Hajj & Umrah Pilgrims

Hajj & Umrah Pilgrims
Make pilgrimage safe for your health

During the Hajj, more than 2 million Muslims from all over the world congregate in Mecca, Saudi Arabia, the holiest city for Muslims, to perform their religious rituals.1

The potential for spread of infectious disease associated with pilgrimage has long been recognised.1 Overcrowding contributes to the potential dissemination of airborne infectious diseases or infections associated with person-to-person transmission during the Hajj.1

So to be protected from disease during Hajj:
  • Saudi Arabian health authorities have introduced mandatory vaccination for meningococcal disease for all pilgrims.1
  • Influenza vaccination should be highly-recommended for all pilgrims.1
  • Pneumococcal vaccination should also be recommended for pilgrims aged over 65 and those who have underlying medical conditions.1


Recommended vaccines for Hajj & Umrah Pilgrims
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  • Influenza (Flu)
    DISEASE:
    • Flu (short for influenza) is an illness caused by influenza viruses. Flu viruses infect the nose, throat and lungs.2
    • Pilgrims are exposed to various infectious respiratory diseases and one of them includes influenza.3

    TRANSMISSION:4
    Flu spreads when infected people talk, cough or sneeze and droplets with virus in them land in the mouths or noses of people nearby. Those infected can spread it to others up to about 6 feet away. People can spread flu to others from one day before they have symptoms to 5 – 7 days after they get sick.

    SIGNS AND SYMPTOMS:2
    • Fever (not everyone with the flu has a fever) or feeling feverish/chills
    • Headache
    • Cough
    • Sore throat
    • Muscle aches
    • Tiredness

    POSSIBLE COMPLICATIONS: 2
    • Pneumonia (lung infection)
    • Ear and sinus infections
    • Worsening of long-term medical conditions, like asthma and diabetes
  • Meningococcal disease
    DISEASE:5
    Meningococcal disease is caused by the bacterium Neisseria meningitidis. The disease is often severe and can be deadly.

    TRANSMISSION:
    Meningococcal bacteria is spread by sharing respiratory and throat secretions (saliva/spit) for example, coughing, kissing or lengthy contact.6

    At least 8 out of 10 pilgrims are carriers of this disease and the risk for meningococcal outbreaks becomes a real concern for other pilgrims.7

    SIGNS AND SYMPTOMS:8
    Flu-like symptoms or sudden onset of:
    • Fever
    • Stiff neck
    • Headache

    It will often cause:
    • Nausea
    • Rash
    • Vomiting
    • Confusion
    • Increased sensitivity to light

    POSSIBLE COMPLICATIONS:
    • Meningococcal meningitis (infection of the thin lining that surrounds the brain and spinal cord)8
    • Meningococcal septicaemia (infection of the bloodstream)8
    • Up to 1 in 5 survivors will suffer disabilities, nervous system problems or brain damage9

  • Diphtheria, tetanus and pertussis
    DISEASE:10
    Diphtheria, tetanus, and pertussis (DTaP) are three serious diseases caused by bacteria.

    TRANSMISSION:
    Diphtheria and pertussis spread from person to person by coughing or sneezing.11,12

    Tetanus does not spread from person to person but the bacteria are usually found in soil, dust, and manure and enter the body through breaks in the skin — usually cuts or puncture wounds caused by contaminated objects.13

    SIGNS AND SYMPTOMS:10
    • Diphtheria causes a thick covering in the back of the throat.
    • Tetanus (lockjaw) causes painful tightening of the muscles, usually all over the body.
    • Pertussis is a highly contagious respiratory tract infection. Coughs may eventually turn more serious.

    POSSIBLE COMPLICATIONS:
    • Diphtheria can lead to breathing problems, paralysis, heart failure and even death.10
    • Tetanus can lead to “locking” of the jaw so the victim cannot open his mouth or swallow. 10
    • Pertussis can lead to pneumonia, convulsions, brain damage and death.14

  • Pneumococcal disease
    DISEASE:15
    Pneumococcal disease is an infection caused by the Streptococcus pneumoniae bacterium. Infection can result in pneumonia, infection of the blood (bacteremia/sepsis), middle-ear infection (otitis media) or bacterial meningitis.

