Hajj Health – Get Ready for a healthier journey

UPDATE: Repositioning this post due to upcoming Hajj journey; please check to make sure you have all that is necessary for your trip.

Recently American Bedu  started a discussion on Hajj/Umrah and families that take their young children and infants on these difficult journeys. In some cases it is out of sheer necessity, in others its a family affair. But in all cases we must be aware of our health and those we chose to journey with.

In an effort to do something on a personal note to make at least one Hajji safer health-wise on their journey into Saudi Arabia, I will post below the known health assessment and screening/vaccination requirements by the CDC and Saudi Arabia for travellers intending to enter Saudi Arabia for Hajj or Umrah. The Poll is a good way of letting me know the word has gotten around and that you are on track for your journey.

According to the CDC–

Before visiting Saudi Arabia, you may need to get the following vaccinations and medications for vaccine-preventable diseases and other diseases you might be at risk for at your destination: (Note: Your doctor or health-care provider will determine what you will need, depending on factors such as your health and immunization history, areas of the country you will be visiting, and planned activities.)

To have the most benefit, see a health-care provider at least 4–6 weeks before your trip to allow time for your vaccines to take effect and to start taking medicine to prevent malaria, if you need it.

Even if you have less than 4 weeks before you leave, you should still see a health-care provider for needed vaccines, anti-malaria drugs and other medications and information about how to protect yourself from illness and injury while traveling.

CDC recommends that you see a health-care provider who specializes in Travel Medicine.  Find a travel medicine clinic near you. If you have a medical condition, you should also share your travel plans with any doctors you are currently seeing for other medical reasons.

If your travel plans will take you to more than one country during a single trip, be sure to let your health-care provider know so that you can receive the appropriate vaccinations and information for all of your destinations. Long-term travelers, such as those who plan to work or study abroad, may also need additional vaccinations as required by their employer or school.

Although yellow fever is not a disease risk in Saudi Arabia, the government requires travelers arriving from countries where yellow fever is present to present proof of yellow fever vaccination. If you will be traveling to one of these countries where yellow fever is present before arriving in Saudi Arabia, this requirement must be taken into consideration.

Be sure your routine vaccinations are up-to-date. Check the links below to see which vaccinations adults and children should get.

Routine vaccines, as they are often called, such as for influenza, chickenpox (or varicella), polio, measles/mumps/rubella (MMR), and diphtheria/pertussis/tetanus (DPT) are given at all stages of life; see the childhood and adolescent immunization schedule and routine adult immunization schedule.

Routine vaccines are recommended even if you do not travel. Although childhood diseases, such as measles, rarely occur in the United States, they are still common in many parts of the world. A traveler who is not vaccinated would be at risk for infection.

Vaccination or Disease	Recommendations or Requirements for Vaccine-Preventable Diseases
Routine	Recommended if you are not up-to-date with routine shots such as, measles/mumps/rubella (MMR) vaccine, diphtheria/pertussis/tetanus (DPT) vaccine, poliovirus vaccine, etc.
Hepatitis A or immune globulin (IG)	Recommended for all unvaccinated people traveling to or working in countries with an intermediate or high level of hepatitis A virus infection (see map) where exposure might occur through food or water. Cases of travel-related hepatitis A can also occur in travelers to developing countries with “standard” tourist itineraries, accommodations, and food consumption behaviors.
Hepatitis B	Recommended for all unvaccinated persons traveling to or working in countries with intermediate to high levels of endemic HBV transmission (see map), especially those who might be exposed to blood or body fluids, have sexual contact with the local population, or be exposed through medical treatment (e.g., for an accident).
Typhoid	Recommended for all unvaccinated people traveling to or working in the Middle East, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water.
Meningococcal (meningitis)	Required for the Hajj: All infants, children, and adult pilgrims are required to provide proof of vaccination with a quadrivalent (A/C/Y/W-135) meningococcal vaccine, issue not more than 3 years and not less then 10 days before arrival in Saudi Arabia. See Health Requirements and Recommendations for Travel to Saudi Arabia during the Hajj for more information.

