Health Regulations - 2020/1441H-Hajj and Umrah Health Regulations

Health Regulations

2020/1441H-Hajj and Umrah Health Regulations

 Health Requirements and Recommendations for Travelers to Saudi Arabia for Hajj and Umrah

The Ministry of Health in the Kingdom of Saudi Arabia issued this document to address the health requirements and recommendations for visitors traveling to Saudi Arabia for the purposes of Umrah, Hajj, or seasonal works in Hajj and Umrah areas during the 1441H (2020G).

Required Vaccinations:

Meningococcal Meningitis:

All travelers, domestic or international, adults and children aged over 2 years arriving for Umrah, Hajj or for seasonal work in Hajj zones, are required to submit a valid vaccination certificate with a quadrivalent (ACYW) meningococcal vaccine administered not less than 10 days prior to the planned arrival to Hajj areas.
Vaccination with ONE of the following vaccines is acceptable:
Quadrivalent (ACYW) polysaccharide vaccine within the last 3 years.
Quadrivalent (ACYW) conjugate vaccine within the last 5 years.
Current scientific evidence suggests that conjugate vaccines are safe and effective for those above 55 years of age.
Health authorities at the pilgrims' country of origin should ensure vaccination within the required validity period and make sure that the type of vaccine is clearly showed in the vaccination certificate.
If the vaccine type is not indicated in the certificate, the certificate will be valid for 3 years.
Vaccination with Quadrivalent (ACYW) conjugate vaccine is also required for:

Residents of the two holy cities (Makkah and Medina).
Any person who might get in contact with pilgrims including personnel in healthcare settings and other authorities.

Poliomyelitis:

Travelers from countries infected with WPV1, cVDPV1 or cVDPV3, with potential risk of international spread, and vulnerable countries to re-infection (Appendix 1-Table 1) are required to submit a valid polio vaccination certificate with at least one of the following vaccines:

At least one dose of bivalent oral polio vaccine (bOPV) within the previous 12 months and administered at least 4 weeks prior to arrival or
At least one dose of inactivated polio vaccine (IPV) within the previous 12 months and administered at least 4 weeks prior to arrival.

Travelers from countries infected with cVDPV2 (Appendix 1-Table 2) are required to submit a valid polio vaccination certificate with at least one dose of IPV within the previous 12 months and administered at least 4 weeks prior to arrival.

Seasonal Influenza:

All domestic pilgrims and health workers in the Hajj and Umrah areas are required to receive the most recently available seasonal Influenza vaccine 10 days prior to their arrival to Hajj and Umrah areas.

Yellow Fever:

All travelers above nine months of age arriving from countries or areas at risk of yellow fever transmission (Appendix 2) must present a valid yellow fever vaccination certificate. The Yellow Fever vaccination certificate is valid for life starting 10 days after vaccination.

Recommended Vaccinations:

Seasonal Influenza:

Travelers arriving for Umrah, Hajj or for seasonal work in Hajj areas are recommended to get vaccinated against seasonal influenza.
Influenza vaccination is particularly important for pregnant women, children under 5 years, the elderly, individuals with chronic medical conditions (such as chronic cardiac, pulmonary, renal, metabolic, neurodevelopmental, liver or hematologic diseases) and individuals with immunosuppressive conditions (such as HIV/AIDS, receiving chemotherapy or steroids, or malignancy).
Countries are encouraged to secure adequate quantities of the most recent influenza vaccine recommended for use in their country to be administered to those intending to perform Hajj. For this year's Hajj, the southern hemisphere vaccine is expected to be available before Hajj and the Ministry of Health in the Kingdom of Saudi Arabia recommends all pilgrims from the southern hemisphere or from countries which use the southern hemisphere vaccine to receive this vaccine at least 10 days prior to commencing hajj.

Preventive measures by health authority at points of entry:

Meningococcal Meningitis: The Ministry of Health in the Kingdom of Saudi Arabia may opt to administer prophylactic antibiotics to some travelers arriving from countries with frequent epidemics of meningococcal meningitis, countries at risk for meningitis epidemics, and countries with outbreaks of non-vaccine groups of N. meningitides (Appendix 3) at the points of entry if deemed necessary.
Poliomyelitis: Travelers from states infected with WPV1, cVDPV1 or cVDPV3, with potential risk of international spread, and vulnerable states to re-infection (Appendix 1-Table 1) will also receive one dose of bOPV at the border points on entry to Saudi Arabia regardless of age and vaccination status.
Yellow Fever: Aircrafts, ships and other means of transportation arriving from countries affected by yellow fever (Appendix 2) are requested to submit a valid certificate indicating that disinsection was applied in accordance with methods recommended by WHO. They may be subjected to inspection 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).
Zika Virus Disease and Dengue Fever: Aircrafts, ships, and other means of transportation coming from countries affected with the Zika virus and/or dengue fever (Appendix 4) are requested to submit a valid certificate indicating that disinsection was applied in accordance with methods recommended by WHO.

Health Practices for Prevention of Conditions of Concern:

Food and Water-Borne Diseases:

Authorities in Saudi Arabia do not permit entry of food with arriving travelers for Hajj and Umrah except in properly canned or sealed containers.
Pilgrims are recommended to observe the following:

Wash hands before and after eating and after going to the toilet.
Thoroughly clean and wash fresh vegetables and fruit.
Cook food thoroughly and store at safe temperatures.
Keep raw and cooked food separated.

