Hajj & Umrah Vaccinations
The Hajj is the largest annual pilgrimage in the world. It is the fifth pillar of Islam and it is obligatory for this pilgrimage to be carried out by every able bodied Muslim at least once in their lifetime if they can afford to do so.
The pilgrimage occurs from the 10th-15th day of the 12th month in the Islamic calendar (Dhu al-Hijjah). The Islamic calendar is eleven days shorter than the Gregorian calendar used in the western world. The Gregorian date of the Hajj is eleven days earlier from year to year.
The Umrah is a pilgrimage to Mecca that can be undertaken at any time of the year. Umrah is not considered as compulsory but it is highly recommended in Islam. There are two different types of Umrah.
Umrah can be combined with the Hajj (Umrat al-tammatu) or taken independently of the Hajj (al-Umrat al mufradah).
Saudi Arabia Hajj Regulations
The health requirements for pilgrimage to Mecca (Hajj and Umrah) are published by the Saudi Arabia Ministry of Health annually.
Saudi Arabia Ministry of Health Updated Advice Regarding MERS-CoV
Recent advice (15 July 2013) issued by the Saudi Arabia Ministry of Health recommends that elderly (above 65 years of age) and those with chronic diseases (e.g. heart disease, kidney disease, respiratory disease, diabetes), immune deficiency (congenital and acquired), malignancy and terminal illnesses, pregnant women and children (under 12 years) postpone the performance of the Hajj and Umrah for their own safety.
They also advise pilgrims to comply with health guidelines to curb the spread of respiratory infections, which can be summarized as follows:
- Wash hands with soap and water or disinfectant, especially after coughing and sneezing.
- Use disposable tissues when coughing or sneezing and dispose of them appropriately.
- Avoid hand contact with the eyes, nose and mouth.
- Avoid direct contact with those showing symptoms of respiratory or other infections.
- Wear masks, especially when in crowded places.
- Maintain good personal hygiene.
Hajj and Umrah Vaccination Requirements
Adults and children over the age of 2 years arriving for the purpose of Umrah or Hajj pilgrimage (or for seasonal work in the Hajj area) are required to produce a certificate of vaccination with quadrivalent (ACYW135) polysaccharide vaccine against meningitis which has been issued not more than 3 years and no less than 10 days prior to arrival in Saudi Arabia. Certificates are not normally required from other categories of visitors or expatriate workers.
- In the UK, visas will not be issued unless proof of vaccination, at least 10 days prior to the expected date of entry, is submitted with the visa application.
Requirements from Countries other than the UK
The Saudi Arabia Ministry of Health has other vaccination requirements for Hajj pilgrims entering from countries other than the UK:
Yellow Fever – All travellers arriving from countries known to be infected with Yellow Fever (as per WHO) must present a valid yellow fever vaccination certificate.
Poliomyelitis – All travellers arriving from countries that have polio virus circulating or from countries at high risk of re-importation of polio virus regardless of age and vaccination status, should receive one dose of oral polio vaccine.
Recommended Vaccines for Hajj and Umrah
All travellers should ensure that they are up-to-date with the recommended immunisations for life in the UK e.g. 5 doses of tetanus vaccine and five doses of polio vaccine. If it has been more than 10 years since the traveller’s last dose of polio vaccine a booster dose should be given. The pre travel consultation also provides a good opportunity to check a traveller’s history of measles and influenza immunisation.
The Saudi Ministry of Health recommends seasonal influenza vaccine for Hajj attendees before arrival, especially for those at increased risk e.g. the elderly, those with chronic chest or heart disease, diabetes or immunosuppression.
Measles and Rubella
Updating immunization against vaccine-preventable diseases in all travellers is strongly recommended. With the recent resurgence of measles and rubella cases, special attention is needed for both of these diseases to avoid widespread outbreaks during this year’s Hajj and Umrah. Check that travellers are immune, either by previous immunisation (2 doses or MMR) or natural measles infection.
- Other vaccine recommendations for Saudi Arabia are available on the country record.
Other Health Risks
Malaria risk is present throughout the year but mainly from September to January. The risk is found in the south western region except high altitude areas of Asir Province and the cities of Mecca, Medina, Jeddah and Taif.
- Hajj pilgrims, many travel between Mecca and Medina. The risk of malaria is low in both cities and antimalarial prophylaxis is not advised while in either city. However, the journey between them passes through an area of high risk for malaria. The journey takes 6 hours by road. If it is undertaken during the daytime, in an air conditioned vehicle from which mosquitoes can be excluded, the risk of malaria is very low and it is reasonable to practice bite avoidance only.
