Hajj is the annual gathering of Islam practitioners in Mecca, Saudi Arabia. During the event, gastrointestinal infections are usually experienced and outbreaks have always been a concern; nevertheless, a deep and integrative study of the etiological agents has never been carried out. Here, I describe for the first time the epidemiology of pathogenic enteric viruses during Hajj 2011, 2012 and 2013. The focus of this study was the common enteric viruses Astrovirus, Norovirus, Rotavirus and Adenovirus. An enzyme Immunoassay established their presence in 14.9%, 15.0% and 6.6% of the reported cases of acute diarrhea for 2011, 2012 and 2013, respectively. For the three years of study, Astrovirus accounted for the majority of the viral infections. To our knowledge, this is the first time an epidemiological study depicts Astrovirus as the main viral agent of gastroenteritis in a mass gathering event. Hajj is rich in strains of Astrovirus, Norovirus and Rotavirus. A first screening by RT-PCR resulted in ten different genotypes. Strains HAstV 2, HAstV 1 and HAstV 5 were identified for Astrovirus. GI.6, GII.3, GII.4 and GII.1 were described for Norovirus and G1P[8], G4P[8] and G3P[8] were found for Rotavirus. The majority of the Astrovirus isolates could not be genotyped suggesting the presence of a new variant(s). Cases like this encourage the use of metagenomics (and nextgeneration sequencing) as a state-of-the-art technology in clinical diagnosis. A sample containing Adenovirus particles is being used to standardize a process for detection directly from stool samples and results will be obtained in the near future. The overall findings of the present study support the concept of Hajj as a unique mass gathering event that potentiates the transmission of infectious diseases. The finding of Norovirus GII.4 Sydney, a variant originated from Australia, suggests that Hajj is a receptor of infectious diseases worldwide. This work is part of the Hajj project, a collaborative effort with the Ministry of Health of the Kingdom of Saudi Arabia in order to describe entirely the epidemiology of gastrointestinal diseases in Hajj. It is expected that the results of this study will serve in the refinement of public health policies.

Alors qu'elles n'intervenaient jusqu'ici que marginalement dans l'économie du pèlerinage à La Mecque (hajj), la catastrophe humanitaire constituée par l'épidémie de choléra de 1865-66 a conduit certaines puissances coloniales comme la France et la Grande-Bretagne, bientôt rejointes par l'Italie, à se saisir directement de la question de l'organisation des déplacements et du séjour de leurs sujets musulmans dans les Villes Saintes du Hedjaz. Pour la première fois dans l'histoire de l'Islam, le hajj a ainsi été supervisé par des puissances non-musulmanes. Si l'objectif affiché de l'intrusion européenne dans l'économie du hajj reste la protection sanitaire des pèlerins et partant du continent européen, il n'en cache pas moins des préoccupations plus politiques. L'enjeu est alors de rendre le hajj « gouvernable ». A cet égard, la Grande Guerre et l'annexion du Hedjaz par le gouvernement saoudien en 1925 constituent des étapes importantes en donnant aux puissances coloniales les moyens de construire de véritables « politiques du pèlerinage ». La décennie 1930 marque ainsi l'apogée de l'intrusion des puissances coloniales européennes dans l'organisation du pèlerinage à La Mecque qu'elles ont contribué à transformer en un instrument d'influence diplomatique et coloniale / While they intervened until then only marginally in the hajj affairs, the humanitarian disaster constituted by the epidemic of cholera of 1865-66 led colonial powers, such as France and Great Britain, soon joined by Italy, to deal directly with the question of the organization of the travels and the stay of their Moslem subjects in the Holy Cities of the Hijaz. For the first time in the history of Islam, the hajj was so overseen by not Moslem powers. If the official aim of european intervention remained the sanitary protection of the pilgrims - and, to a certain extent, the protection of the European continent - it hides not less more political concerns from it. Here the stake consists in making the hajj « governable ». In this respect, the Great War and the Hijjaz annexation by Saudi government in 1925 constitute important stages providing colonial powers the means to build of real « pilgrimage policies ». For the european colonial powers, the 1930's represent the peak of their intrusion in pilgrimage to Mecca organization they have contributed to turn into an instrument of diplomatic and colonial influence

