About 5000 South Africans depart yearly for the Hajj; the largest annual congregation on earth, involving an estimated three million pilgrims all converging to perform set rituals within specified time-frames in relatively confined spaces. Though the actual Hajj only lasts for five days, most pilgrims spend about a month in Saudi Arabia, with a significant percentage being over fifty years old. The massive crowds, congestions, changing seasons (the Hajj follows the lunar calendar, which is about ten days earlier each year in comparison to the Gregorian one), ongoing construction, and the older age group of pilgrims (often suffering from medical problems), and present winter season in which it occurs, makes the Hajj a potential site for epidemic events and pandemic spread. The recorded meningococcal epidemics highlight the above, and the current 2009 pandemic novel H1N1 influenza strain has led to unprecedented concern.
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