Editor,—Annually, some two and a half million pilgrims congregate in the city of Mecca in Saudi Arabia to perform the Hajj (pilgrimage), a religious duty for all adult Muslims who are physically and financially able. Because of the very large numbers of peoples from disparate regions, and the hostile climate of the Arabian Desert, the chances of disease are high. Heat exhaustion, sunstroke, and infectious diseases such as pneumonia and meningitis have traditionally caused the greatest disease burden.1

One of the rites of the Hajj is for males to shave their heads, although trimming the hair is also acceptable. Most will choose the former, often in makeshift centres run by opportunistic barbers. A razor blade is commonly used, and may be used on several scalps before ultimately being discarded. The risks of blood borne infections such as HIV and hepatitis B and C are obvious, especially considering that many pilgrims come from regions of the world where such infections are endemic.2 Pilgrims should be aware of the potential dangers and be educated to insist on the use of a new blade. We would also strongly recommend that they be vaccinated against hepatitis B.