Heat-Related Conditions:

Pilgrims, especially older individuals, are recommended to avoid direct sun exposure while performing rituals and to drink sufficient amount of fluids. Countries are requested to provide education on health-related illness to their pilgrims prior to travel. Medications that can exacerbate dehydration (e.g. diuretics) or interfere with heat exchange may need adjustment by treating physicians.

Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) and Other Respiratory Infections:

Efforts to prevent MERS-CoV infections during mass gatherings such as Hajj and Umrah have been successful. However, other viral respiratory tract infections are common.
All arriving travelers for Umrah, Hajj or for seasonal work in Hajj zones are recommended to comply with following:

Wash hands with soap and water or a disinfectant, especially after coughing and sneezing, after using toilets, before handling and consuming food, and after touching animals.
Use disposable tissues when coughing or sneezing and dispose of used tissues in a wastebasket.
Wear regular face masks when in crowded places.
Avoid contact with those who appear ill and avoid sharing their personal belongings.
Avoid visits and contact with camels in farms, markets, or barns.
Avoid drinking unpasteurized milk or eating raw meat or animal products that have not been thoroughly cooked.

Zika Virus Disease and Dengue Fever:

Pilgrims are recommended to take necessary measures to avoid mosquito bites during the day and evening, which include wearing protective clothing (preferably light-colored) that covers as much of the body as possible; using physical barriers such as window screens and closed doors; and applying insect repellent (as per the label instructions on the product) to skin or clothing that contains DEET, IR3535 or Icaridin.

Responding to International Health Events:

In the case of a public health emergency of international concern, or in the case of any event subject to notification under the International Health Regulations (2005), the health authorities in Kingdom of Saudi Arabia will undertake all additional necessary measures in consultation with the WHO.

Hajj Medical Missions:

The Ministry of Health in the Kingdom of Saudi Arabia requires the medical missions accompanying the pilgrims to comply with the following technical requirements:

The mission should have at least 1 physician per 1,000 pilgrims accompanying the mission and at least 20% of the accompanying physicians in the medical mission should be public health physicians.
Medical missions should have a valid medical waste contract with a certified local company that covers the entire Hajj season.
Medical mission clinics should include at least one infectious diseases isolation room that meets Saudi Arabia Ministry of Health standards.
The medical mission shall commit to reporting notifiable infectious diseases to the Saudi Arabian Health System using approved reporting methods.

Physical Ability and Health Education:

Pilgrims and relevant officials in countries of origin are encouraged to consider the physical ability and health conditions of individuals applying for Hajj and Umrah. Those with severe medical conditions such as terminal cancers, advanced cardiac, respiratory, liver, or kidney diseases, and senility are exempt from these religious duties.
Health authorities in countries of origin are requested to provide basic health education to pilgrims prior to travel. This may include food safety, heat-exhaustion, and means of preventing infectious diseases.
Pilgrims are recommended to update their vaccination status against vaccine-preventable diseases. These include vaccination against Diphtheria, Tetanus, Pertussis, Polio, Measles, Varicella and Mumps.

Appendix 1:

Table 1: States infected with WPV1, cVDPV1 or cVDPV3, with potential risk of international spread, and vulnerable states to re-infection:

Africa	Asia
Nigeria	Afghanistan
Somalia	Myanmar
	Pakistan
	Papua New Guinea
	Yemen

Table 2: States infected with cVDPV2, with potential risk of international spread:

Africa	Asia
Democratic Republic of the Congo	Philippines
Mozambique
Niger
Nigeria
Somalia

Appendix 2:

Countries/areas at risk of Yellow Fever transmission, as per the WHO International Travel and Health guidelines, are:

Americas
Argentina
Bolivarian Republic of Venezuela
Bolivia
Brazil
Colombia
Ecuador
French Guiana
Guyana
Panama
Peru
Surinam
Trinidad and Tobago

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

Appendix 3:

Countries/areas with frequent epidemics of meningococcal meningitis and countries at risk for meningitis epidemics (WHO International Travel and Health, 2015):

Africa
Benin	Guinea-Bissau
Burkina Faso	Kenya
Burundi	Mali
Cameroon	Mauritania
Central African Republic	Niger
Chad	Nigeria
Côte d’Ivoire	Republic of South Sudan
Democratic Republic of the Congo	Rwanda
Eritrea	Senegal
Ethiopia	Sudan
Gambia	Tanzania
Ghana	Togo
Guinea	Uganda

Appendix 4:

Countries with current or previous Zika virus transmission:

Africa
Angola
Burkina Faso
Burundi
Cabo Verde
Cameroon
Central African Republic
Côte d’Ivoire
Ethiopia
Gabon
Guinea-Bissau
Nigeria
Senegal
Uganda

Asia
Bangladesh	Malaysia
India	Micronesia
Indonesia	New Caledonia
Maldives	Palau
Myanmar Papua	New Guinea
Thailand	Philippines
American Samoa	Samoa
Cambodia	Singapore
Cook Islands	Solomon Islands
Fiji	Tonga
French Polynesia	Vanuatu
Lao People’s Democratic Republic	Viet Nam
Marshall Islands

** Americas**
Grenada	Peru
Guadeloupe	Puerto Rico
Guatemala	Saint Barthélemy
Guyana	Saint Kitts and Nevis
Haiti	Saint Lucia
Honduras	Saint Martin
Chile	Saint Vincent and the Grenadines
Jamaica	Sint Maarten
Martinique	Suriname
Mexico	Trinidad and Tobago
Montserrat	Turks and Caicos
Nicaragua	United States of America
Panama	United States Virgin Islands
Paraguay	Venezuela