(RNS) Almost every pilgrim who makes the Hajj, Islam’s holy pilgrimage to Mecca, brings home an unwelcome souvenir: the common cold.

That, however, has never deterred tour operator Emad Elseidy, who has led Hajj pilgrimage groups for about 10 years. The 42-year-old Egyptian immigrant accepts — almost embraces — the possibility of getting sick during Hajj, but thinks fears about the H1N1 virus, or swine flu, are overblown.

“I’m expecting it. A basic cold, 80 percent of people get it. I call it the Mecca cough,” said Elseidy, owner of the Washington-based American Hajj Union Inc., who added that H1N1 fears didn’t keep him from selling out all of his 1,250 Hajj packages this year.

Not all Muslims, however, are taking H1N1 so casually.

Dunia Ramadan and her husband, Omar, never thought about postponing their Hajj, but they did get the H1N1 shot when they normally would not have.

“We weren’t too worried about getting (H1N1), but I didn’t want to get sick over there,” said Dunia Ramadan, 26, of Upland, Calif. “You may not be able to complete your Hajj.”

Some Hajj travel agents are reporting that many would-be pilgrims are postponing the sacred pilgrimage — which is required at least once of all Muslims who are physically and financially able to travel — because of flu concerns and tight finances.

“It’s the virus, and it’s the economy,” said Mohammed Abdulwaheed, president of Caravan Travel Inc., in Edison, N.J. “This is the worst year in my history.”

In recent years, Abdulwaheed has usually booked about 400 Hajj travel packages, which typically cost between $4,000 and $7,000. This year, he is taking fewer than 200 pilgrims. Those who are going, he added, have followed his recommendations to get a flu shot.

“We want everybody to come back healthy,” he said.

H1N1 has killed more than 6,500 people globally, and could be especially contagious in an environment like the Hajj, which draws more than 2 million Muslims who share sleeping quarters, bathrooms, plates, cups, and crowd into ritual sites for several days.

For the Saudi Arabian government, which as “custodian” of Mecca’s holy sites takes responsibility for pilgrims’ health and safety, the swine flu presents the latest in a long line of Hajj-related health and safety worries.

“The Hajj is always a concern,” said Nail Al-Jubeir, a spokesman for the Saudi Arabian embassy in Washington. “When you have that many people, it’s a problem. You’re creating an incubator.”

Hundreds of people die every year during Hajj from disease, heart attacks or even crowd stampedes. Respiratory diseases such as pneumonia and flu are most often the causes of Hajj hospital admissions, according to a 2006 study by Saudi physicians published in the Lancet medical journal.

Doctors in Marseille, France, which has a significant Muslim population, reported in a letter published this month by the Centers for Disease Control and Prevention that 60 percent of the city’s returning pilgrims in 2006 came back with some kind of respiratory problem. Other common dangers include tuberculosis, diarrhea, and hepatitis B and C. Meningitis killed more than 100 pilgrims during outbreaks in 2000 and 2001.

The Saudis, who pride themselves on a top-tier medical system built with oil wealth, prepare in multiple ways. In recent years, they have deployed about 10,000 physicians, nurses and other medical workers in stations set up along the Hajj circuit. Airports have thermal sensors to detect passengers with high fevers. Saudi Arabia now requires all pilgrims to have certificates of vaccination against meningitis; pilgrims from certain countries need vaccinations against yellow fever.

In September, the Saudis announced they will require an oral polio vaccine on arrival to guard against viruses carried by pilgrims from Afghanistan, Pakistan, India and Nigeria. Saudis have also urged — but not mandated — seniors and children to stay home this year. Many elderly pilgrims, however, especially from Muslim countries where Hajj waiting lists can stretch for decades, disregard health concerns.

“They’ve been looking forward to this trip for a long time, and they may not have a chance next year,” said Al-Jubeir.

No matter how well the Saudis prepare for an outbreak, experts say the most important precautions will have to be undertaken by pilgrims themselves.

For years, medical professionals have urged pilgrims to exercise and get fit ahead of the trip, and to bring face masks, hand sanitizer, cold medicine, and vitamins. In 2002, the World Muslim League in Mecca issued a fatwa allowing the use of alcohol-based hand sanitizers even though alcohol is forbidden in Islam.

“There are many people who don’t follow these recommendations, because of their lack of education or lack of sophistication,” said Joan Pitcher, the chief operating officer at the Penn State Hershey Cancer Institute in Pennsylvania, and a Muslim convert. With a shortage of H1N1 vaccine, she has advised pilgrims to get shots for both the seasonal flu and bacterial pneumonia.

“You have to count on pilgrims to do these things to protect themselves,” she said.