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Going To The Hajj?? Health Requirements and Recommendations Just Issued For All Hajj Pilgrims Going To The Largest Gathering In The World

September 8, 2012

The Hajj, the annual pilgrimage to Makkah (Mecca), Saudi Arabia — which all adult Muslims who are physically and financially able to do so are obliged to make once in their lifetime — takes place on different dates each year; the 2012 Hajj is expected to take place between 24 and 29 Oct 2012.  The Hajj is the largest gathering of its kind in the world. Each year, over 2 million Muslims from around the world gather in Makkah. Umrah is a shorter, non-compulsory pilgrimage for Muslims that can be performed at any time.

The Hajj is the largest gathering in the world and therefore a great location for disease transmission.

The National Travel Health Network and Centre (NaTHNaC) has issued its annual guidance detailing all the health requirements and recommendations that Hajj pilgrims need to consider before they leave for their trip   The guidance has been produced in conjunction with the UK Department of Health and is in line with that issued by the World Health Organization, and that on visa requirements and other recommendations set by the Saudi Arabia Ministry of Health.

Hajj and Umrah Requirements

Meningococcal Meningitis

All pilgrims aged 2 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 3 years and not less than 10 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. Therefore, vaccination is also advised for personal protection of all pilgrims, including those under the age of 2 years.

Chemoprophylaxis against meningococcal infection will be given to all arrivals from countries in the African meningitis belt to lower the meningitis carrier rate. The Ministry of Health (MOH) of Saudi Arabia regards these countries as: Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Cote d’Ivoire, Eritrea, Ethiopia, Gambia, Guinea, Guinea-Bissau, Mali, Niger, Nigeria, Senegal, and Sudan. It is assumed that this requirement also applies to arrivals from South Sudan.

Poliomyelitis

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 10 years ago, should receive a booster using the trivalent tetanus, diphtheria and polio vaccine.

In addition, the MOH of Saudi Arabia requires that all travellers arriving from Afghanistan, Angola, Chad, the Democratic Republic of the Congo, Nigeria and Pakistan, regardless of age and vaccination history, receive one dose of oral polio vaccine (OPV) at least 6 weeks prior to departure for Saudi Arabia. This requirement also applies to travellers from India, which is defined as a recently endemic country at high risk of importation of poliovirus [1]. 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 6 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: China, Central African Republic, Cote d’Ivoire, Kenya, Mali, Niger, Somalia and Yemen.

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).

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 immunizations including measles, mumps and rubella (MMR).

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

  • Seasonal influenza: The MOH of Saudi Arabia recommends that all pilgrims be vaccinated against seasonal influenza. 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.
  • A common viral respiratory infection (known as Hajj cough) has no vaccine but is experienced by many pilgrims at the Haji. It 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.

One of the rites of Hajj is for men to have their head shaved.

  • 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.  The Saudi authorities provide licensed barbers with a new blade to use for each pilgrim, however, unlicensed barbers may not conform to this standard.  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

Diarrhea illnesses are transmitted by the consumption of contaminated food or water. Dehydration can occur with diarrhea 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 diarrhea. 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 (500 mg twice daily for up to 3 days) in the absence of contraindications is generally the antibiotic of choice for adults.

Vector-borne Diseases

Malaria is not present in Medina or Makkah, but malaria is a risk in the southwestern, 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 practice insect bite avoidance measures that will reduce the risk of other vector-borne diseases, such as dengue fever.

1. National Travel Health Network and Centre. Advice for pilgrims for the Hajj and Umrah season of 1433 (2012). Health Information Sheet, updated September 2012. Available at: http://www.nathnac.org/pro/factsheets/Hajj_Umrah.htm

2. World Health Organization. Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj). Wkly Epidemiol Rec. 87: 277-80, 2012. Available at:

http://www.who.int/wer/2012/wer8730.pdf

3. Memish ZA. The Hajj: Communicable and non-communicable health hazards and current guidance for pilgrims. Eurosurveillance. 15(39); 30 September 2010. Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19671

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