.
T97 11996-12050 Sentence denotes 66 The pathogen has been identified as Alkhumra virus.
T98 12051-12115 Sentence denotes 67, 68 During the Hajj 2001, four cases were diagnosed in Mecca.
T99 12116-12152 Sentence denotes 69 So far, there have been 37 cases.
T100 12153-12233 Sentence denotes Ebola virus is another cause of VHF that has caused several outbreaks in Africa.
T101 12234-12380 Sentence denotes Saudi Arabia banned all Ugandan residents from attending the Hajj 2001 because of the concern over Ebola, which has killed more than 170 Ugandans.
T102 12381-12439 Sentence denotes 70, 71 This ban was lifted by the end of 2001 Hajj season.
T103 12440-12630 Sentence denotes Briefly in 2003, SARS (severe acute respiratory syndrome) presented a potentially enormous threat to Hajj pilgrims, particularly because the virus' spread could be facilitated by air travel.
T104 12631-12738 Sentence denotes 72, 73 The conditions of the Hajj could turn a single case of SARS into an epidemic of unprecedented scale.
T105 12739-13036 Sentence denotes Saudi authorities implemented several strategies to prevent the entry of SARS, including delayed entry for pilgrims from countries reporting local SARS transmission: people from these countries would not be allowed to enter Saudi Arabia until 10 days had elapsed since they left their own country.
T106 13037-13131 Sentence denotes 74 76 and authorities do not believe that the virus presents any further concerns to the Hajj.
T107 13132-13182 Sentence denotes Avian influenza (H5N1) is of major global concern.
T108 13183-13296 Sentence denotes 77-79 The WHO reported 175 confirmed human cases of avian influenza A (H5N1) as of Mar 6, 2006 , of whom 95 died.
T109 13297-13409 Sentence denotes Although this number is low, this frequently mutating, highly virulent virus is a major threat to Hajj pilgrims.
T110 13410-13530 Sentence denotes The Saudi Authorities have already restricted bird importation in order to prevent avian influenza entering the country.
T111 13531-13560 Sentence denotes At present no vaccine exists.
T112 13561-13663 Sentence denotes 80 In November, 2004, a Sudanese child was diagnosed with polio one day after arrival in Saudi Arabia.
T113 13664-13739 Sentence denotes 6, 81 This case coincided with the diagnosis of another 104 cases in Sudan.
T114 13740-13972 Sentence denotes 81 In response, the Saudi ministry of health now stipulates that all visitors under the age of 15 years from countries reporting cases of polio will be required to show proof of vaccination to obtain visas for entry to Saudi Arabia.
T115 13973-14156 Sentence denotes In addition, irrespective of previous immunisation status, polio vaccination at Saudi Arabian borders for people younger than 15 years arriving from those countries will be mandatory.
T116 14157-14289 Sentence denotes 4, 6 Although some believe that polio spreads to other countries by returning pilgrims, there is no evidence to support this belief.
T117 14290-14369 Sentence denotes Cardiovascular disease is the most common cause (43%) of death during the Hajj.
T118 14370-14442 Sentence denotes 82 Many patients have cardiac arrests, outside hospitals, at Hajj sites.
T119 14443-14573 Sentence denotes Although healthcare response workers are ambulance-supported emergency medical service teams, pilgrims can rarely be resuscitated.
T120 14574-14682 Sentence denotes Retrieving patients in "peri-arrest" from massive crowds is difficult, and can itself pose danger to others.
T121 14683-14821 Sentence denotes Hajj is arduous even for healthy adults-for those with pre-existing cardiac disease, the physical stress can easily precipitate ischaemia.
T122 14822-14961 Sentence denotes The onus is on the pilgrim to avoid the Hajj if their cardiac status is precarious, and clinicians must encourage this preventative stance.
T123 14962-15117 Sentence denotes Cardiac patients planning for the Hajj should consult with their doctors before the journey; ensure sufficient supply of, and compliance with, medications.