La résistance aux antibiotiques chez les bactéries est un problème majeur mondial du fait de son augmentation. Récemment, la transmission des bactéries résistantes aux humains, aux animaux et à l’environnement sont de plus en plus décrits dans la littérature. Ces dernières années, les voyages internationaux ont augmenté massivement ce qui a permis aux bactéries résistantes de se propager d’un lieu à un autre. Les voyageurs internationaux sont les principaux acteurs de l’acquisition et de la propagation des gènes de résistance aux antibiotiques. Le plus grand rassemblement annuel de personnes comme le pèlerinage à la Mecque est connu pour être un réservoir pour la transmission des maladies infectieuses telles que la grippe, les épidémies méningococciques ou la tuberculose. Par conséquent, les voyageurs en particulier les pèlerins représentent une source importante de propagation de bactéries multi-résistantes. Les études sur la transmission et l'acquisition de gènes de résistance pendant le Hajj sont rares. Par conséquent, ce projet de thèse a trois objectifs principaux permettant de mieux comprendre la prévalence des gènes de résistance et des bactéries multi-résistantes au cours du Hajj:(i)l’étude de la surveillance épidémiologique des gènes de résistance chez les pèlerins avant et après le Hajj,(ii)l’étude des facteurs de risque d'acquisition de gènes de résistance aux antibiotiques chez les pèlerins,(iii)les études épidémiologiques moléculaires des bactéries résistantes chez les pèlerins et d'autres sources, tels que les patients, les animaux et l’environnement en utilisant des techniques comme le typage des séquences multi-locus et le séquençage du génome complet. / Antibiotic resistance in bacteria is increasing and become a worldwide problem. Newresistance bacteria or mechanisms are emerging and spreading rapidly. Recently, thetransmission of antibiotic-resistant (AR) bacteria among humans, animals, and the variousenvironments are vastly recognized. With the growth of international travels over the pastdecades, this provides opportunities for AR bacteria to be spread rapidly from one geographiclocation to another. During trips, travelers changed diets, lifestyles, and their environmentsresulting in the alteration of AR patterns of bacteria residing in the gut. Thus, internationaltravelers are one of the most important modes for the acquisition and spread of AR genes.The largest annual mass gathering, the Hajj (pilgrimage to Mecca) is well known as a sourcefor infectious diseases transmission such as influenza, meningococcal outbreaks ortuberculosis. Thus, travelers, especially pilgrims, are one of the most significant sources forspreading AR bacteria. However, studies of the transmission and acquisition of AR genesduring Hajj in pilgrims are scarce. Therefore, this research thesis was carried out with threemain objectives to better understanding the prevalence of AR genes and bacteria during Hajj:(i) epidemiological surveillance of AR genes in pilgrims before and after Hajj, (ii) risk factorsanalysis concerning AR genes acquisition in pilgrims, (iii) molecular epidemiological studiesof AR bacteria in pilgrims, including patients, animals, and environment with the use ofmulti-locus sequence typing and whole genome sequencing.

Hajj, the annual Muslim pilgrimage to Mecca, Saudi Arabia is a unique mass gathering event that attracts approximately 3 million pilgrims from around the globe. This diverse pilgrim population coupled with the nature of the performed activities raise major public health concerns in the host country with potential global implications. Although gastroenteritis and diarrhea are common among the pilgrims performing Hajj, the microbial etiologies of these infections are still unknown. We used molecular and antigenic approaches to identify the main pathogens associated with Hajj diarrhea. 544 fecal samples from pilgrims suffering from diarrhea whilst performing Hajj during three consecutive seasons (2011-2013) and 99 control samples from 2011 were screened for 16 pathogens that include bacterial, parasitic and viral etiologies that are commonly associated with diarrheal infections. At least one of the screened pathogens could be detected in 42% (n=228) of the samples from the diarrheal cases. Bacteria were the main agents detected in 83% (n=189) of the positive samples, followed by viral and parasitic agents detected in 6% (n=14) and 5% (n=12) respectively. We have also standardized a 16S-based metagenomic approach to identify the gut microbiome in diarrheal cases and non-diarrheal controls in 76 samples. Also, we have standardized a shotgun metagenomics protocol for the direct characterization (diagnosis) of enteric pathogens without cultivation. This approach was used successfully to identify viral (adenovirus) and bacterial causes of Enterotoxigenic E. coli diarrhea from Hajj samples. The findings in this study fill in clear gaps in our knowledge of the etiologies associated with diarrheal infections during Hajj. Foodborne bacteria were the major contributors to Hajj-diarrheal infections. This was coupled with the increased incidences of antimicrobial resistance loci associated with the identified bacteria. These findings would help the public health policy makers to develop and introduce appropriate public health measures to improve the food safety during Hajj.

