CDC Travel Notice: Hajj Health Requirements and Recommendations

Safety & Security Report

The following report was released by the Centers of Disease Control (CDC) on October 20:

In the News
Health Requirements and Recommendations for Travel to Saudi Arabia during the 2009 Hajj: Information for U.S. Travelers

Each year, millions of people travel to the Kingdom of Saudi Arabia to participate in the Hajj, a pilgrimage to the holy places of Islam. This year, the week of the Hajj begins on November 25.

If you are traveling to Saudi Arabia for the Hajj, you can expect large crowds at mass gatherings and places of worship and lodging. This overcrowding may lead to an increased risk of accidental injury and infectious diseases, such as meningococcal disease (meningitis), influenza (including 2009 H1N1 flu), and other diseases spread easily from person to person.

Vaccinations for pilgrims traveling from the United States to Saudi Arabia to perform Hajj   Required for entry: ·         Meningococcal vaccine (quadrivalent)   Recommended for travel: ·         Routine vaccinations (such as MMR, tetanus, diphtheria, pertussis) ·         Influenza vaccine (seasonal flu vaccine) ·         Influenza A (H1N1) 2009 monovalent vaccine (when available and traveler is at high risk for flu complications) ·         Polio ·         Hepatitis A ·         Hepatitis B ·         Typhoid

Vaccinations Required by Saudi Arabia

To protect the health and safety of pilgrims, Saudi Arabia has established the following health requirements for all visitors:

·         All pilgrims over 2 years old must get a vaccine to protect against meningococcal disease. This requirement means that you —

• Need to have had your vaccine no more than 3 years and no less than 10 days before you arrive in Saudi Arabia.
• Must show proof of meningococcal vaccination on a valid certificate of vaccination (International Certificate of Vaccination or Prophylaxis) before you can enter the cities of Mecca and Medina to perform the Hajj. If you do not have this proof of vaccination, you may be denied entry.
• Note for clinicians: This vaccine MUST be a quadrivalent (A/C/Y/W-135) meningococcal vaccine.
• All pilgrims will be screened for diseases that must be reported under the International Health Regulations, including dengue fever, meningococcal meningitis, and yellow fever. This year screening may include 2009 H1N1 flu.

CDC-Recommended Vaccinations

Quadrivalent (A/C/Y/W-135) Meningococcal Vaccine

In addition to the Saudi government requirement, CDC recommends quadrivalent meningococcal vaccine because of outbreaks of meningitis associated with the Hajj in 1987 and 2000. There are two types of quadrivalent meningococcal vaccine: meningococcal conjugate vaccine, which is recommended for people aged 2-55, and meningococcal polysaccharide vaccine, which is recommended for people over 55 but can be given to people aged 2-55.

Routine Vaccines

Before you leave for Saudi Arabia, make sure you are up to date on all routine vaccinations, which include polio, measles/mumps/rubella (MMR), tetanus, diphtheria, and pertussis. These vaccines are necessary to protect you from diseases that are still common in many parts of the world, even though they may rarely occur in the United States. For more information about routine vaccinations, see the vaccine recommendations in the Immunization Schedules for your age group and the age groups of any other people traveling with you.

If you are traveling with a child, his or her routine schedule for immunizations may need to change to meet pre-travel recommendations. Discuss your travel plans with your child’s doctor or a health-care provider who is familiar with advising parents of children who travel.

Influenza Vaccine

All travelers are urged to get a yearly flu vaccine to protect against seasonal influenza. Before you travel to Saudi Arabia to perform the Hajj, make sure you have been vaccinated against seasonal influenza at least 2 weeks before traveling. Learn more about the flu vaccine by reading Key Facts about Seasonal Flu Vaccine.

To limit the spread of 2009 H1N1 flu and to reduce the risk of flu exposure for people at increased risk of flu complications, Saudi Arabia recommends that pilgrims should be at least 12 years old and not over 65 years of age. Saudi Arabia also recommendations that pilgrims refrain from performing Umrah or the Hajj if they have chronic diseases such as heart, liver, or kidney diseases, complications of diabetes, obesity, or any other diseases or conditions that affect a person’s overall health and immunity. In addition, the Ministry of Health recommends that pilgrims should be vaccinated against the 2009 H1N1 flu vaccine when it becomes available.

Other Recommended Vaccines for Saudi Arabia

Travelers to Saudi Arabia should consider some additional vaccinations. Hepatitis A and typhoid fever are diseases you can get through contaminated food and water. In addition to practicing safe food and water habits, you can also get vaccinated against these two diseases.

The prevalence of Hepatitis B is high in the Middle East, including Saudi Arabia. Travelers to this region are recommended to receive this vaccine, if they have not already completed the series.

