21 December 2005                                      Printable (pdf) version

 

Guidelines for Hajj Pilgrims

 

Hajj, the annual pilgrimage to Mecca, is the largest gathering of its kind in the world. Each year over two million Muslims from around the world gather in Mecca. The Hajj takes place between the eighth and thirteenth day of the last month of the Islamic calendar; the next Hajj will take place between the 8 and 12 January 2006 [1].

 

Vaccination advice

Meningococcal meningitis: All pilgrims to Hajj are required to show proof of vaccination against meningococcal meningitis ACW135Y. This vaccine should have been received not more than three years and not less than ten days before arrival in Saudi Arabia. Vaccination should be recorded in a vaccination book showing the traveller’s full name.

Meningococcal meningitis has occurred during previous Hajj pilgrimages, and cases in other countries have been associated with contact with returning pilgrims [2]. Hence, in addition to being a requirement to obtaining a visa, vaccination against meningococcal meningitis is advised for personal protection.

Chemoprophylaxis against meningococcal infection will also be given to arrivals from the African meningitis belt to lower the meningitis carrier rate among them [3]. The countries within the belt are: Benin, Burkina Faso, Cameroon, Chad, Central African Republic, Côte d’Ivoire, Eritrea, Ethiopia, Gambia, Guinea, Guinea-Bissau, Mali, Niger, Nigeria, Senegal and Sudan. Ciprofloxacin tablets (500mg) will be given to adults, rifampicin to children, and ceftriaxone injection to pregnant women.

Polio: All travellers to Saudi Arabia should 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, all travellers under the age of 15 years arriving from countries that have reported wild type polio virus will be required to show valid and up-to-date proof of vaccination in order to obtain entry visas [4]. These countries are currently Afghanistan, Angola, Burkina Faso, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Egypt, Eritrea, Ethiopia, Guinea, India, Indonesia, Mali, Niger, Nigeria, Pakistan, Somalia, Sudan and Yemen. Note that this list is subject to change.

Tetanus: A booster is recommended if not received within the last ten years. In the UK, when a tetanus booster is recommended, the trivalent tetanus, diphtheria and polio vaccine is the vaccine of choice.

Diphtheria: A booster is recommended if not received within the last ten years. In the UK, when a diphtheria booster is recommended, the trivalent tetanus, diphtheria and polio vaccine is the vaccine of choice.

Typhoid: Vaccination is recommended for all pilgrims to the Hajj.

Hepatitis A: Vaccination is recommended for all pilgrims to the Hajj.

Hepatitis B: Hepatitis B virus is found in body fluids and can be transmitted either percutaneously or by close sexual contact.

Percutaneous transmission may 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. Although the Saudi authorities provide licensed barbers who use a new blade for each pilgrim, other barbers may not conform to such standards. Therefore, shaving with a previously used blade could carry a risk of hepatitis B and other blood-borne infections.  Pilgrims can consider taking with them a disposable razor for this purpose.

Influenza: Influenza is transmitted via air-borne droplet infection. Certain groups are at particular risk of complications from influenza including those aged 65 years and over, and those with pre-existing medical conditions such as chest, heart or kidney conditions, a history of splenectomy, or diabetes. All travellers who fall into any of these categories should receive influenza vaccine annually. In addition, as influenza is readily transmitted in crowded conditions, pilgrims to the Hajj can consider vaccination against influenza.

Rabies: Those exposed to potentially rabid animals should seek urgent post-exposure prophylaxis vaccination.

Yellow fever: All travellers arriving from countries endemic for yellow fever must present a valid yellow fever vaccination certificate in accordance with the International Health Regulations [3]. These countries are listed by the World Health Organization in the Weekly Epidemiologic Record.

 

Food and water advice

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

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

In addition travellers should be advised to carry oral rehydration treatment and an anti-motility agent such as loperamide. Antibiotic treatment can be 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 drug of choice.

 

Vector-borne diseases

Malaria is not normally present in Medina or Mecca, but malaria is a risk in other areas of Saudi Arabia. Pilgrims may also plan further travel before or after Hajj to countries in Asia and Africa, and should seek advice about malaria prevention.

Pilgrims are advised to practice insect bite avoidance measures that also protects against other vector-borne diseases.

 

Other health risks

Heat-related hazards

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

If at all possible, travel to Mecca before the start of Hajj should be considered in order to allow a period of acclimatisation to the heat.

A high protection factor sunscreen should be applied regularly and liberally to exposed skin. Male pilgrims are not allowed to cover their heads; however an umbrella, preferably white in colour, will provide shade from the sun.

 

Desert sand can reach very high temperatures; good quality footwear should therefore 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. 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 often in hot weather. Pilgrims should ensure that they are physically fit before travelling.

 

Menstruation

Women who anticipate their periods falling during the Hajj period may wish to delay menstruation by using the contraceptive pill. Women are advised to discuss this with their GP or family planning clinic well before departure.

Medical kits

All pilgrims should take a basic medical kit with them, which should include simple analgesia, plasters, anti-motility medication such as loperamide, and oral rehydration treatment. Pilgrims who take regular medication should ensure they have an adequate supply and carry a copy of their prescription.

Insurance

All pilgrims to Hajj should ensure that they have adequate travel health insurance.

 

References

1. Shafi S, Memish ZA, Gatrad AR, Sheikh A. Hajj 2006: communicable disease and other health risks and current official guidance for pilgrims. Eurosurveillance 2005; 10. [cited 19 December 2005]. Available at: http://www.eurosurveillance.org/ew/2005/051215.asp#2  

2. World Health Organization. 2001 - Meningococcal disease, serogroup W135 - update. 16 May 2001 [cited 23 November 2005]. Available at: http://www.who.int/csr/don/2001_05_16/en/.

3. World Health Organization. Health conditions for travellers to Saudi Arabia pilgrimage to Mecca (Hajj). Wkly Epid Record. 2005: 80: 431. Available at: http://www.who.int/wer/2005/wer8049.pdf

4. NaTHNaC clinical update. Saudi Arabia - poliomyelitis vaccination requirements. 23 August 2005 [cited 23 August 2005]. Available at: http://www.NaTHNaC.org/pro/clinical_updates/polio_saudi.htm.

 

Links

Department of Health advice for travellers to Hajj or Umrah

Royal Embassy of Saudi Arabia London. http://www.ukemb.mofa.gov.sa

Royal Embassy of Saudi Arabia Washington DC. Hajj requirements.  http://www.saudiembassy.net/Travel/hajj.asp

The Muslim Council of Britain.

http://www.mcb.org.uk/