T124 15118-15265 Sentence denotes They should avoid crowds, perform some rituals by proxy, and report to the closest health centre for any symptom indicating cardiac decompensation.
T125 15266-15329 Sentence denotes Trauma is a major cause of morbidity and mortality at the Hajj.
T126 15330-15518 Sentence denotes In a prospective study on 713 trauma patients, who were injured while performing Hajj, presenting to the emergency room, 248 (35%) were admitted to surgical departments and intensive care.
T127 15519-15595 Sentence denotes 83 The most common surgical presentations were orthopedic and neurosurgical.
T128 15596-15654 Sentence denotes 83 Trauma risks are not confined to holy sites themselves.
T129 15655-15789 Sentence denotes 84, 85 For a large part of the Hajj, pilgrims travel either by foot, walking through or near dense traffic, or in vehicles themselves.
T130 15790-15902 Sentence denotes Extreme traffic buildup, poor compliance with seatbelts, and disordered traffic flow contributes to trauma risk.
T131 15903-15999 Sentence denotes Motor vehicle accidents are inevitable, and contribute to casualties and deaths during the Hajj.
T132 16000-16170 Sentence denotes The national database compiled by the Saudi National Committee for Traffic Safety recorded 267 772 motor vehicle accidents in Saudi Arabia, of which 4848 were fatalities.
T133 16171-16340 Sentence denotes The highest incidence of accidents-94 699-was recorded in Mecca province indicating a very high risk of motor vehicle accidents in view of Mecca's relatively small size.
T134 16341-16391 Sentence denotes Stampede is perhaps the most feared trauma hazard.
T135 16392-16523 Sentence denotes Once started, little can be done to stop panic spreading through crowds, contributing to casualties, and all too often, fatalities.
T136 16524-16654 Sentence denotes 86 At the Hajj 2006, stampedes followed pilgrims tripping over fallen luggage, and resulted in 380 deaths and 289 wounded (panel).
T137 16655-16767 Sentence denotes Fatalities result from asphyxiation or head injury, neither of which can be attended to quickly in large crowds.
T138 16768-16864 Sentence denotes Particularly dangerous for stampedes is the Jamarat area, where crowds surge around the pillars.
T139 16865-17070 Sentence denotes 2 To reduce this crowding, the cylindrical columns have been replaced with elliptical ones, increasing the surface area available for stoning and dissipating intense crowd pressure surrounding each column.
T140 17071-17141 Sentence denotes After the Hajj 2006 in January, work started on a new Jamarat project.
T141 17142-17269 Sentence denotes A 4-level Jamarat bridge will be built at an estimated cost of $1·1 billion with a capacity of 5 million pilgrims over 6 hours.
T142 17270-17388 Sentence denotes The 12 entrances and 13 exits will be supported with helipads, electronic surveillance, and shading and cooling mists.
T143 17389-17448 Sentence denotes 80% of this new project will be ready for 2007 Hajj season.
T144 17449-17488 Sentence denotes The panel lists Hajj-related disasters.
T145 17489-17629 Sentence denotes Each disaster results in policy change, and a redoubling of effortswhich have so far cost more than $25 billion to prevent future incidents.
T146 17630-17632 Sentence denotes 87
T147 17633-17750 Sentence denotes In 1997, fire devastated the Mina area when makeshift tents were set ablaze by open stoves, since banned at the Hajj.
T148 17751-17813 Sentence denotes There were 343 deaths and more than 1500 estimated casualties.
T149 17814-17905 Sentence denotes 88 Since then all makeshift tents have been replaced by permanent fibreglass installations.
T150 17906-18014 Sentence denotes At Hajj time, teflon-coated awnings are added, and the aluminum frames remain in place the rest of the year.
T151 18015-18062 Sentence denotes No pilgrim is permitted to set up his own tent.
T152 18063-18123 Sentence denotes Additionally, pilgrims are not allowed to cook food at Mina.
