Health Requirements and Recommendations for Travellers to SaudiArabia for Hajj and Umrah9 June 2019Editorial noteThis publication is to inform international travellers of the requirements and recommendationsfor entry into Saudi Arabia for Hajj and Umrah, as provided by the Saudi health authorities. Itcan also be found on the website of the Ministry of Health of the Kingdom of Saudi ements.aspxThe Ministry of Health in the Kingdom of Saudi Arabia issued this document to address thehealth requirements and recommendations for visitors traveling to Saudi Arabia for the purposesof Umrah, Hajj, or seasonal works in Hajj and Umrah areas during the 1440H (2019G).Infectious Diseases of Importance during Hajj and UmrahYellow FeverThe Ministry of Health in the Kingdom of Saudi Arabia requires that all travellers arriving fromcountries or areas at risk of yellow fever transmission (see below) must present a valid yellowfever vaccination certificate. The Yellow Fever vaccination certificate is valid for life starting 10days after vaccination.Countries/areas at risk of Yellow Fever transmission, as per the WHO International Travel andHealth guidelines, are:African states: Angola, Benin, Burkina Faso, Burundi, Cameroon, the Central AfricanRepublic, Chad, Congo, Côte d’Ivoire, the Democratic Republic of the Congo, EquatorialGuinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali,Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Sudan, the Republic of South Sudan,Togo, and Uganda.South and Central American States: Argentina, the Bolivarian Republic of Venezuela,Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Paraguay, Peru, Bolivia,Surinam, and Trinidad and Tobago.Aircraft, ships and other means of transportation arriving from countries affected by yellow feverare 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 ofgranting free pratique (including permission to enter a port, to embark or disembark, and todischarge or load cargo or stores).Meningococcal meningitisAdults 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) meningococcalvaccine administered not less than 10 days prior to the planned arrival to Saudi Arabia.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 thoseabove 55 years of age.Health authorities at the pilgrim countries should ensure vaccinating their pilgrims within therequired validity period and make sure that the Type of vaccine is clearly showed in thevaccination 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: Domestic pilgrims.Residents of the two holy cities (Makkah and Medina).Any person who may get in contact with pilgrims including personnel in healthcaresettings and other authorities.The Ministry of Health in the Kingdom of Saudi Arabia may opt to administer prophylacticantibiotics to some travellers to at the points of entry if deemed necessary.PoliomyelitisTravellers from areas with active poliovirus transmission (i.e. those with active transmission of awild or vaccine-derived poliovirus) and from countries at risk of polio reintroduction (see WHOnote 1) are required to submit a valid polio vaccination certificate.Travellers arriving from Afghanistan, Democratic Republic of the Congo, Mozambique, Niger,Nigeria, Pakistan, Papua New Guinea, Syria, Myanmar, Yemen and Somalia should present proofof vaccination with at least one of the following vaccines: At least one dose of bivalent oral polio vaccine (OPV) within the previous 12 months andadministered at least 4 weeks prior to arrival orat least one dose of inactivated polio vaccine (IPV) within the previous 12 months andadministered at least 4 weeks prior to arrival.

Travellers arriving from Afghanistan, Nigeria, Pakistan, Papua New Guinea, Syria, Myanmar,Yemen and Somalia will also receive one dose of OPV at the border points on Entry in SaudiArabia.Seasonal InfluenzaThe Ministry of Health in the Kingdom of Saudi Arabia recommends that all Visitors arriving forUmrah, Hajj or for seasonal work in Hajj zones to get vaccinated against seasonal influenza.Influenza vaccination is particularly important for pregnant women, children under 5 years, theelderly, individuals with chronic medical conditions (such as chronic cardiac, pulmonary, renal,metabolic, neurodevelopmental, liver or hematologic diseases) and individuals withimmunosuppressive conditions (such as HIV/AIDS, receiving chemotherapy or steroids, ormalignancy).Countries are encouraged to secure adequate quantities of the most recent influenza vaccinerecommended for use in their country to be administered to those intending to perform Hajj. Forthis year's Hajj, the southern hemisphere vaccine is expected to be available before Hajj and theMinistry of Health in the Kingdom of Saudi Arabia recommends all pilgrims from the southernhemisphere or from countries which use the southern hemisphere vaccine to receive thisvaccine at least 10 days prior to commencing hajj.Ministry of Health in the Kingdom of Saudi Arabia requires all domestic pilgrims and healthworkers in the Hajj and Umrah areas to receive the most recently available seasonal Influenzavaccine 10 days prior to their arrival to Hajj and Umrah areas.Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) and other respiratory infectionsEfforts to prevent MERS-CoV infections during mass gatherings such as Hajj and Umrah havebeen implemented. However, other viral respiratory tract infections are common.The Ministry of Health in the Kingdom of Saudi Arabia recommends all arrivals for Umrah, Hajj orfor seasonal work in Hajj to comply with following: Wash hands with soap and water or a disinfectant, especially after coughing andsneezing, after using toilets, before handling and consuming food, and after touchinganimals. Use disposable tissues when coughing or sneezing and dispose of used tissues in awastebasket. Wear regular face masks when in crowded places. Avoid contact with those who appear ill and avoid sharing their personal belongings. Avoid visits to and contact with camels in farms, markets, or barns. Avoid drinking unpasteurized milk or eating raw meat or animal products that have notbeen thoroughly cooked.

