Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj)
This publication is to inform visitors of the full requirements for entry into Saudi Arabia, as provided by the Saudi health authorities.
The Ministry of Health of Saudi Arabia has issued the following requirements and recommendations for entry visas for the Hajj and Umra seasons in 20171
I. Yellow fever
(A) In accordance with the International Health Regulations 2005,2 all travellers arriving from countries or areas at risk of yellow fever transmission (see list below) must present a valid yellow fever vaccination certificate. The validity of the yellow fever vaccination certificate extends for the life of the person vaccinated, beginning 10 days after the date of vaccination3.
In the absence of such a certificate, the individual will be placed under strict surveillance until the certificate become valid or until a period of not more than 6 days from the last date of potential exposure to infection have lapsed, 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 20174).
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, South Soudan, Sudan, Togo and Uganda.
Argentina, the 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 the International Health Regulations (2005), 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).
II. 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 135) vaccine against meningitis, proving the vaccine was administered no more than 3 years and no less than 10 days before arrival in Saudi Arabia5. 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 (ACYW135) vaccine and state clearly the type of the vaccine used on the vaccination card.
(B) Visitors from countries in the African meningitis belt
For visitors arriving from countries in the African meningitis belt: Benin, Burkina Faso, Cameroon, Chad, Central African Republic, Côte d’Ivoire, Eritrea, Ethiopia, Gambia, Guinea, Guinea-Bissau, Mali, Niger, Nigeria, Senegal, Sudan and South Sudan, the above stated requirements apply.
In addition, 1 tablet (500 mg) of ciprofloxacin chemoprophylaxis will be administered to adults (excluding pregnant women) and children over 12 years at port of entry to lower the rate of carriers.
(C) Interior pilgrims and the Hajj workers
Vaccination with quadrivalent (ACYW135) vaccine is required for the following:
- all citizens and residents of Medina and Mecca who have not been vaccinated during the past 3 years with a polysaccharide vaccine or 5 years with a conjugate vaccine;
- all citizens and residents undertaking the Hajj who have not been vaccinated in the past 3 years with a polysaccharide vaccine or 5 years with a conjugate vaccine;
- all Hajj workers including individual working at entry points or in direct contact with pilgrims who have not been vaccinated in the past 3 years with a polysaccharide vaccine or 5 years with a conjugate vaccine.
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 1 August 2017):
- States infected with Wild Polio Virus 1 or circulating Vaccine Derived Polio Virus with potential risk of international spread: Afghanistan, Nigeria and Pakistan;
- States no longer infected but remain vulnerable to reinfection: Cameroon, Central African Republic, Chad, Guinea, Laos People’s Democratic Republic, Madagascar, Myanmar, Niger, and Ukraine;
- States which remain vulnerable to Polio: Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Iraq, Kenya, Liberia, Sierra Leone, Somalia, South Sudan, 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.
As long as wild and vaccine-derived poliovirus continue to circulate anywhere, Saudi Arabia encourages pre-departure vaccination of all travellers from all polio-free countries.
IV. 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 2017, prior to arrival, 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 required for internal pilgrims, particularly those with pre-existing health conditions described above, as well as for all health-care workers in the Hajj premises.
V. Zika and Dengue
The Aedes aegypti mosquito has not been detected in the Hajj and Umra areas for many years, however this mosquito is present in surrounding cities. The Ministry of Health recommends travellers for Hajj and Umra to take insect bite avoidance measures during daytime and night time hours to reduce the risk of infection with Dengue and other mosquito borne diseases.
Zika virus has not been reported in Saudi Arabia. Travellers arriving from Zika epidemic and endemic countries are recommended to take insect bite avoidance measures during daytime and night time hours to reduce the risk of introduction of Zika virus to Saudi Arabia. Further advice is available at WHO website6.
The risk for most travellers is very low provided that simple precautions are taken. However, travelers coming from countries with ongoing outbreaks may be at risk and may develop symptoms after arrival to the Hajj premises.
International travellers should take protection measures against food- and water-borne diseases. These measures include: appropriate hygiene, such as hand-washing with soap; drinking only clean or bottled water, safe preparation and storage of food and safe disposal of human excreta.
In case of symptoms of diarrhoea and vomiting, the most important treatment is rehydration. Packets of oral rehydration salts are available from primary healthcare centers and hospitals.
VII. 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.
Intense heat has adverse effects on health. Hajj and Umra performers need to be reminded to avoid direct sun exposure, avoid the most densely crowded areas, avoid strenuous activity and rest frequently. When the option exists, performance of rituals at nonpeak hours is encouraged. Hajj and Umra performers are advised to drink enough fluid to be able to maintain usual urine production and that older travellers should take particular care to consume extra fluids in hot conditions. Also, consumption of salt-containing food and drink that helps to replenish the electrolytes should be recommended in case of heat exhaustion and after excessive sweating.
Countries are encouraged to consider the physical ability and health conditions of individuals applying for Hajj and Umra. Those with sever medical conditions like terminal cancers, advanced cardiac or respiratory, liver or kidney diseases and senility should be exempted from these religious duties.
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.
IX. International outbreaks response
The Saudi Ministry of Health recommends that people aged over 65years 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.
To prevent the spread of respiratory infectious disease, the Saudi Ministry of Health also advises all pilgrims to comply with common public health recommendations, such as:
- to wash hands with soap and water or disinfectant, especially after coughing and sneezing, after using toilets, before handling and consuming food, after touching animals;
- to use disposable tissues when coughing or sneezing and dispose of it in the waste basket;
- to avoid, as much as possible, hand contact with the eyes, nose and mouth;
- to wear masks, especially when in crowded places;
- to avoid direct contact with the persons who appear ill with cough, sneeze, expectoration, vomiting, diarrhoea and do not share their personal belongings;
- to maintain good personal hygiene;
- to avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas;
- to avoid contact with sick animals;
- to 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, 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.
For more information please contact
Dr. Abdullah M Assiri
Ministry of Health, Saudi Arabia
1 Requirements and recommendations from the Ministry of Health of Saudi Arabia
2 International Health Regulations (2005), Third Edition. Geneva, World Health Organization, 2016
3 Amendment to International Health Regulations (2005), Annex 7 (yellow fever).
4 International travel and health. Geneva, WHO, ITH 2017 updates
5 Both polysaccharide and conjugate vaccines are valid options: the first one confer a protection of at least three years and the latter at least five years.
6 See http://www.who.int/csr/disease/zika/en/