3% traveling by sea—largely from Egypt and Sudan—into the Saudi seaports of Jeddah and Yanbo. Twenty countries accounted for more than 80% of all international pilgrims worldwide (see Table 1). The largest numbers of international pilgrims performing the Hajj in 2008 originated from the WHO’s Eastern Mediterranean Region (733,417), Selleckchem Ribociclib followed by the South-East Asia Region (463,316), the European Region (243,351), the African Region (217,972), the Western Pacific Region (60,877), and finally the Region of the

Americas (13,311). Of these international pilgrims, 11.3, 64.1, 16.6, and 8.0% originated from low, lower middle, upper middle, and high income countries, respectively. A total of 195,501 pilgrims this website from 40 low-income countries performed the Hajj in 2008, although just 3 of these countries accounted for 57% of such pilgrims—Bangladesh (50,419), Afghanistan (32,621), and Yemen

(28,018). The next 18 low-income countries were the source of between 1,000 and 10,000 pilgrims totaling 79,101 people. These countries included Niger (8,231), Senegal (8,043), Tajikistan (6,883), Mali (6,526), Somalia (6,463), Guinea (5,792), Uzbekistan (5,559), Chad (5,251), Ethiopia (3,926), Benin (3,674), Myanmar (3,342), Mauritania (3,189), Ghana (2,550), Kenya (2,451), Burkina Faso (2,350), Tanzania (1,976), Gambia (1,848), and Togo (1,381). An additional 19 countries were the source of less than 1,000 pilgrims totaling 5,342

people. Furthermore, 10 lower middle- income countries sent more than 25,000 pilgrims each to the Hajj, which included Indonesia (214,159), India (173,265), Pakistan (170,573), Iran (111,511), Nigeria (97,396), Egypt (94,015), Morocco (48,483), Sudan (38,652), Iraq (35,326), and Syria (30,556). A scatterplot of the number of pilgrims performing C1GALT1 the Hajj by country and the economic status of the country (see Figure 1) measured as GNI per capita depicts which countries may be most vulnerable to H1N1 after the Hajj (ie, those with the highest number of pilgrims and the lowest financial resources). Our analysis of international passenger traffic at Jeddah IAP revealed three annual surges in travel associated with: (1) a summer tourism festival located in Jeddah; (2) the month of Ramadan when many Muslims travel to Mecca to take part in a lesser pilgrimage known as the Umrah; and (3) the Hajj. At the time of the Hajj, approximately three million international passenger trips are regularly made via Jeddah or Medina IAP—the two main commercial airports used by pilgrims traveling to and from Mecca (see Figure 2; data from Medina IAP not shown). With the notable exception of Indonesia, we found that a substantial majority of the world’s pilgrims originated from the Northern hemisphere in 2008, which was in the midst of influenza season when the Hajj began in late November.