Chaque année, deux à trois millions de musulmans de plus de 180 pays à travers le monde affluent vers l'Arabie Saoudite pour l'accomplissement du grand pèlerinage à la Mecque, appelé communément le "Hajj". Les virus, et particulièrement celui de la grippe, sont les causes les plus fréquentes d'infections respiratoires aiguës chez les pèlerins.Nous avons décidé de réaliser une étude bibliographique afin de rechercher des preuves de l'efficacité des mesures non pharmaceutiques de prévention des infections respiratoires pendant le Hajj. En résumé, bien que le lavage des mains soit fréquent parmi les pèlerins, le port du masque reste un défi majeur et la distanciation sociale, visant à réduire les contacts avec les personnes infectées, difficilement réalisable pendant le séjour en Arabie Saoudite. Les données sur l'efficacité de ces mesures non pharmaceutiques dans le contexte du Hajj sont limitées et les résultats sont contradictoires, soulignant la nécessité d'études supplémentaires.En 2012 et 2013, nous avons conduit une étude prospective afin d'évaluer sur la même cohorte de pèlerins la prévalence de virus et de bactéries pouvant être responsables d'infections respiratoires aiguës, avant le départ de France pour le Hajj et au retour d'Arabie Saoudite. Nous avons ainsi démontré l'acquisition par les pèlerins de virus respiratoires, principalement rhinovirus, coronavirus (non MERS-CoV) et les virus grippaux, pendant leur séjour en Arabie Saoudite. Aucun n'a été testé positif pour le MERS-CoV. Aussi, une proportion importante de pèlerins a été infectée par Streptococcus pneumoniae, alors que leur couverture vaccinale contre le pneumocoque est faible. / Annually, over two million Muslims from more than 180 countries gather in the Kingdom of Saudi Arabia to perform the pilgrimage to Mecca, also known as the "Hajj". Respiratory viruses, and especially influenza virus, are the most common cause of acute respiratory infection among pilgrims.We conducted a review to summarize the evidence related to the effectiveness of non-pharmaceutical interventions in preventing the spread of respiratory infectious diseases during the Hajj. Overall, although hand hygiene compliance is high among pilgrims, face mask use and social distancing remain difficult challenges. Data about the effectiveness of these measures at the Hajj are limited, and results are contradictory, highlighting the need for future large-scale studies.In 2012 and 2013, we conducted for the first time a prospective longitudinal study of pilgrims, to determine the prevalence of viruses and bacteria potentially responsible for acute respiratory symptoms, before departing from France for the Hajj and before leaving Saudi Arabia. We thus demonstrated the acquisition of respiratory viruses, most notably rhinovirus, coronaviruses (other than MERS-CoV), and influenza viruses, by pilgrims during their stay in Saudi Arabia. None of the pilgrims was positive for MERS-CoV. Also, while vaccination coverage against pneumococcal infection is low among pilgrims, many of them have acquired Streptococcus pneumoniae.

