Tuberculosis infection during Hajj pilgrimage. The risk to pilgrims and their communities

Millions of Muslims travel to Makkah every year to perform Hajj. Many pilgrims come from countries with a high incidence of tuberculosis (TB). Over-crowding, physical exhaustion, heat, and co-morbid conditions of mostly middle-aged and elderly pilgrims make them susceptible to infection, or reactivation of latent TB. Evidence from previous reports indicated a significant risk of acquiring infection during Hajj. Pilgrims infected in Makkah may spread the infection to contacts in their countries. Spread of multi-drug resistant TB is a real concern. Control efforts are required to reduce the risk of infection and transmission. Screening of pilgrims from high burden countries before travel with chest x-ray will help to detect and treat active TB, and prevent infection of others. Low incidence countries may consider carrying out tuberculin skin test or Quanti-FERON TB assay for pilgrims before and after Hajj, to identify and treat recent converters. National and international coordinated efforts are essential for successful implementation of control measures to prevent the spread of the disease.