Health Tips for Hajj 2018 Pilgrims - Dr.M.A.Aleem

Health Tips for Hajj 2018 Pilgrims

Dr.M.A.Aleem
Former Vice-Principal
KAPV Govt. Medical College and MGM Govt. Hospital.

Consultant Neurologist
ABC Hospital

Trichy 620018
Tamilnadu
India

Hajj

The Hajj is the largest annual pilgrimage in the world.
The pilgrimage occurs from the 8th-13th day of the 12th month in the Islamic calendar (Dhu al-Hijjah). The Islamic calendar is eleven days shorter than the Gregorian calendar used in the western world. The Gregorian date of the Hajj is eleven days earlier from year to year. In 1439H (2018) Hajj will fall approximately between 19th to 24th August 2018.

General Travel Advice

All pilgrims should aim to be fit for Hajj, the pilgrimage can be an arduous undertaking for even the fittest individual. Keeping active, improving mobility and exercising appropriately is recommended.  Some travellers may benefit from a general health check-up with their doctors prior to departure to optimise their health, particularly the elderly, those with underlying health problems or during pregnancy.  Female pilgrims may wish to delay menstruation during Hajj and this should be discussed well in advance with the lady doctors who may prescribe hormonal therapy.

Pilgrims taking regular medication should review their prescription with their doctors and ensure that they have sufficient medicines to cover the trip. A letter from the doctor with details of current medication may be useful for immigration purposes and all medicines should be kept in their original packaging and carried in the hand luggage with a printed copy of the prescription.

A personal medical/first aid kit is essential for pilgrims. It should include dressings, plasters, small bandages, antiseptic lotion/cream, adhesive tape, sun burn lotion, scissors, safety pins, antihistamine cream, blister dressings, rehydration salts, analgesics for pain and an antidiarrhoeal agent such as loperamide.

These are updated annually.
In addition the Saudi MoH website includes useful health information and resources

For  pilgrims to Saudi Arabia. 
Saudi Arabia Ministry of Health Updated Advice (2018)
For Hajj 1439H (2018) the Saudi MoH recommends that the elderly (above 65 years of age), those with chronic diseases (e.g. heart disease, kidney disease, respiratory disease, diabetes), immune deficiency (congenital and acquired), malignancy, terminal illness, pregnant women and children (under 12 years) postpone the performance of the Hajj and Umrah for their own safety.

Hajj  Vaccination Requirements

Meningococcal Meningitis

Visitors arriving for Hajj or for seasonal work in Hajj zones, are required to submit a valid vaccination certificate with a Quadrivalent (ACWY) meningococcal vaccine administered no less than 10 days prior to arrival to Saudi Arabia. 

Vaccination with ONE of the following vaccines is acceptable:
Quadrivalent (ACWY) polysaccharide vaccine within the last 3 years.
Quadrivalent (ACWY) conjugate vaccine within the last 5 years.
Note: If the vaccine type is not indicated in the certificate, the certificate will be valid for 3 years.
Vaccination with Quadrivalent (ACWY) conjugate vaccine is also required for:
Domestic pilgrims.

Residents of the two holy cities (Mecca and Medina).

Any person who may be in contact with pilgrims including personnel in healthcare settings.

The Saudi MoH may opt to administer prophylactic antibiotics to some travellers at the points of entry if deemed necessary.

Yellow Fever

The Saudi MoH requires that all travellers arriving from countries or areas at risk of yellow fever transmission must present a valid yellow fever vaccination certificate. The yellow fever vaccination certificate is valid for life starting 10 days after vaccination.

Poliomyelitis

The Saudi MoH has announced that all travellers arriving from countries with circulating wild or vaccine-derived poliovirus (cVDPV2) and from countries at risk of polio reintroduction are required to submit a valid polio vaccination certificate.
Travellers arriving from Afghanistan, Nigeria, Pakistan, Myanmar, Ethiopia, Somalia, the Republic of South Sudan, the Syrian Arab Republic, and Yemen should present proof of vaccination with one of the following vaccines: 

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

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

All travellers arriving from the Democratic Republic of the Congo require a proof of receipt of at least 1 dose of IPV within the previous 12 months and administered at least 4 weeks prior to arrival. 
Travellers arriving from Afghanistan, Nigeria, Pakistan, Myanmar, Ethiopia, Somalia, the Republic of South Sudan, the Syrian Arab Republic, and Yemen will also receive one dose of OPV at the border points on arrival into Saudi Arabia.

