Analyses of Foodborne Disease Outbreaks during Hajj, Makkah, Kingdom of Saudi Arabia, 2009 - 2011 Open Access

Alzahrani, Saud Hamed (2013)

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PURPOSE: The Hajj is an annual mass gathering where > 1.8 million Muslim pilgrims from 183 countries come to Makkah, Kingdom of Saudi Arabia (KSA) for approximately two weeks. The KSA Ministry of Health (MOH) is responsible for ensuring the early detection and prevention of infectious diseases that can be transmitted among the markedly great number of pilgrims, such as foodborne illnesses. Foodborne illnesses are especially significant public health problems during mass gatherings. From 2009 - 2011, the Hajj Food Safety Unit (FSU) gathered data on all foodborne outbreaks, yet these data have yet to be fully analyzed to determine the underlining risk factors and the best methods for prevention and control of further outbreaks.

METHODS: A review was made of foodborne disease outbreaks (FBDOs) using data gathered by the FSU in Makkah from 2009 - 2011.

RESULTS: During the three Hajj seasons of 2009 through 2011, a total of seven FBDOs were reported with a range of 2 - 45 cases per outbreak, totaling 107 cases. Among these cases, 74 were female (70%) and 33 were male (30%). Egyptians were the most common nationality affected (69%), followed by Saudis, Malaysians, and Turks (23%, 6%, and 2% respectively). The mean age among cases was 46 years with a SD of 16 years.

CONCLUSIONS: This study found a strong relationship between the three largest FBDOs during Hajj and storage conditions and food handling methods reported over the study period. We recommend improving compliance with the Hazard Analysis Critical Control Point program and establish training programs in food safety. The FSU's work should be expanded through the electronic notification system and the reassessment of lab methods used during FBDO investigations.

Table of Contents

Table of Contents

Chapter 1: Introduction. 1

1.1 Preventive Medicine Program for Hajj 3

1.2 Rationale. 5

1.3 Aim.. 5

1.4 Objectives. 5

Chapter 2: Literature Review.. 6

2.1 FBDO Investigation. 7

2.2 Most Important Bacterial Pathogens Involved in FBDO.. 9

2.2.1 Salmonella enteritidis. 9

2.2.2 Staphylococcus aureus. 11

2.2.3 Bacillus cereus. 11

2.2.4 Clostridium perfringens. 12

2.2.5 Escherichia coli 12

2.2.6 Listeria monocytogenes. 13

2.2.7 Shigellosis (bacillary dysentery) 14

2.3 Food Handlers and FBDO.. 15

Chapter 3: Manuscript 18

Introduction. 20

Methods. 25

Results. 26

Conclusion and Recommendations. 32

Chapter 4: Conclusion and Recommendations. 36

4.1 Conclusion. 36

4.2 Recommendations. 38

4.2.1 Improving compliance with the Hazard Analysis Critical Control Point (HACCP) program 38

4.2.2 Training programs in food safety. 40

4.2.3 Reassessing the lab methods used in FBDO investigations. 41

4.2.4 Expanding the electronic notification system.. 41

References. 42

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