Other Recommendations for Travelers

Tips to reduce the chances of illness and injury?

• Prepare for your health before you leave. Learn how by visiting Your Survival Guide to Safe and Healthy Travel.
• Heat-related illness is a risk due to large crowds, high temperatures, and extensive walking. Children, the elderly, and those with certain health problems (such as cardiac disease) are at even higher risk. Learn more about temperature extremes to help prevent heat-related illness.
• Drink plenty of water to prevent dehydration.
  • Drink only beverages that have been bottled and sealed.
  •  Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
• Wash your hands often with soap and water, especially after coughing or sneezing. If soap and water are not available, use an alcohol-based hand rub,* when your hands are not visibly dirty.

* If soap and water are not available and you do not have an alcohol-based product while you are traveling, other hand sanitizers that do not contain alcohol may be useful.

• Avoid sharing sharp objects, such as razors, with others.
• Wear sunscreen (at least SPF15) to prevent sunburn, and wear sunglasses with UV protection to protect your eyes.
• Cover your head, when possible, to reduce heat exposure.
• If you are not feeling well during your trip, you should get medical attention. A U.S. consular officer can assist in locating medical services and notifying family or friends. For more information, see Know What To Do if You Become Sick or Injured on Your Trip.
• If you do not feel well after you return from your trip, you should get medical attention and mention that you have recently traveled.

What to do if you have symptoms of flu—

Symptoms of flu (including 2009 H1N1 flu) include: fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people may also have vomiting and diarrhea. People may be infected with the flu and have respiratory symptoms without a fever.

If you become sick with symptoms of flu before or during travel:

• It is expected that most people will recover without needing medical care.
• If you have severe illness or you are at high risk for flu complications, seek medical care.
• A U.S. consular officer can help you find local medical care in a foreign country. To contact the U.S. embassy or consulate in the country you are visiting, call Overseas Citizens Services at:
  • 1-888-407-4747 if calling from the U.S. or Canada,
  • 00-1-202-501-4444 if calling from other countries, or
  • Visit Websites of U.S. Embassies, Consulates, and Diplomatic Mission to find the contact information for the local U.S. Embassy of the country you are visiting.

• Avoid further travel for at least 24 hours after fever or fever-like symptoms are gone. Your fever should be gone without using a medicine that reduces fever.

·         Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

• Wash your hands often with soap and water, especially after coughing or sneezing. If soap and water are not available, use an alcohol-based hand rub,* when your hands are not visibly dirty.

*If soap and water are not available and you do not have an alcohol-based product while you are traveling, other hand sanitizers that do not contain alcohol may be useful.

·         Avoid touching your eyes, nose, or mouth.

·         Follow all local health recommendations. For example, if you are sick, you may be asked to put on a surgical mask to protect others or to stay in your home or hotel to prevent the spread of 2009 H1N1 flu.

·         For more information about what to do if you become sick while you are traveling outside the United States, visit Your Survival Guide for Safe and Healthy Travel.

Safety Tips

• Make a photocopy of your passport to carry with you at all times.
• Develop plans for where to meet if you become separated from your traveling companions.
• Register with the U.S. Department of State. This free registration service allows you to submit your contact information during your trip so that a consular officer can contact and assist you in an emergency. See the U.S. Department of State’s Travel Registration site for more information and to register.
• See the Tips for Traveling Abroad page on the U.S. Department of State website for more safety tips.

A Note to Travelers

The information in this document is intended for U.S. travelers. If you are not traveling directly from the United States to Saudi Arabia, the requirements may be different. For example:

People entering Saudi Arabia for the Hajj who are coming from countries/areas where there is a risk of yellow fever transmission must show proof of yellow fever vaccination. This requirement does not apply for travelers coming from the United States, since there is no risk of yellow fever transmission in the United States.

Pilgrims under 15 years of age who enter Saudi Arabia from polio-affected countries are required to receive the oral polio vaccine before applying for an entry visa. The Saudi government will also, regardless of vaccination history, give these travelers a dose of oral polio vaccine (OPV) when they arrive. While this requirement does not apply to pilgrims traveling from the United States, it is still a good idea to talk to your doctor and make sure that you have been fully vaccinated against polio. To learn more, see polio vaccination.

More Information

For general health information about travel to the Saudi Arabia, see the Health Information for Travelers to Saudi Arabia destination page.

For information about security while traveling, see the recent Travel Warning for Saudi Arabia from the U.S. Department of State.

For the official documentation of full requirements for entry into Saudi Arabia for the Hajj, see the Saudi Arabia Ministry of Health Regulations (May 25, 2009)