English abstract
The strategic location of the arabian Peninsula between Africa, Asia and Europe, has since early historical times drawn travellers, seafarers, and merchants to this part of the Middle East. It is inevitable that importation of communicable diseases should be a feature of such population movements. In Saudi Arabia, this has been demonstrated repeatedly over past decades, with epidemics occurring during the annual Hajj, when over a million pilgrims from more than 80 countries congregate together with a similar number of local worshippers for a week in Mecca and Medina. Plague used to break out almost every year until 98,1 and other frequent outbreaks have included smallpox,2 cholera,3 and meningococcal infection.3,4 The latter has continued to pose a problem despite the use of bivalent (A,C) vaccination for intending pilgrims, and two recent meningococcal outbreaks in 2000 and 200 caused by new serogroups required planning to introduce quadrivalent (A,C,Y, W135) vaccination in the future.5 All Arabian Peninsula countries have been subject to outbreaks of introduced communicable diseases caused by various micro-organisms, although these have not always been so well documented as the Saudi epidemics.