The Female Voices of Islam is arguing for feminism to be regarded as a theory instead of an ideology so that the voices of contemporary female Muslims can be heard. This paper reviews the arguments of four such women: Amina Wadud, Fatima Mernissi, Asra Q. Nomani, and finally Zainab al-Ghazali. Collectively their discourses support equality for men and women within the Islamic tradition, while their individual ways of approaching the subject differ dramatically. Wadud and Nomani support the theory that an egalitarian ethic can be found in the roots of the Islamic tradition, in both text and ritual. Mernissi investigates how economic evolution of Islamic society stimulates a shift in spatial boundaries for Muslim women. Al-Ghazali does not address female inequality within the tradition, but advocates an egalitarian ethic through the example she sets in Egyptian society. She is concerned with a world wide observance of “true” Islam.

Hajj is very important to all Muslims across the globe. Because of its religious significance, the Hajj pilgrimage experiences a massive number of visitors each year, most of whom are foreign and require consumer goods during the six-day pilgrimage. The large number of pilgrims often results in a sharp increase in demand for consumer goods. Suppliers must ensure that they have adequate amounts of these products so that they can meet the needs of the pilgrims as well as their different tastes for these goods. It is however usually difficult to determine exactly how much is required. This complexity creates demand uncertainty that the firms in the industry must be able to cope with for them to succeed. Small- and medium-sized enterprises (commonly referred to as SMEs) play an important role in the food chain throughout the Hajj season in the Kingdom of Saudi Arabia (KSA). However, SMEs are recognised to experience severe obstacles that have the potential to threaten their continuity, and the industry succumbs to the crisis of demand uncertainty throughout the short period of the peak season of Hajj each year. This problem is complex due to the constant increase in the number of pilgrims and the continuous changes in their needs and preferences. Demand uncertainty can ultimately result in an increase in production costs, long lead times, substandard service levels, and quality problems, especially in terms of food obsolescence. There is a gap in the literature regarding aligning sources of uncertainty with supply chain strategies in an effort to improve supply chain performance. More specifically, the impact of supply chain integration strategies (SCI) on manufacturing strategies, such as postponement practice (PP) and mass customisation capability (MCC) to mitigate demand uncertainty (DUM), has not been fully explored. This study investigates three fundamental issues: 1 - how effective supply chain integration (internal integration and external integration) can be applied in Saudi’s SMEs food industry, and how the interaction between them mutually manipulates the improvement of postponement practice and mass customisation capability in food productions in Hajj; 2 - how the volume of cooperation leads to the mitigation of demand uncertainty in maintaining the survival of small and medium enterprises that operate in food production in Hajj; and 3 - how the environmental condition (i.e. competitive intensity) moderates the influence of supply chain integration (SCI) on this interaction in Saudi’s food SMEs that operate in Hajj. iii Based on the extended resource-based view (ERBV) of the firm, the strategic resources and knowledge come not only from within the organisation’s boundaries, but also from outside. Thus, a firm’s overall strategic capability may be embedded in a wider network of inter-firm exchange relationship. Contingency theory furthermore argues that an organisation should align their practices, processes and strategies with their business environment. In consideration to the extant literature, a number of hypotheses were defined, demonstrating the correlation between supply chain integration, postponement practice, mass customisation capability and demand uncertainty mitigation. Subsequently, a conceptual framework was developed with the objective to verify the relationship amongst the constructs. Mixed methodologies were employed; qualitatively, with 12 CEOs working in different SMEs in the food industry across KSA were initially interviewed to validate the conceptual framework. Content and face validity was accomplished with a group of academics and experts. A pilot study was carried out on a sample of 50 subcontractors, Hajj campaigns, pilgrimage institutions and food suppliers. Consequently, an online survey was conducted amongst SMEs to test the hypotheses. As a result, 239 responses were received from the SMEs in the food sector in the KSA. Partial Least Square (PLS) was used for the analysis. The interviewees were identified through snowball sampling (Detailed in the next sections). Quantitative data were collected using the convenience sampling technique, given the non-availability of the sampling frame. Based upon the extended resource-based view (ERBV) of the firm, alongside contingency theory, the initial and final results of the pilot test and survey were seen to be steady with these theories, where supply chain integration was viewed not only as having a significant direct and indirect effect on the postponement practice and mass customisation capability by SMEs of food during Hajj, but also as playing a critical role throughout the employment of postponement practice as an important strategy, empowering mass customisation capability to mitigate demand uncertainty. Likewise, both results were seen to be consistent with contingency theory; that is, a firm should coordinate their supply chain integration activities, postponement practice and mass customisation capability to their business environment, particularly with high competitive intensity to enhance demand uncertainty mitigation. In order to achieve competitive intensity, organisations are mainly focused on emerging markets and expanding their product lines. In the event that organisations begin targeting similar set opportunities, they risk bringing upcompetitive intensity for themselves, which increases the cost of growth. The cost of business will be noticeable when considering marketing speed, media inflation, the rate of innovation and trade spend in marketing, all of which are indicators of completion intensity. Improvements in supply chain efficiency, optimising strategies in marketing and extracting the best of return on investments from promotions by organisations also indicates competition intensity. Costs, competition and the ability to differentiate are some of the main determining factors of competition. Importantly, these are all tied up within uncertainty mitigation. However, despite the fact that internal integration has a positive direct and indirect effect on the postponement practice, mass customisation capability is created by SMEs of food industry, in addition to its direct effect upon both supplier integration and customer integration. Customer integration has also been found to improve postponement practice as well as mass customisation capability in a direct fashion. Supplier integration has a significant impact on postponement practice; however, it seems not significantly associated positively with mass customisation capability. Moreover, postponement practice also has an effect in mitigating demand uncertainty, both directly and indirectly, through mass customisation capability. Finally, mass customisation capability similarly has been found to enhance demand uncertainty mitigation. Research indicates that the direct and indirect effects of all constructs increase when there is intense competition in Hajj.