T153 18124-18222 Sentence denotes Smoking is forbidden during the Hajj by Islamic teaching, thus reducing the risk of a naked flame.
T154 18223-18299 Sentence denotes Continuous public education is being undertaken to further reduce fire risk.
T155 18300-18417 Sentence denotes Heat exhaustion and heatstroke is a leading cause of morbidity and mortality during the Hajj, particularly in summer.
T156 18418-18473 Sentence denotes 89, 90 Temperatures in Mecca can rise higher than 45ºC.
T157 18474-18607 Sentence denotes Lack of acclimatisation, arduous physical rituals, and exposed spaces with limited or no shade, produces heatstroke in many pilgrims.
T158 18608-18661 Sentence denotes Adequate fluid intake and seeking shade is essential.
T159 18662-18774 Sentence denotes Supplicating pilgrims might not notice the dangers of extreme heat exposure until their symptoms are pronounced.
T160 18775-18920 Sentence denotes Water mist sprayers operate regularly in the desert at Arafat, a time of high risk for heatstroke, when many stand for long hours during the day.
T161 18921-19069 Sentence denotes Performing rituals at night, using umbrellas, seeking shade, and wearing high-SPF sunblock creams are all advisable and permissible during the Hajj.
T162 19070-19135 Sentence denotes Children accompanying their parents must be especially protected.
T163 19136-19363 Sentence denotes The timings of rites are flexible and acceptable at the pilgrim's convenience-it is key that pilgrims are aware of this since, through fear of committing errors, they might not make sensible choices in completing their rituals.
T164 19364-19448 Sentence denotes For the management of heatstroke, hospitals are equipped with special cooling units.
T165 19449-19663 Sentence denotes 91 Although the Hajj is not due to fall in the summer for several years, Saudi winters are warmer (25-30ºC) than most pilgrims will be used to, and they must seek shade and drink plenty of fluid during their rites.
T166 19664-19731 Sentence denotes Abattoir workers at the Hajj are exposed to unique traumatic risks.
T167 19732-19842 Sentence denotes Over a million cattle are slaughtered each Hajj, up to half a million before noon on the 10th day of the Hajj.
T168 19843-19942 Sentence denotes 92 In one study, 298 emergency visits for hand injury were treated in Mecca over four Hajj seasons.
T169 19943-20083 Sentence denotes 93 More than 80% were injuries from animal slaughter; many avoidable injuries were sustained by lay people and not trained abattoir workers.
T170 20084-20204 Sentence denotes Pilgrims need to be assured that professional slaughtering arrangements are easily available at the Hajj, and far safer.
T171 20205-20206 Sentence denotes 2
T172 20207-20317 Sentence denotes The numbers of people undertaking the Hajj continue to grow, in spite of the past 4 years of regional turmoil.
T173 20318-20411 Sentence denotes Overall, the Hajj remains surprisingly peaceful and organised, in view of its colossal scale.
T174 20412-20589 Sentence denotes But travellers to Mecca face specific environmental hazards, both through the physical environment, and through the unique microbiological setting created there during the Hajj.
T175 20590-20661 Sentence denotes Years ago, the pilgrimage itself was arduous, and many died on the way.
T176 20662-20759 Sentence denotes Now, however, the Hajj itself presents risks which, unanticipated, can lead to disease and death.
T177 20760-20850 Sentence denotes Additionally, the potential for disease to spread is greater in our time of global travel.
T178 20851-21012 Sentence denotes Clinicians must be aware of risks and strategies to tackle them, many of which are simple measures, and can be undertaken both before departure and in the field.
T179 21013-21129 Sentence denotes Doctors must also be aware of the risks posed by returned pilgrims, and be alert to reporting any post-Hajj illness.
T180 21130-21224 Sentence denotes Hajj management, even for a nation as well-resourced as Saudi Arabia, is an overwhelming task.
T181 21225-21397 Sentence denotes International collaboration by planning vaccination campaigns, developing visa quotas, and arranging rapid repatriation are integral to managing health hazards at the Hajj.