Recommended Vaccines for Hajj 

All travellers should ensure that they are up-to-date with the recommended immunisations for life in the UK e.g. 5 doses of tetanus vaccine and five doses of polio vaccine. If it has been more than 10 years since the traveller's last dose of polio vaccine a booster dose should be given.
Seasonal Influenza
The Saudi MoH recommends seasonal influenza vaccine for Hajj attendees before arrival.

Measles and Rubella

With the recent resurgence of measles and rubella cases, special attention is needed for both of these diseases to avoid widespread outbreaks during this year's Hajj . Check that you are immune, either from previous immunisation (2 doses of MMR) or natural measles infection.
Other vaccine recommendations for Saudi Arabia are available on the country record.

Other Health Risks

Mosquito Bite Avoidance

Mosquito bite avoidance measures are important for the prevention of arthropod-borne infections present in Saudi Arabia e.g. dengue fever, leishmaniasis, chikungunya and Rift Valley fever. Zika virus has not been detected in Saudi Arabia.
Further information on these infections and malaria is available on the Saudi Arabia country record.

Respiratory Infections and MERS CoV

Respiratory tract infections can spread easily in crowded areas.  Middle East Respiratory Syndrome Coronavirus (MERS CoV) can cause fever, cough and breathing difficulties.  The precise way it is spread in not fully known, but very close contact with cases and contact with dromedary camels are linked to infection.
The Saudi MoH advises pilgrims to comply with health guidelines to curb the spread of respiratory infections including MERS CoV, which can be summarized as follows:

Wash hands with soap and water or disinfectant, especially after coughing and sneezing.

Use disposable tissues when coughing or sneezing and dispose of them appropriately.

Avoid hand contact with the eyes, nose and mouth.

Avoid direct contact with infected persons or use of their personal gadgets.

Avoid direct contact with animals, particularly camels and stay away from their gathering places.

Avoid drinking camel milk unless it is pasteurised or boiled, camel urine or eating undercooked camel meat.

If symptoms of fever, cold, flu-like illness or cough develop
seek medical help early
avoid crowded areas or wear face masks if this is not possible.

Maintain good personal hygiene. 

Travellers' Diarrhoea

Diarrhoeal disease is common during Hajj and all travellers are at risk.  Diarrhoeal disease may be more severe in young children, the elderly and those with underlying health problem who may become rapidly and dangerously dehydrated.

Climate Related Health Risks

Even during the winter months temperatures during the day in Saudi Arabia can reach 30°C,  sunburn, sunstroke, heat exhaustion, heat stroke and dehydration are a risk.  

Good quality footwear is essential as sand in the desert can get very hot.

Ideally pilgrims should arrive in time to allow acclimatisation to the hot conditions before undertaking Hajj. 

Pilgrims should be advised to rest, maintain good hydration with safe liquids, seek shade where possible and use a sunscreen factor 15 or higher.  

 Pilgrims can create shade by using an umbrella. Some rituals can be performed in the evening to avoid high daytime temperatures; Saudi authorities have decreed that pilgrims can perform the Stoning of the Devil anytime between sunrise and sunset.

Blood-borne Virus Transmission 

Associated with Shaving

At the end of Hajj, Muslim men shave their heads, and non-sterile blades can transmit blood-borne infections, such as hepatitis B, hepatitis C, and HIV. Only licensed barbers at officially designated centres should be visited. A disposable single-use blade or your personal razor should be used.

Accidents and Injuries

In the unique setting of Hajj pilgrimage it is unsurprising that accidents and injuries occur. The Saudi Arabia government has made improvements to ensure the safety of pilgrims.

Traffic vehicle accidents are a potential hazard as pilgrims may walk long distances through or close to dense traffic and busy roads. Minor injuries to the feet are common. Pilgrims with diabetes or poor circulation to the lower limbs must take particular care and wear appropriate footwear.

It is strongly recommended that all pilgrims obtain comprehensive travel and medical insurance (including repatriation) before travel.