    TRANSMISSION:16
    Pneumococcal bacteria spread from person-to-person by direct contact with respiratory secretions, like saliva or mucus.

    SIGNS AND SYMPTOMS:17
    Pneumococcal pneumonia (lung infection) is the most common serious form of pneumococcal disease. Symptoms include:
    • Fever and chills
    • Chest pain
    • Cough
    • Rapid breathing or difficulty breathing

    Pneumococcal meningitis is an infection of the tissue covering the brain and spinal cord. Symptoms include:
    • Stiff neck
    • Headache
    • Photophobia (eyes being more sensitive to light)
    • Fever
    • Confusion

    Pneumococcal bacteremia is a blood infection. Symptoms include:
    • Fever
    • Low alertness
    • Chills

    POSSIBLE COMPLICATIONS:
    • Brain damage17
    • Death17
    • Disabilities like hearing loss or loss of arms or legs18


Travel advice before you embark on your pilgrimage19

  • Keeping active, improving mobility and exercising appropriately is recommended. Some pilgrims may benefit from a general health check-up with their GP prior to departure to optimise their health, particularly the elderly and those with medical conditions.
  • If you take regular medication you should ask your GP to review your prescription and ensure that you have sufficient medicines to cover your trip.
  • A personal first aid kit is essential for pilgrims, it should include items such as dressings, plasters, small bandages, antiseptic lotion/cream, adhesive tape, sun burn lotion, scissors, safety pins, anti-histamine cream, blister dressings, rehydration salts, analgesics for pain and an anti-diarrhoeal agent.



References:
  1. WHO. International Travel and Health. Chapter 9. Special group of travellers. Available at here. Last accessed Jan 2020.
  2. CDC. Key Facts About Influenza (Flu). Available at here. Last accessed Jan 2020.
  3. Alfelali M, et al. Changes in the prevalence of influenza-like illness and influenza vaccine uptake among Hajj pilgrims: A 10-year retrospective analysis of data. Vaccine 2015;33(22):2562-2569.
  4. CDC. How Flu Spreads. Available at here. Last accessed Jan 2020.
  5. CDC. Meningococcal Disease. Available at here. Last accessed Jan 2020.
  6. CDC. Meningococcal Disease – Transmission. Available at here. Last accessed Jan 2020.
  7. Memish ZA. The Hajj: communicable and non-communicable health hazards and current guidance for pilgrims. Euro Surveill 2010;15(39):pii=19671. Available at here. Last accessed Jan 2020.
  8. CDC. Meningococcal Disease – Signs and Symptoms. Available at here. Last accessed Jan 2020.
  9. CDC. Meningococcal Disease – Diagnosis, Treatment, and Complications. Available at here. Last accessed Jan 2020.
  10. CDC. Diphtheria, Tetanus, and Pertussis Diseases and How to Protect Against Them. Available at here. Last accessed Jan 2020.
  11. CDC. Pertussis (Whooping Cough). Available at here. Last accessed Jan 2020.
  12. CDC. Diphtheria – Causes and Transmission. Available at here. Last accessed Jan 2020.
  13. CDC. Tetanus. Available at here. Last accessed Jan 2020.
  14. CDC. Pertussis (Whooping Cough) – Babies and Children. Available at here. Last accessed Jan 2020.
  15. NFID. Pneumococcal Disease Fact Sheet for the Media. Available at here. Last accessed Jan 2020.
  16. CDC. Pneumococcal Disease: Risk Factors and Transmission. Available at here. Last accessed Jan 2020.
  17. CDC. Pneumococcal Disease: Symptoms and Complications. Available at here. Last accessed Jan 2020.
  18. CDC. Features. Diseases & Conditions. Adults: Protect Yourself with Pneumoccocal Vaccines. Available at here. Last accessed Jan 2020.
  19. NHS UK. Hajj and Umrah Pilgrimage: General Travel Advice. Available at here. Last accessed Jan 2020.