Preparing for the 2009 Hajj: Training and piloting a mobile-based real-time surveillance system during the 2009 Umrah Ramadan

Background: Approximately 2 million Muslims from >140 countries annually embark on the Hajj and Umrah pilgrimages to the Kingdom of Saudi Arabia (KSA). Given the 2009 pandemic influenza A (H1N1) global outbreak, the KSA Ministry of Health (MOH) hosted an International Consultation on Infectious Disease Prevention and Control for Hajj and Umrah. The consultants recommended establishing a hand-held data-collection surveillance system, and KSA's MOH in collaboration with the Centers for Disease Control and Prevention (CDC) developed and deployed a Mobile-based Disease Surveillance System (MDSS). Before and during Ramadan Umrah (August 2009), KSA MOH participants were trained on the system and pilot-tested it. The recommendations from this pilot-test guided process and system modifications that enhanced MDSS for the Hajj (November 2009). Methods: During a 2-week period in Jeddah, KSA, 41 healthcare practitioners participated in two MDSS trainings. Among them, 59% (n = 24) were trained as MDSS supervisors and trainers who then trained project interviewers. After training, a 3-day MDSS pilot-test was performed in four hospitals in Makkah, KSA. Participants evaluated the training by completing pre- and posttest questionnaires and by providing feedback in a pilot posttest focus group. Results: Trainees reported that they were sufficiently trained for mobile data collection. The focus group recommendations included adding Arabic language support and establishing dedicated lines of Internet access for MDSS. Additionally, participants reported that real-time data feed can allow situational awareness for H1N1 and other reportable diseases. Technical concerns, customizable components, and questionnaire modifications were also noted. Conclusion: As a result of the MDSS training and pilot-test, the full version was executed in KSA during the 2009 Hajj. The findings provide implications for future infectious disease preparedness and surveillance for mass gatherings.