NaTHNaC | Hajj_Umrah, Health Professionals

Health Information Sheets

Updated August 2011

Advice for Pilgrims for the Hajj and Umrah Season of 1432 (2011)

Hajj, the annual pilgrimage to Makkah (Mecca), is the largest gathering of its kind in the world. Each year over two million Muslims from around the world gather in Makkah. The Hajj pilgrimage occurs from the 8th and 12th day of the twelfth month of the Islamic calendar, and is estimated to fall between 4 and 9 November 2011.

Umrah is a shorter, non-compulsory pilgrimage for Muslims that can be performed at any time.

Hajj and Umrah Requirements

Meningococcal meningitis: All pilgrims aged two years and older are required to show proof of vaccination against meningococcal meningitis ACW135Y for the purposes of Hajj or Umrah [1]. Vaccination is also a requirement for obtaining a visa.

This vaccine should have been received not more than three years and not less than ten days before arrival in Saudi Arabia, and should be recorded in a vaccination book showing the traveller’s full name. If a traveller is in possession of an International Certificate of Vaccination or Prophylaxis (ICVP) booklet, meningococcal meningitis vaccine can be recorded in the ‘Other Vaccinations’ pages.

Meningococcal meningitis has occurred during previous Hajj pilgrimages and has spread to other countries in association with returning pilgrims [2]. Therefore, vaccination is also advised for personal protection of all pilgrims, including those under the age of two years.

The conjugated ACWY (Menveo®) vaccine is the preferred vaccine for all travellers [3]. Children aged two months to one year should receive two doses of Menveo® with an interval of one month. Full details of vaccines and schedules can be found in the meningococcal chapter of Immunisation against infectious diseases (the ‘Green Book’) [3].

Chemoprophylaxis against meningococcal infection will be given to all arrivals from countries in the African meningitis belt to lower the meningitis carrier rate [1,4]. The Ministry of Health of Saudi Arabia regards these countries as: Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Eritrea, Ethiopia, Gambia, Guinea, Guinea-Bissau, Mali, Niger, Nigeria, Senegal, South Sudan and Sudan.

Polio: All pilgrims to Hajj and Umrah are recommended to ensure their polio vaccination is up-to-date. Travellers whose last dose of polio was more than ten years ago, should receive a booster, using the trivalent tetanus, diphtheria and polio vaccine.

In addition, the Ministry of Health (MoH) of Saudi Arabia requires that all travellers arriving from Afghanistan, Angola, Chad, the Democratic Republic of the Congo, India, Nigeria, Pakistan, South Sudan and Sudan, regardless of age and vaccination history, receive one dose of oral polio vaccine (OPV) at least six weeks prior to departure for Saudi Arabia [1,4]. All such travellers will be required to receive a further dose of OPV upon their arrival in Saudi Arabia. They will need to carry proof of vaccination.

The MoH of Saudi Arabia also requires that all travellers aged less than 15 years from countries with imported cases of polio in the last 12 months, show proof of vaccination with OPV at least six weeks prior to visa application. Irrespective of vaccination history, these travellers will be required to receive a further dose of OPV on arrival in Saudi Arabia. The MoH considers the following countries to have imported cases: Burkina Faso, Congo, Côte d’Ivoire, Gabon, Guinea, Kenya, Kazakhstan, Liberia, Mali, Mauritania, Nepal, Niger, Russian Federation, Senegal, Sierra Leone, Somalia, Tajikistan, Turkmenistan and Uganda.

Yellow fever: All pilgrims to Hajj and Umrah arriving from countries or areas at risk for transmission of yellow fever must present a valid ICVP documenting yellow fever vaccination completed in accordance with International Health Regulations (2005) [5]. These countries are listed by the WHO in International Travel and Health, Annex 1 [6].

Hajj and Umrah Recommendations

Vaccination advice

General vaccination advice for travellers to Saudi Arabia can be found on the NaTHNaC Country Information Page. All pilgrims should ensure that they are up-to-date with routine immunisations including measles, mumps and rubella (MMR).

The following vaccine-preventable diseases have particular relevance to Hajj and Umrah pilgrims.

Seasonal influenza: The Ministry of Health of Saudi Arabia recommends that all pilgrims are vaccinated against seasonal influenza [1].

Influenza is transmitted via the respiratory route and is easily transmitted in crowded conditions. Certain groups are at particular risk of complications from influenza including those aged 65 years and older, pregnant women and those with pre-existing medical conditions such as chest, heart, liver or kidney conditions, a history of splenectomy, or diabetes [7]. Travellers who fall into any of these categories should receive influenza vaccine annually from their usual healthcare provider. For those who do not fall into any of these categories, vaccine can be purchased and administered at some high street chemists, other retailers or private travel clinics.

Viral respiratory infection (known as Hajj cough) experienced by many pilgrims at the Hajj, can range from a mild inconvenience to a severe illness, and can interfere with performing the rites. Simple precautions such as use of tissue to cover coughs and sneezes, safe disposal of the tissue, and hand washing will help reduce the spread of respiratory infection.

Advice about the prevention of influenza can be found on the NaTHNaC Health Information Sheet on seasonal influenza.

Hepatitis B: Hepatitis B virus is found in body fluids and can be transmitted either percutaneously or by sexual contact. Percutaneous transmission can occur through the use of contaminated medical, dental, or other instruments; all pilgrims should consider hepatitis B vaccine.

