Multicausal factors underlying post-hajj oxygen desaturation: a case-based analysis from two elderly pilgrims at the 2025 surabaya debarkation

  • Aridin Gustaf
  • Tias Pramesti Griana

Abstract

Oxygen desaturation is a significant clinical concern among Hajj pilgrims, particularly in older adults with comorbidities such as lower respiratory tract infections. Prolonged travel, exposure to extreme environmental conditions, and immune decline during pilgrimage substantially contribute to respiratory compromise. This report describes two elderly pilgrims who developed oxygen desaturation upon arrival at the Surabaya debarkation site in 2025. The first patient, an 88-year-old woman, presented with desaturation following the pilgrimage and was diagnosed with community-acquired pneumonia after hospitalization at King Abdul Aziz Hospital, Mecca. The second patient, a 75-year-old woman with no prior comorbidities, developed mild desaturation suspected to be due to bronchopneumonia following high-risk environmental exposure during the pilgrimage. Contributing factors included advanced age, prolonged air travel, exposure to extreme temperatures, post-hospital immobility, and dehydration. These cases highlight that post-Hajj desaturation is multifactorial and predominantly affects elderly pilgrims. Early identification, comprehensive pre-departure health screening, continuous monitoring during and after pilgrimage, and implementation of early detection systems at debarkation sites are essential to prevent severe complications and reduce morbidity among returning pilgrims.

References

Alandijany, T.A. (2024) “Respiratory viral infections during Hajj seasons,” Journal of Infection and Public Health, 17, pp. 42–48. Available at: https://doi.org/10.1016/j.jiph.2023.04.006.
Alfano, F. et al. (2024) “Respiratory Syncytial Virus Infection in Older Adults: An Update,” Drugs and Aging. Adis, pp. 487–505. Available at: https://doi.org/10.1007/s40266-024-01118-9.
Fastl, C. et al. (2024) “Heat vulnerability: health impacts of heat on older people in urban and rural areas in Europe,” Wiener Klinische Wochenschrift, 136(17–18), pp. 507–514. Available at: https://doi.org/10.1007/s00508-024-02419-0.
Fitrianti, A.D. et al. (2025) “RISK FACTORS FOR PNEUMONIA IN ELDERLY INDONESIAN HAJJ PILGRIMS (DATA ANALYSIS OF SISKOHATKES 2023) Faktor Risiko Pneumonia Pada Jemaah Haji Indonesia Usia Lanjut (Analisis Data Siskohatkes 2023),” Jurnal Berkala Epidemiologi, 13(1), pp. 40–48. Available at: https://doi.org/10.20473/jbe.v13i12025.40.
Geng, Z. et al. (2023) “Differential impact of heat and hypoxia on dynamic oxygen uptake and deoxyhemoglobin parameters during incremental exhaustive exercise,” Frontiers in Physiology, 14. Available at: https://doi.org/10.3389/fphys.2023.1247659.
Goyani, P., Christodoulou, R. and Vassiliou, E. (2024) “Immunosenescence: Aging and Immune System Decline,” Vaccines. Multidisciplinary Digital Publishing Institute (MDPI). Available at: https://doi.org/10.3390/vaccines12121314.
Lee, H. and Yoon, H.-Y. (2024) “Impact of ambient temperature on respiratory disease: a case-crossover study in Seoul,” Respiratory Research, 25(1), p. 73. Available at: https://doi.org/10.1186/s12931-024-02699-0.
Liu, Z. et al. (2023) “Immunosenescence: molecular mechanisms and diseases,” Signal Transduction and Targeted Therapy, 8(1), p. 200. Available at: https://doi.org/10.1038/s41392-023-01451-2.
Mahdi, H.A. et al. (2023) “Epidemiological Differences in Hajj-Acquired Airborne Infections in Pilgrims Arriving from Low and Middle-Income versus High-Income Countries: A Systematised Review,” Tropical Medicine and Infectious Disease. Multidisciplinary Digital Publishing Institute (MDPI). Available at: https://doi.org/10.3390/tropicalmed8080418.
Mahomed, O., Jaffer, M.N. and Parker, S. (2024) “Morbidity amongst South African Hajj pilgrims in 2023—a retrospective cohort study,” Scientific Reports, 14(1), p. 12622. Available at: https://doi.org/10.1038/s41598-024-62682-z.
Murdaca, G. et al. (2023) “Impact of Immunosenescence on Viral Infections with an Emphasis on COVID-19,” Frontiers in Bioscience - Landmark. IMR Press Limited. Available at: https://doi.org/10.31083/j.fbl2809225.
Narimani, S., Nouri, M. and Khoshmirsafa, M. (2025) “Public Health Risks and Intervention Strategies in Mass Religious Gatherings: A Systematic Review of Evidence from Arbaeen and
7
Hajj (2000 - 2024),” Mass Gather Med J., 1(2). Available at: https://doi.org/10.69107/mgmj-164454 (Accessed: November 12, 2025).
Ndlovu, N. and Chungag, B.N. (2024) “Impact of heat stress on cardiovascular health outcomes of older adults: A mini review,” Aging and Health Research, 4(2), p. 100189. Available at: https://doi.org/https://doi.org/10.1016/j.ahr.2024.100189.
Noviari, D. and Santi, A. (2025) “DINAMIKA EPIDEMIOLOGI: MENGUNGKAP INTERAKSI HOST, AGEN, DAN LINGKUNGAN DALAM MENGHADAPI ANCAMAN PENYAKIT GLOBAL,” EZRA SCIENCE BULLETIN, 3(1).
Périard, J.D., Eijsvogels, T.M.H. and Daanen, H.A.M. (2021) “Exercise under heat stress: thermoregulation, hydration, performance implications, and mitigation strategies,” Physiological Reviews, 101(4), pp. 1873–1979. Available at: https://doi.org/10.1152/physrev.00038.2020.
Putot, A. et al. (2025) “Comprehensive management of pneumonia in older patients,” European Journal of Internal Medicine. Elsevier B.V., pp. 14–24. Available at: https://doi.org/10.1016/j.ejim.2025.02.025.
Quiros-Roldan, E. et al. (2024) “The Impact of Immune System Aging on Infectious Diseases,” Microorganisms, 12(4). Available at: https://doi.org/10.3390/microorganisms12040775.
Tony Wolf, S. et al. (2023) “Heat stress vulnerability and critical environmental limits for older adults,” Communications Earth and Environment, 4(1). Available at: https://doi.org/10.1038/s43247-023-01159-9.
Wrona, M. V. et al. (2024) “The 3 I’s of immunity and aging: immunosenescence, inflammaging, and immune resilience,” Frontiers in Aging. Frontiers Media SA. Available at: https://doi.org/10.3389/fragi.2024.1490302.
Published
2026-01-02
How to Cite
GUSTAF, Aridin; GRIANA, Tias Pramesti. Multicausal factors underlying post-hajj oxygen desaturation: a case-based analysis from two elderly pilgrims at the 2025 surabaya debarkation. Proceeding Annual Symposium on Hajj and Umrah Medicine, [S.l.], v. 3, p. 7-13, jan. 2026. ISSN 2987-548X. Available at: <https://conferences.uin-malang.ac.id/index.php/anshar/article/view/3680>. Date accessed: 13 june 2026. doi: https://doi.org/10.18860/anshar.v3i0.3680.