title: Strengthening health security at the Hajj mass gatherings: characteristics of the infectious diseases surveillance systems operational during the 2015 Hajj.
abstract: BACKGROUND
  Hajj is one of the largest and the most ethnically and culturally diverse mass gatherings worldwide. The use of appropriate surveillance systems ensures timely information management for effective planning and response to infectious diseases threats during the pilgrimage. The literature describes infectious diseases prevention and control strategies for Hajj but with limited information on the operations and characteristics of the existing Hajj infectious diseases surveillance systems.
  
  
  METHODS
  We reviewed documents, including guidelines and reports from the Saudi Ministry of Health's database, to describe the characteristics of the infectious diseases surveillance systems that were operational during the 2015 Hajj, highlighting best practices and gaps and proposing strategies for strengthening and improvement. Using Pubmed and Embase online search engines and a combination of search terms including, 'mass gatherings' 'Olympics' 'surveillance' 'Hajj' 'health security', we explored the existing literature and highlighted some lessons learnt from other international mass gatherings.
  
  
  RESULTS
  A regular indicator-based infectious disease surveillance system generates routine reports from health facilities within the Kingdom to the regional and central public health directorates all year round. During Hajj, enhanced indicator-based notifiable diseases surveillance systems complement the existing surveillance tool to ensure timely reporting of event information for appropriate action by public health officials.
  
  
  CONCLUSIONS
  There is need to integrate the existing Hajj surveillance data management systems and to implement syndromic surveillance as an early warning system for infectious disease control during Hajj. International engagement is important to strengthen Hajj infectious diseases surveillance and to prevent disease transmission and globalization of infectious agents which could undermine global health security.
authors.affiliation: Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Badriah M
authors.initials: BM
authors.lastname: Alotaibi
authors.affiliation: Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Saber
authors.initials: S
authors.lastname: Yezli
authors.affiliation: Public Health Deputyship, Ministry of Health, Riyadh, Saudi Arabia.|Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Abdul-Aziz A
authors.initials: AA
authors.lastname: Bin Saeed
authors.affiliation: Makkah Regional Health Affairs, Ministry of Health, Jeddah, Saudi Arabia.
authors.forename: Abdulhafeez
authors.initials: A
authors.lastname: Turkestani
authors.affiliation: Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Amnah H
authors.initials: AH
authors.lastname: Alawam
authors.affiliation: Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Kingsley L
authors.initials: KL
authors.lastname: Bieh
mesh_terms: D003140:Communicable Disease Control / Q000379:methods*; D003141:Communicable Diseases / Q000453:epidemiology*; D004196:Disease Outbreaks / Q000517:prevention & control*; D006287:Health Planning Guidelines; D006801:Humans; D007514:Islam; D011159:Population Surveillance / Q000379:methods; D012529:Saudi Arabia / Q000453:epidemiology; D014195:Travel
keywords: Hajj; infectious diseases; mass gatherings; outbreak; surveillance