Background: The Hajj pilgrimage poses significant public health challenges due to the risk of infectious disease transmission. Despite mandatory vaccination policies, barriers such as hesitancy, logistical issues, and vaccine availability persist. Objective: This study assesses vaccine uptake, reasons for compliance or non-compliance, and barriers among Hajj pilgrims. Methods: A cross-sectional study was conducted during the 2024 Hajj season, with data collected via structured interviews from 5,355 participants. Descriptive statistics and logistic regression analyzed vaccination status and influencing factors. Results: Of the participants, 4298 (80.3%) reported receiving mandatory or recommended vaccines, including influenza, COVID-19, and meningococcal. Primary motivators for vaccination were compliance to mandatory requirements 2240 (52.1%) and healthcare provider recommendations 2018 (46.9%). Among non-vaccinated respondents, the main reasons included belief in vaccine ineffectiveness 250(23.7%), reliance on natural immunity 243(23%), and lack of awareness 174(16.5%). Common barriers included long wait times 721(13.5%) and limited access to vaccination centers 543(10.1%). Women and individuals with higher education demonstrated greater vaccine uptake, while logistical barriers were more prevalent among self-employed and less-educated participants. Conclusion: Despite high vaccine uptake, barriers remain. Addressing hesitancy, improving access, and aligning vaccine availability with Hajj timing are essential to enhance coverage and reduce disease transmission risks. Clinical Trial Number: Not applicable.

Background: While efforts have been made to control meningococcal disease or carriage during mass gatherings (MGs), it is still a significant problem. This meta-analysis aims to assess the prevalence and predictors of meningitis carriage during MGs and travel. Methodology: PubMed, Scopus, Embase, and Cochrane were searched from their conception to January 2025. Cohort and cross-sectional studies assessing the prevalence of meningitis carriage and its serotype related to MGs and/or travel, and risk factors associated with its spread, were considered. The Newcastle–Ottawa scale was used for the quality assessment of studies. Results: Out of 1301 studies, 25 were considered for this meta-analysis. The largest geographic area involved was Saudi Arabia. A meta-analysis of 24 studies identified a pooled prevalence rate of meningococcal disease or carriage of 15.9% (95%CI: 4.45–27.4%) and the most frequent infecting organisms to be Serotype C (13.9%; 95%CI: −14.7 to 42.5; 4 studies) and A (11.5%; 95%CI: −2.13 to 25.2; 9 studies) among those at MGs or traveling. Age, gender, smoking history, and the vaccination status did not affect the infection risk. Conclusions: There is an increased prevalence of meningococcal disease and carriage, especially Serogroups A and C, associated with MGs and travel. New interventions and methodologies should be undertaken to control and prevent meningococcal disease or carriage transmission during such events.

Hajj, one of the largest annual religious gatherings, attracts millions of Muslim pilgrims globally, with a significant proportion being older adults. Cogn

Objectives: In view of a lack of evidence on the subject, we aimed to perform a scoping review to understand the impact of health education among people attending mass gatherings. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines. PubMed, EMBASE, Scopus, and Cochrane Library were searched from inception to March 2025 to identify eligible studies. Observational and interventional studies that reported the impact of health education on any health-related outcome among those attending a mass gathering were considered. A narrative synthesis of review results was performed to gather evidence. Recommendations were framed in the context of this evidence. Results: Of the 1731 records, only 17 studies met the inclusion criteria. These included cross-sectional (n = 10), pre-post design (n = 3), quasi-experimental (n = 2), randomized controlled trial (n = 1), and ethnographic (n = 1) studies. These studies involved participants attending hajj, umrah, and basketball events. The current evidence on health education in mass gatherings is highly varied in its objectives, intervention strategy, educational plan, mode of delivery, design, and reported outcomes. Most studies agreed that health education should be initiated by the country of origin and continued throughout the event. It is recommended that this education should be tailored to patient needs based on age, medical condition, and other personal factors, and given in the local language for better acceptability. Such sources can be provided in various forms, either online or offline, as per the participant’s convenience. Conclusions: The current evidence on the effectiveness of health education during mass gatherings, particularly in pilgrimage settings, is varied and inconsistent. Participant-tailored health education should be provided, preferably in the local language, through convenient formats.

Background Heat-related illnesses (HRIs) remain a significant health concern during mass gatherings (MGs), where high temperatures and physical exertion exacerbate physiological stress. This study examines the clinical spectrum, management practices, and treatment outcomes of HRIs among pilgrims during the 2024 Hajj season, to inform public health responses and mitigation strategies. Methods A cross-sectional study was conducted across nine healthcare facilities in Makkah and the Mashaer region during the 2024 Hajj. Data were retrospectively extracted from medical health care facilities registries using a standardized form to capture demographic characteristics, clinical presentation, management interventions, and in-hospital outcomes of patients diagnosed with heat-related illness. Results Of the 2,785 screened patients, 2,551 had complete clinical records, and 1,576 met the diagnostic criteria for heat exhaustion or heatstroke, with outcome data available. Most of the patients were male (1,171; 74.3%), with nearly half aged 60 years or older (776; 49.2%) and a large proportion aged 39–59 years (693; 44.0%). The majority were non-Saudi pilgrims (1,419; 90%), primarily from Arab countries, with 793 (50.3%) from these regions. A total of 1,094 patients (69.4%) had no prior history of HRIs. Common symptoms included altered mental status in 635 (40.3%) patients, dizziness in 486 (30.8%), and management interventions included intravenous fluid administration in 569 cases (36.1%) and the application of cooling measures in emergency settings for 1,105 patients (70.1%). The overall mortality rate was 77 (4.9%) cases. Intensive care unit (ICU) admission and elevated lactic acid levels were significantly associated with poor outcomes. Conclusion Heat-related illness during the Hajj remains a major public health concern, with a substantial clinical burden and potentially severe outcomes. Early recognition, timely intervention, and targeted education are essential for high-risk groups. Strengthening frontline preparedness and resource deployment is crucial to reducing its potential impact.