Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj) – 2015

1. Yellow fever

(A) In accordance with International Health Regulations 2005 [1],¹ all travellers arriving from countries or areas at risk of yellow fever (see list below) must present a valid yellow fever vaccination certificate showing that the person was vaccinated at least 10 days before arrival at the border.

In the absence of such a certificate, the individual will be placed under strict surveillance for 6 days from the date of vaccination or the last date of potential exposure to infection, whichever is earlier. Health offices at entry points will be responsible for notifying the appropriate Director General of Health Affairs in the region or governorate about the temporary place of residence of the visitor.

The following countries/areas are at risk of yellow fever transmission (as defined by the International travel and health update 2015 [2]²).

Africa

Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, The Republic of South Soudan, Sudan, Togo and Uganda.

Americas

Argentina, Bolivarian Republic of Venezuela, Brazil, Colombia, Ecuador, French Guyana, Guyana, Panama, Paraguay, Peru, Plurinational State of Bolivia, Suriname and Trinidad and Tobago.

(B) Aircrafts, ships and other means of transportation coming from countries affected by yellow fever are requested to submit a certificate indicating that it applied disinsection in accordance with methods recommended by WHO.

In accordance with International Health Regulations 2005 [1], all arriving ships will be requested to provide to the competent authority a valid Ship Sanitation Certificate. Ships arriving from areas at risk for yellow fever transmission may also be required to submit to inspection to ensure they are free of yellow fever vectors, or disinsected, as a condition of granting free pratique (including permission to enter a port, to embark or disembark and to discharge or load cargo or stores).

2. Meningococcal meningitis

(A) Visitors from all countries

Visitors arriving for the purpose of Umra or pilgrimage (Hajj) or for seasonal work are required to submit a certificate of vaccination with the quadrivalent (ACYW) vaccine against meningitis issued no more than 3 years and no less than 10 days before arrival in Saudi Arabia. The responsible authorities in the visitor’s country of origin should ensure that adults and children aged over 2 years are given 1 dose of the quadrivalent polysaccharide (ACYW) vaccine.

(B) For visitors arriving from countries in the African meningitis belt, namely Benin, Burkina Faso, Cameroon, Chad, Central African Republic, Côte d’Ivoire, Eritrea, Ethiopia, Gambia, Guinea, Guinea-Bissau, Mali, Niger, Nigeria, Senegal, Sudan and the Republic of South Sudan.

In addition to the above stated requirements, ciprofloxacin chemoprophylaxis will be administered at port of entry to lower the rate of carriers to adults and children over 12 years (one 500 mg tablet).

(C) Interior pilgrims and the Hajj workers

Vaccination with quadrivalent (ACYW) vaccine is required for:

• -all citizens and residents of Medina and Mecca who have not been vaccinated during the past 3 years;
• -all citizens and residents undertaking the Hajj;
• -all Hajj workers who have not been vaccinated in the past 3 years;-any individual working at entry points or in direct contact with pilgrims in Saudi Arabia.

3. Poliomyelitis

Regardless of age and vaccination status, proof of receipt of a dose of oral polio vaccine (OPV) or inactivated poliovirus vaccine (IPV), within the previous 12 months and at least 4 weeks prior to departure, is required to apply for an entry visa for Saudi Arabia for travellers arriving from the following countries, territories or areas (as of 16 May):

• (1)those which have never interrupted indigenous virus transmission: Afghanistan, Nigeria, Pakistan (as of 30 June 2015);
• (2)those which have had transmission of an imported wild poliovirus or a circulating vaccine-derived poliovirus within the past 12 months: Cameroon and Somalia;
• (3)those which remain vulnerable to polio: Equatorial Guinea, Ethiopia, Iraq, Palestine (the West Bank and Gaza Strip), Syrian Arab Republic and Yemen.

All travellers from these countries will also receive 1 dose of OPV at border points on arrival in Saudi Arabia. Saudi Arabia encourages vaccination of travelers from polio-free countries which remain at particular risk of importations (e.g. India, Indonesia).

4. Seasonal influenza

The Ministry of Health of Saudi Arabia recommends that international pilgrims be vaccinated against seasonal influenza with most recently available vaccines, i.e. those for Southern Hemisphere 2015, before arrival into the kingdom of Saudi Arabia, particularly those at increased risk of severe influenza diseases including pregnant women, children aged over 5 years, the elderly, and individuals with pre-existing health conditions such as asthma, chronic heart or lung diseases and HIV/AIDS infection.

In Saudi Arabia, seasonal influenza vaccination is recommended for internal pilgrims, particularly those with pre-existing health conditions described above, as well as for all health-care workers in the Hajj premises.

5. Health education

Health authorities in countries of origin are required to provide information to pilgrims on infectious diseases symptoms, methods of transmission, complications, and means of prevention.

6. Food

Hajj and Umra performers are not allowed to bring fresh food in Saudi Arabia. Only properly canned or sealed food or food stored in containers with easy access for inspection is allowed in small quantities, sufficient for one person for the duration of his or her trip.

7. International outbreaks response

The Saudi Ministry of Health recommends that people aged over 65 years and those with chronic diseases (e.g. heart disease, kidney disease, respiratory disease, diabetes) and pilgrims with immune deficiency (congenital and acquired), malignancy and terminal illnesses, pregnant women and children aged under 12 years planning to come for Hajj and Umra this year, to postpone the performance of the Hajj and Umra for their own safety.

The Saudi Ministry of Health also advises all pilgrims to comply with common public health recommendations to prevent the spread of respiratory infectious disease, such as:

• -wash hands with soap and water or disinfectant, especially after coughing and sneezing, after using toilets, before handling and consuming food, after touching animals;
• -use disposable tissues when coughing or sneezing and dispose of it in the waste basket;
• -try as much as possible to avoid hand contact with the eyes, nose and mouth;
• -wear masks, especially when in crowded places;
• -avoid direct contact with the persons who appear ill with cough, sneeze, expectoration, vomiting, diarrhoea and do not share their personal belongings – maintain good personal hygiene;
• -avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas;
• -avoid contact with sick animals;
• -avoid drinking raw camel milk or camel urine or eating meat that has not been properly cooked.

Updating immunization against vaccine-preventable diseases in all travellers is strongly recommended. Preparation for international travel provides opportunity to review the immunization status of travellers. Incompletely immunized travellers can be offered routine vaccinations recommended in national immunization schedules (these usually include diphtheria, tetanus, pertussis, polio, measles and mumps), in addition to those needed for the specific travel (e.g. meningococcal vaccination for Hajj).

In the event of a public health emergency of international health concern, or in the case of any disease outbreak subject to notification under the International Health Regulations 2005 [1], the health authorities in Saudi Arabia will undertake additional preventive precautions (not included in the measures mentioned above) following consultation with WHO and necessary to avoid the spread of infection during the pilgrimage or on return to their country of origin.