Frontiers of Medicine

, Volume 10, Issue 4, pp 527–530 | Cite as

Yellow fever and Hajj: with all eyes on Zika, a familiar flavivirus remains a threat

  • Qanta A. Ahmed
  • Ziad A. Memish


Hajj is among the world’s largest mass gatherings, drawing between 2 and 3.5 million Muslims from 183 nations annually to perform pilgrimage in Mecca, Saudi Arabia. Infectious disease outbreaks can be imported both into the Hajj population and exported internationally by returning pilgrims. The domestic Saudi population can also be at risk of outbreaks traveling amid this mass migration. With yellow fever reported for the first time in China following the infection of expatriate Chinese workers in Angola and a full blown outbreak underway in wider West Africa, the prospect of yellow fever outbreaks in Asia threatens to impact Saudi Arabia, both during and beyond the Hajj season. With global focus trained on Zika, the rising threat of yellow fever cannot be overlooked. Strategies to mitigate risk to Saudi Arabia and the global population are thereby suggested.


yellow fever mass gathering Saudi Arabia Hajj Zika virus 


  1. 1.
    Wasserman S, Tambyah PA, Lim PL. Yellow fever cases in Asia: primed for an epidemic. Int J Infect Dis 2016; 48: 98–103CrossRefPubMedGoogle Scholar
  2. 2.
    Elachola H, Ditekemena J, Zhuo J, Gozzer E, Marchesini P, Rahman M, Sow S, Kattan RF, Memish ZA. Yellow fever outbreaks, vaccine shortages and the Hajj and Olympics: call for global vigilance. Lancet 2016 Sep 5. [Epub ahead of print] doi: 10.1016/S0140-6736 (16)31546-XGoogle Scholar
  3. 3.
    Wang L, Zhou P, Fu X, Zheng Y, Huang S, Fang B, Zhang G, Jia K, Li S. Yellow fever virus: increasing imported cases in China. J Infect 2016; 73(4): 377–380CrossRefPubMedGoogle Scholar
  4. 4.
    Gulland A. Vigilance still needed to contain Africa’s yellow fever outbreak, says WHO. BMJ 2016; 354:i4756CrossRefPubMedGoogle Scholar
  5. 5.
    Beasley DW, Mc Auley AJ, Bente DA. Yellow fever virus: genetic and phenotypic diversity and implications for detection, prevention and therapy. Antiviral Res 2015; 115: 48–70CrossRefPubMedGoogle Scholar
  6. 6.
    Monath TP, Vasconcelos PF. Yellow fever. J Clin Virol 2015; 64: 160–173CrossRefPubMedGoogle Scholar
  7. 7.
    Burki T. Yellow fever in Africa: a disaster waiting to happen. Lancet Infect Dis 2016; 16(8): 896–897CrossRefPubMedGoogle Scholar
  8. 8.
    Maguire HC, Heymann DL. Yellow fever in Africa. BMJ 2016; 354: i3764CrossRefPubMedGoogle Scholar
  9. 9.
    WHO. Yellow fever global vaccine stockpile in emergencies. (Accessed September 10, 2016)Google Scholar
  10. 10.
    Jamie A. Yellow fever spreads rapidly in Africa, vaccine supply running low. 20160621/yellow-fever-spreads-rapidly-africa-vaccine-supply-running-low.htm (Accessed September 10, 2016)Google Scholar
  11. 11.
    Barrett AD. Yellow fever in Angola and beyond—the problem of vaccine supply and demand. N Engl J Med 2016; 375(4): 301–303CrossRefPubMedGoogle Scholar
  12. 12.
    Kupferschmidt K. Yellow fever outbreak triggers vaccine alarm. Science 2016; 352(6282): 128–129CrossRefPubMedGoogle Scholar
  13. 13.
    No authors listed. Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj), 2016. Wkly Epidemiol Rec 2016; 91(26-27): 331–335Google Scholar
  14. 14.
    Mo Y, Alferez Salada BM, Tambyah PA. Zika virus—a review for clinicians. Br Med Bull 2016; 119(1): 25–36CrossRefPubMedGoogle Scholar

Copyright information

© Higher Education Press and Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Division of Pulmonary Disease and Critical Care Medicine, Department of MedicineWinthrop University Hospital; State University of New York (SUNY) at Stony BrookStony BrookUSA
  2. 2.Ministry of HealthRiyadhKingdom of Saudi Arabia
  3. 3.College of MedicineAlfaisal UniversityRiyadhKingdom of Saudi Arabia

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