Zika Virus Disease and Dengue FeverThe Ministry of Health in the Kingdom of Saudi Arabia requires that aircrafts, ships, and othermeans of transportation coming from countries affected with the Zika virus (see WHO note 2)and/or dengue fever (see WHO note 3) are requested to submit a valid certificate indicating thatdisinsection was applied in accordance with methods recommended by WHO.The Ministry of Health in the Kingdom of Saudi Arabia recommends pilgrims to take necessarymeasures to avoid mosquito bites during the day and evening, which includes wearing protectiveclothing (preferably light-colored) that covers as much of the body as possible; using physicalbarriers such as window screens and closed doors; and applying insect repellent (as per the labelinstructions on the product) to skin or clothing that contains DEET, IR3535 or icaridin.Food and Water-Borne DiseasesAuthorities in Saudi Arabia don’t permit entry of food with arrivals for Hajj and Umrah exceptthat in small quantities and in properly canned or sealed containers. The Ministry of Health in theKingdom of Saudi Arabia recommends all pilgrims to observe the following: Wash hands before and after eating and after going to the toilet.Thoroughly clean and wash fresh vegetables and fruit.Food should be cooked thoroughlyFood should be kept at safe temperaturesRaw and cooked food should be kept separatedHeat-Related ConditionsThe Ministry of Health in the Kingdom of Saudi Arabia recommends all pilgrims, especially olderindividuals, to avoid direct sun exposure while performing rituals and to drink sufficient amountof fluids. Countries are requested to provide education on health-related illness to their pilgrimsprior to travel. Medications that can exacerbate dehydration (e.g. diuretics) or interfere withheat exchange may need adjustment by treating physicians.Responding to International Health EventsIn the case of a public health emergency of international concern, or in the case of any eventsubject to notification under the International Health Regulations (2005), the health authoritiesin Kingdom of Saudi Arabia will undertake all additional necessary measures in consultation withthe WHO.Hajj Medical MissionsThe Ministry of Health in the Kingdom of Saudi Arabia requires the medical missionsaccompanying the pilgrims to comply with the following technical requirements: The mission should have at least 1 physician per 1,000 pilgrims accompanying themission and at least 20% of the accompanying physicians in the medical mission shouldbe public health physicians.

Medical missions should have a valid medical waste contract with a certified localcompany that covers the entire Hajj season.Medical mission clinics should include at least one infectious diseases isolation room thatmeets MoH standards.The medical mission shall commit to reporting notifiable infectious diseases to the SaudiArabian Health System using approved reporting methods.Physical Ability and Health EducationPilgrims and relevant officials in countries of origin are encouraged to consider the physicalability and health conditions of individuals applying for Hajj and Umrah. Those with severemedical conditions such as terminal cancers, advanced cardiac, respiratory, liver, or kidneydiseases, and senility are exempt from these religious duties.Health authorities in countries of origin are requested to provide basic health education topilgrims prior to travel. This may include food safety, heat-exhaustion, and means of preventinginfectious diseases.The Ministry of Health in the Kingdom of Saudi Arabia recommends all pilgrims to update theirimmunization status against vaccine-preventable diseases. These include vaccination againstDiphtheria, Tetanus, Pertussis, Polio, Measles, Varicella and Mumps.WHO notes1. WHO-determined areas with active poliovirus transmission (i.e. those with activetransmission of a wild or vaccine-derived poliovirus) and countries at risk of polioreintroduction can be found here: ublic-health-emergency-status/2. Countries that have ever had documented evidence of autochthonous, mosquito-borneZika virus (note: not all countries currently have evidence of ongoing transmission) Mapa. AFROi. Angola; Burkina Faso; Burundi; Cabo Verde; Cameroon; Central AfricanRepublic; Côte d’Ivoire; Ethiopia; Gabon; Guinea-Bissau; Nigeria; Senegal;Ugandab. AMRO/PAHOi. Anguilla; Antigua and Barbuda; Argentina; Aruba; Bahamas; Barbados;Belize; Bolivia (Plurinational State of); Bonaire, Sint Eustatius and Saba;Brazil; British Virgin Islands; Cayman Islands; Colombia; Costa Rica; Cuba;Curaçao; Dominica; Dominican Republic; Ecuador; El Salvador; FrenchGuiana; Grenada; Guadeloupe; Guatemala; Guyana; Haiti; Honduras; ISLADE PASCUA – Chile; Jamaica; Martinique; Mexico; Montserrat; Nicaragua;Panama; Paraguay; Peru; Puerto Rico; Saint Barthélemy; Saint Kitts andNevis; Saint Lucia; Saint Martin; Saint Vincent and the Grenadines; Sint

Maarten; Suriname; Trinidad and Tobago; Turks and Caicos; United Statesof America; United States Virgin Islands; Venezuela (Bolivarian Republic of)c. SEAROi. Bangladesh; India; Indonesia; Maldives; Myanmar; Thailandd. WPROi. American Samoa; Cambodia; Cook Islands; Fiji; French Polynesia; LaoPeople’s Democratic Republic; Marshall Islands; Malaysia; Micronesia(Federated States of); New Caledonia; Palau; Papua New Guinea;Philippines; Samoa; Singapore; Solomon Islands; Tonga; Vanuatu; VietNam3. The list of countries currently affected by increase in dengue cases:a. After a drop in the number of cases in 2017-18, sharp increase in dengue cases isbeing observed in 2019.In the Western Pacific region, increase in cases have beenobserved in Australia, Cambodia, China, Lao PDR, Malaysia, Philippines, Singapore,Vietnam while Den- 2 was reported in New Caledonia and Den-1 in FrenchPolynesia.b. In African region Dengue outbreaks have also been reported in Congo, Côted'Ivoire, Tanzania;c. In SEA region: Sri Lanka, India, Thailand, East Timor, Maldivesd. In EMR region dengue has increased in Algeria, Sudan, Yemen and Pakistane. Several countries of the American region have also observed an increase in thenumber of cases. Argentina, Bolivia, Venezuela, Brazil, Paraguay, Peru, Mexicoand Dominican Republic.