4 December 2007

Health Requirements and Recommendations for Travelers to Saudi Arabia during the H= ajj

The US Centers for Disease Control and Prevention (CDC) posted updated information on their website that is “current as of today, December 04, 2007” that pertains to this year’s Hajj, a pilgrimage to the Islamic holy places= in Saudi Arabia. This year the Hajj begins December 18^th.

CDC recommended vaccinations include the meningococcal vaccine, influenza vaccine, hepatiti= s A vaccine, hepatitis B vaccine, typhoid vaccine, and polio vaccine or adult booster. In addition, “routine immunizations” should be up-to-date including measles, mumps, rubella (“MMR”), and diphtheria, pertussis, and tetanus = (“DPT”).

CDC also provides detailed information on how to decrease the risk of heat injury and other illnesses. Meningococcal disease symptoms and risk factors are listed, in p= art because of meningitis outbreaks associated with the Hajj in 1987 and 2000, = as cited in this CDC document.

The final sentenc= e of this CDC four-page document states: “For the official documentation of full requirements for entry into Saudi Arabia for the Hajj, see the World Health Organization (WHO) Weekly epidemiological record, November 2, 2007”.

This WHO Weekly Epidemiological Record (“WER” No. 44, 2007, 82, pages 385-388 c= an be found at: www.who.int/wer) states that “the Ministry of Health of Saudi Arabia has issued requirements for the forthcoming Hajj season as follows”. Clear, specif= ic information is provided regarding: (I) Yellow Fever, (II) Meningococcal meningitis, (III) Poliomyelitis, (IV) Influenza vaccination, (V) Disease surveillance and health regulations at borders (airports, ports), and (VI) Foods.

For example, for meningococcal meningitis prevention it is stated: “ Vis= itors from around the world arriving for the purpose of “Umra” or pilgrimage or for seasonal work are requested to produce a certificate of vaccination with the quadrivalent (ACYW135) vaccine against meningococcal meningitis, issued not more than 3 years and not less than 10 days before arrival in Saudi Arabia.”

“Arrivals f= rom countries of the African meningitis belt, namely: Benin, Burkina Faso, Cameroon, Chad, Central African Republic, Cote d’ Ivoire, Eritrea, Ethiopia, Gambia, Guinea, Guinea-Bissau, Mali, Niger, Nigeria, Senegal, and Sudan” will also be given chemoprophylaxis against meningococcal dise= ase “at points of entry to all arrivals from these countries to lower the rate of carriers among them. Ciprofloxacin tablets (500mg) will be given to adults, rifampicin to children and ceftriaxone to pregnant women” (p. 386).

Under section V (= Disease surveillance and health at borders) it is stated that “People aged le= ss than 15 years and traveling to Saudi Arabia from polio-affected countries w= ill be vaccinated with OPV regardless of previous vaccination history. All adult travelers from Afghanistan, India, Nigeria, Pakistan, and Sudan should also receive 1 dose of OPV at border points” (p. 387). <= /p>

Regarding influen= za vaccination “The Ministry of Health of Saudi Arabia recommends that pilgrims be vaccinated against influenza before arrival, particularly those with pre-existing conditions (e.g., the elderly, people with chronic chest = or heart diseases or cardiac, hepatic, or renal failure)”.

In reading these preventive public health measures involving screening for diseases and documentation of vaccinations, administration of one or more vaccines to specific populations, and antibiotic prophylaxis against meningococcal dise= ase for certain highest-risk persons (including different antibiotics for adult= s, children, and pregnant women) one is reminded of emergency preparedness and response activities in recent years against infectious diseases and biohaza= rds in the US, and other nations.

Some of the best practices and lessons learned are potentially shared in these public health settings, even thought they might appear widely different in their respecti= ve contexts.

Daniel R. Lucey, = MD, MPH

Adjunct Professor= of Microbiology and Immunology

Georgetown Univer= sity Medical Center

Co-Director, M.S. Graduate Program in

Biohazardous Thre= at Agents and Emerging Infectious Diseases

EROne Institutes, Department of Emergency Medicine

Washington Hospit= al Center, Washington, DC

Website for this posting: www.BePast.org

e-mail: Daniel.R. Lucey@Medstar.net