One of the rites of Hajj is for men to have their head shaved. The Saudi authorities provide licensed barbers with a new blade to use for each pilgrim, however, unlicensed barbers may not conform to this standard [8]. Pilgrims should avoid shaving with a blade previously used by another, as this could result in transmission of hepatitis B and other blood borne infections such as hepatitis C, for which there is no vaccine. Pilgrims can consider taking with them a disposable razor for personal use during this rite.

Food and water advice

Diarrhoeal illnesses are transmitted by the consumption of contaminated food or water. Dehydration can occur with diarrhoea and is of particular risk in hot weather. Babies, infants, the elderly and those with chronic medical conditions are more vulnerable to dehydration.

All pilgrims to Hajj and Umrah are advised to take food and water hygiene precautions.

Travellers should also take with them oral rehydration therapy and self-treatment for diarrhoea. An anti-motility agent such as loperamide can be carried and an antibiotic considered, especially for those travellers who have an underlying medical condition. Ciprofloxacin (500mg twice daily for up to three days) in the absence of contraindications is generally the antibiotic of choice.

Vector-borne diseases

Malaria is not present in Medina or Makkah, but malaria is a risk in the south-western, rural region of Saudi Arabia. Pilgrims planning further travel before or after Hajj or Umrah to malaria risk areas in Saudi Arabia or Asia, Africa and Latin America, should seek advice about malaria prevention.

Pilgrims are advised to practise insect bite avoidance measures that will reduce the risk of other vector-borne diseases, such as dengue fever.

Heat and sun-related hazards

Daytime temperatures in Saudi Arabia, even during the winter months, can reach over 30°C. Associated risks include sunburn, dehydration, heat exhaustion, and heat stroke.

If possible, travel before the start of Hajj should be considered in order to allow a period of acclimatisation to the heat. Pilgrims should ensure that they drink plenty of clean water (preferably bottled or boiled and cooled) to avoid dehydration.

Sunscreen with a sun protection factor of at least 15 to 30 should be applied liberally to exposed skin every two to three hours. Male pilgrims are not allowed to cover their heads; however an umbrella will provide shade from the sun.

Desert sand can reach very high temperatures; good quality footwear should be worn to avoid burning the feet. Footwear must be removed during times of prayer, and to avoid losing them, pilgrims are advised to carry their footwear in a bag.

Accidents and injuries

Minor injuries are relatively common, particularly to the feet. More serious injuries can occur as a result of stampedes as pilgrims undertake the stoning rite or other mass activities. Pilgrims are advised to avoid peak times, while elderly and infirm persons may wish to consider appointing a proxy for the performance of this rite.

Other Health Advice

Physical fitness: Performing the rituals of Hajj is demanding and involves walking great distances usually in hot weather. Pilgrims should ensure that they are physically fit before travelling.

Cold: During the winter months the weather can be very cold overnight. Pilgrims should ensure they take appropriate bedding with them such as blankets and sleeping bags.

Menstruation: Women who anticipate their periods occurring during the Hajj may wish to delay menstruation, which is possible to achieve using hormonal treatment. Women should discuss this with their GP or family planning clinic well before departure.

Medical kits: All pilgrims should take a basic medical kit that includes simple analgesia (pain killers), plasters, and oral rehydration treatment. An anti-motility agent (such as loperamide) can be carried to treat the symptoms of diarrhoea. Pilgrims who take regular medication should ensure they have an adequate supply and carry a copy of their prescription.

Insurance: All pilgrims to Hajj and Umrah should have adequate travel health insurance.

Pilgrims should carry with them their GP's details which may be required should emergency medical care be necessary.

Further information on health risks for travellers to Saudi Arabia can be found on the NaTHNaC Saudi Arabia Country Information Page.

Pilgrims should also seek advice about the health risks for any travel that may be undertaken either before or following Hajj or Umrah. Information on health risks for other destinations throughout the world can be found on the NaTHNaC Country Information Pages.

References

1. Memish ZA. Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj) 1432/2011). J Infect Pub Hlth. 4;105-7, 2011

2. World Health Organization. 2001 – Meningococcal disease, serogroup W135 – update. 16 May 2001 [Accessed 25 August 2011]. Available at: http://www.who.int/csr/don/2001_05_16/en/.

3. Meningococcal Ch 22. In: Salisbury D, Ramsay M, Noakes K (eds). Immunisation against infectious disease. 2006 updated March 2011. Department of Health, London. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalasset

s/@dh/@en/documents/digitalasset/dh_125942.pdf

4. Memish ZA. Personal communication. 1 September 2011.

5. World Health Organization. International Health Regulations (2005). [Accessed 26 August 2011]. Available at: http://www.who.int/csr/ihr/en/

6. World Health Organization. International and travel health. 2011; World Health Organization, Geneva. Available at: http://www.who.int/ith/chapters/en/index.html

7. Influenza. Chapter 19. In: Salisbury D, Ramsay M, Noakes K (eds). Immunisation against infectious disease. 2006 updated July 2011 . Department of Health, London. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalasse

ts/@dh/@en/documents/digitalasset/dh_128829.pdf

8. Memish ZA. The Hajj: Communicable and non-communicable health hazards and current guidance for pilgrims. Eurosurveillance. 15(39); 30 September 2010. [Accessed 26 August 2011]. Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=

19671