Note: Bite avoidance measures are important for the prevention of other mosquito-borne infections present in Saudi Arabia e.g. dengue fever.
Diarrhoeal disease is common during Hajj and all travellers are at risk, but the risk is greatest for those consuming food which has been contaminated during preparation or storage, unpasteurised dairy products, raw unpeeled fruit and vegetables or contaminated water. In practice, those travelling on low budgets are at greatest risk. Diarrhoeal disease may be more severe in young children, the elderly and those with underlying health problem who may become rapidly and dangerously dehydrated.
Climate Related Health Risks
Even during the winter months temperatures during the day in Saudi Arabia can reach 30°C. This can put pilgrims at risk of sunburn, sunstroke, heat exhaustion, heat stroke and dehydration. Hajj pilgrims may spend a lot of time walking and good quality footwear should be worn as the sand in the desert can get very hot and burn the feet; this is particularly important for those with diabetes. To ensure that shoes do not get lost when removed for prayer they should be kept in a small bag.
Ideally pilgrims should arrive in time to allow acclimatisation to the hot conditions before undertaking Hajj. Pilgrims should be advised to rest, maintain good hydration with safe liquids, seek shade where possible and use a sunscreen factor 15 or higher. In recent years the Saudi Ministry has endeavoured to provide shade in densely populated areas. Pilgrims can also create shade by using an umbrella. Some rituals can be performed in the evening to avoid high daytime temperatures; Saudi authorities have decreed that pilgrims can perform the Stoning of the Devil anytime between sunrise and sunset.
Note: In the winter months the temperature during the night can fall to a very low level and pilgrims should be prepared for this by having sufficient warm bedding and clothing with them.
Blood-borne Virus Transmission Associated with Shaving
At the end of Hajj, Muslim men shave their heads, and unclean blades can transmit blood-borne infections, such as hepatitis B, hepatitis C, and HIV. Licensed barbers are tested for these blood-borne pathogens and are required to use disposable, single-use blades. Unlicensed barbers continue to operate by the roadside, where they may use unsterile blades on multiple men. Male travellers should be advised to be shaved only at officially designated centres, which are clearly marked or carry their own razor for personal use.
Accidents and Injuries
In the unique setting of Hajj pilgrimage it is unsurprising that accidents and injuries occur. The Saudi government has made improvements to ensure the safety of pilgrims following the tragic Hajj stampede in 2006, when more than 365 pilgrims were killed and more than 289 were injured. Modifications have been made to buildings at Jamaraat and new bridges have been built.
As pilgrims may walk long distances through or close to dense traffic and busy roads, motor vehicle accidents are a potential hazard. Minor injuries to the feet are commonly associated with walking during Hajj and pilgrims with diabetes or poor circulation to the lower limbs must take particular care and wear appropriate footwear. All injuries to the feet of those with other health issues such as diabetes, should be assessed carefully by a healthcare professional.
It is strongly recommended that all pilgrims obtain comprehensive travel and medical insurance (including repatriation) before travel.
General Travel Advice
Hajj pilgrimage can be an arduous undertaking for even the fittest individual; some travellers may benefit from a general health check-up with their GP prior to departure e.g. the elderly, those with underlying health problems such as heart or lung conditions, diabetes, hypertension, malignancy or pregnancy.
All pilgrims should aim to be fit for Hajj and keeping active, improving mobility and exercising appropriately is recommended. Those with chronic conditions such as asthma, diabetes or epilepsy should aim to have their control at an optimum level prior to travel; this also applies to those on anticoagulant therapy with warfarin.
Pilgrims taking regular medication should review their prescription with their GP and ensure that they have sufficient medicines to cover the trip. A letter from the GP may be useful for immigration purposes and all medicines should be kept in their original packaging and carried in the hand luggage with a printed copy of the prescription.
Some female pilgrims may wish to delay menstruation if it is scheduled to occur during Hajj and this should be discussed well in advance with the GP who may prescribe hormonal therapy.
A personal medical/first aid kit is essential for all travellers. For pilgrims it should include dressings, plasters, small bandages, antiseptic lotion/cream, adhesive tape, sun burn lotion, scissors, safety pins, antihistamine cream, blister dressings, rehydration salts, analgesics for pain and an antidiarrhoeal agent such as loperamide. Some may include antibiotic cover for underlying health problems or treatment of travellers’ diarrhoea.
Resources and Information
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©Information courtesy of Fit for Travel – a public access website provided by the NHS (Scotland)