Rabies vaccination is only recommended for certain travelers, including:

• travelers with high occupational risks, such as veterinarians
• long-term travelers and expatriates living in areas with a high risk of exposure
• travelers involved in any activities that might bring them into direct contact with bats, such as wildlife professionals, researchers, veterinarians, or adventure travelers visiting areas where bats are commonly found

Note: Rabies vaccine is temporarily in limited supply. For updates on the rabies vaccine supply, please check the Rabies News and Highlights page regularly.

Malaria

Drugs to Prevent Malaria (antimalarial drugs)

If you will be visiting a malaria risk area in Saudi Arabia, you will need to take one of the following antimalarial drugs: atovaquone/proguanil, doxycycline, or mefloquine (primaquine in special circumstances and only after G6PD testing).

Note: Chloroquine is NOT an effective antimalarial drug in Saudi Arabia and should not be taken to prevent malaria in this region.

Malaria risk area in Saudi Arabia: Risk in Al Bahah, Al Madinah, Asir (excluding the highaltitude areas above 2,000 m), Jizan, Makkah, Najran, and Tabuk province. No risk in urban areas of Jeddah, Mecca, Medina, and Ta’if.

A Special Note about Antimalarial Drugs

You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use.

Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available.

For detailed information about these antimalarial drugs, see Information for the Public: Prescription Drugs for Malaria.

More Information About Malaria

Malaria is always a serious disease and may be a deadly illness. Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health-care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites (see below).

Travelers to malaria risk-areas in Saudi Arabia, including infants, children, and former residents of Saudi Arabia, should take one of the following antimalarial drugs listed above.

Symptoms

Malaria symptoms may include

• fever
• chills
• sweats
• headache
• body aches
• nausea and vomiting
• fatigue

Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, you should see a doctor right away if you develop a fever during your trip.

Malaria may cause anemia and jaundice. Malaria infections with Plasmodium falciparum, if not promptly treated, may cause kidney failure, coma, and death. Despite using the protective measures outlined above, travelers may still develop malaria up to a year after returning from a malarious area. You should see a doctor immediately if you develop a fever anytime during the year following your return and tell the physician of your travel.

Items to Bring with you to Saudi Arabia

• The prescription medicines you take every day
• Antimalarial drugs
• Medicine for diarrhea -over the counter. Now there are Multi-sypmtom capsules that take care of the associated gas, cramping and intestinal discomfort.
• Iodine tablets and portable water filters to purify water if bottled water is not available.
• Sunblock and sunglasses for protection from harmful effects of UV sun rays
• Antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol
• To prevent insect/mosquito bites, bring:
  • Lightweight long-sleeved shirts, long pants, and a hat to wear outside, whenever possible.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Bed nets treated with permethrin, if you will not be sleeping in an air-conditioned or well-screened room and will be in malaria-risk areas. For use and purchasing information, see Insecticide Treated Bed Nets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.

See other suggested over-the-counter medications and first aid items for a travelers’ health kit.

Note: Check the Air Travel section of the Transportation Security Administration website for the latest information about airport screening procedures and prohibited items.

Other Diseases Found in the Middle East

The following are disease risks that might affect travelers; this is not a complete list of diseases that can be present. Environmental conditions may also change, and up to date information about risk by regions within a country may also not always be available:

• Cutaneous leishmaniasis -Protecting yourself against insect bites (see below) will help to prevent these diseases. Many diseases, like malaria and dengue, are spread through insect bites.
• Schistosomiasis -To prevent schistosomiasis, do not swim in fresh water (except in well-chlorinated pools) in these countries.
• Measles continues to reported from the region.
• Pilgrims to the Hajj (Saudi Arabia) have acquired meningococcal infections caused by serotypes A and W-135, as well as influenza infecctions.

Staying Healthy During Your Trip

• Prevent Insect Bites
• Prevent Animal Bites and Scratches
• Be Careful about Food and Water
• Avoid Injuries
• Personally, keep your wits about you

After You Return Home

If you are not feeling well, you should see your doctor and mention that you have recently traveled. Also tell your doctor if you were bitten or scratched by an animal while traveling.

Updated post- October 24, 2008:

• Hajj Requirements from the Royal Saudi Arabian Embassy in Washington, DC-USA
• Hajj Central from Soundvision – The Hajj Guide