Hajj, the annual Islamic pilgrimage to Makkah, Saudi Arabia, is a unique mass gathering event that brings more than 2 million individuals from around the world. Several public health considerations, such as the spread of infectious diseases, must be taken into account with this large temporary influx of people. Gastrointestinal diseases, such as diarrhea, are common at Hajj, yet little is known about the etiology. The human gut microbiome, collection of organisms residing within the intestinal tract, has been under intense study recently, since next generation DNA sequencing technologies allow for extensive surveying of genetic material found in complex biological samples, such as those containing many different organisms. Thus, using 16S rRNA and metagenomic shotgun sequencing, we have characterized the gut microbiome of over 612 pilgrims with and without diarrhea. Several metadata factors, such as hospitalization and different comorbidities, were found to have significant effects on the overall gut microbiome composition. Metagenomic shotgun sequencing efforts revealed the presence of antimicrobial resistance genes originating from disparate regions from around the world. This study provides a snapshot of information concerning the health status of the gut microbiome of Hajj pilgrims and provides more context to the investigation of how to best prepare for mass gathering events.

The Sultani Hajj Route between AlMadinah and Makkah is one of the most significant heritage properties in Saudi Arabia. However, it has not been identified or designated as a significant cultural route worthy of conservation. Hence, many significant historic elements and sites along the route are being lost or damaged. This thesis was written to use World Heritage Cultural Route criteria to identify the Sultani Hajj Route as a heritage resource worthy of conservation. The thesis reviews UNESCO guidelines and criteria for designating cultural routes on the World Heritage List (WHL), and then applies these guidelines to identify the Sultani Hajj Route for possible designation on the WHL. Based on interviews and field surveys, 77 significant historic properties associated with the Sultani Hajj Route are identified, and 12 of these heritage resources are described in detail. The goal of this thesis is to spark interest in conserving this universally valuable Saudi cultural route while acknowledging that many concerns still need to be addressed, including raising public awareness and increasing public participation in the conservation process.

Mass gatherings stress local and global health care systems as they bring together individuals from all over the world that have very different health conditions. We firstly provide an overview of the concepts and results of mathematical epidemiology and public health. Secondly, we present an introduction to the mathematical modelling of measles using deterministic and stochastic approaches for both single and multiple populations. Lastly, we develop a model for mass gatherings and present an application to measles during the Hajj by studying an SIR deterministic metapopulation model with residency and its stochastic analogue. The models incorporate real world country data and time dependent movement and transmission rates, accounting for realistic volume of international travel and seasonality of measles activity. Numerical results for the deterministic system are presented. We conclude with a discussion on further work.