Content
Special Groups
Travelers
In this chapter:
Vaccination for traveler will depend on:
- Country of visit
- Duration and place of stay
- Intended activities
The following websites provide updated information on immunisation for travelers and should be referred to when offering advice on travel vaccination.
• • WHO International travel and health (www.who.int/ith)
• • Centers for Disease Control (wwwnc.cdc.gov/travel/)
• • International Association for Medical Assistance to Travelers (www.iamat.org)
Preferably travellers are advised to use the IHR 2005 International Certificate of Vaccination or Prophylaxis. The certificate is available from the WHO website at https://www.who.int/ihr/IVC200_06_26.pdf
Table 21.10 Vaccination Summary for Travelers
Vaccines for Hajj and Umrah Pilgrimage
The Hajj and Umrah are religious pilgrimages to Mecca, Saudi Arabia. Hajj only takes place from 8th-12th of Dhul Hijah, the last month of the Islamic year, while Umrah can be performed at any time. Approximately 3 million Muslims from over 180 countries make the Hajj every year. The Umrah pilgrims are estimated to be approximately 20 million every year with the projection of 30 million in 2030. The pilgrims should be educated on the general healthcare and communicable diseases’ preventions.
All pilgrims should be up-to-date with routine vaccinations. The most current vaccination requirements are available from the Saudi Arabian Ministry of Health website (www.moh.gov.sa/en/). The recommended vaccines for Hajj and Umrah pilgrimage are also available at CDC website (https://wwwnc.cdc.gov/travel/yellowbook/2018/select-destinations/saudi-arabia-hajj-umrah-pilgrimage).
Compulsory Meningococcal Vaccine
The Saudi Ministry of Health requires all pilgrims to receive the meningococcal vaccine. Hajj and Umrah visas will not be issued without proof of vaccination. All adults and children aged more than 2 years must receive a single dose of quadrivalent A/C/Y/W135 vaccine. They must also show proof of vaccination on a valid International Certificate of Prophylaxis. They must have received the vaccine less than 2-3 years (depending on the brand administered*) and more than 10 days before arriving in Saudi Arabia. Meningococcal vaccination requirements are updated regularly by the Saudi Arabian authorities and can be found at www.moh.gov.sa/en/Hajj
Recommended vaccines for respiratory infections
Respiratory tract infections are common during Hajj, with pneumonia being the most common cause of hospital admission. These risks underscore the need for pneumococcal conjugate and/or polysaccharide vaccines for pilgrims aged ≥60 years and for younger travelers with comorbidities.
The Scientific Committee for Influenza and Pneumococcal Vaccination of the Saudi Thoracic Society recommends the following before the Hajj season:
- All persons at ≥50 year are recommended to receive sequential vaccination before the Hajj or Umrah beginning with PCV13 followed by PPV23 at least 8 weeks later (ideally 1 year). If this is not possible, it is recommended to administer one dose of PPV23.
- Immunocompetent persons <50 years with risk factors are recommended to receive single dose PPV23 at least 3 weeks before the Hajj.
- Because of lack of evidence, it is not recommended to provide pneumococcal vaccines routinely to healthy persons aged <50 years.
Seasonal influenza vaccine is strongly recommended for all pilgrims. Inactivated Influenza vaccine can be administered concurrently with pneumococcal polysaccharide vaccine.
Additional vaccinations and measures
The crowded conditions during Hajj increase the probability of respiratory pathogens transmission. Risk of tuberculosis transmission is estimated to be about 10% in those with high levels of exposure. Transmission of emerging pathogens e.g. Middle East respiratory syndrome (MERS) has also been documented in 2012. For further information, refer to the Saudi Arabian MOH website (https://www.moh.gov.sa/en/Hajj/HealthGuidelines/HealthGuidelinesDuringHajj/Pages/default.aspx).
In addition to the above vaccines, hepatitis A and B, influenza and typhoid vaccines are also recommended (Refer relevant sections).
Behavioural interventions such as hand hygiene, wearing a face mask, cough etiquette, social distancing, and contact avoidance may mitigate respiratory illness among pilgrims. Pre-travel advice about common respiratory conditions should include a general assessment for respiratory fitness, necessary vaccinations, and prescription of adequate supplies of portable respiratory medications (inhalers are easier to transport than nebulizers).
References
- Alharbi N.S. Al-Barrak, A. M., Al-Moamary, M. S., Zeitouni, M. O., Idrees, M. M., Al-Ghobain, M. O., Al-Shimemeri, A. A. & Al-Hajjaj, M.S. (2016). The Saudi Thoracic Society pneumococcal vaccination guidelines-2016. Annals of Thoracic Medicine, 11(2): 93-102.
- Kingdom of Saudi Arabia. Ministry of Health (2018). Health Requirements and Recommendations for Travelers to Saudi Arabia for Hajj and Umrah – 2018/1439H. https://www.moh.gov.sa/en/hajj/pages/healthregulations.aspx
- US. Centers for Disease Control and Prevention (2018). Traveller’s Health – Saudi Arabia: Hajj/Umrah Pilgrimage. https://wwwnc.cdc.gov/travel/yellowbook/2018/select-destinations/saudi-arabia-hajj-umrah-pilgrimage