In 2006, over 1.5 million people traveled to Saudi Arabia to perform the Hajj, a pilgrimage to the holy places of Islam. This year, the week of the Hajj begins on December 18, 2007. People planning to travel to Saudi Arabia for the Hajj should expect large crowds at places of worship, gathering, and lodging. Transportation services can also become overburdened. Crowded conditions may play a role in the transmission of certain infections, such as meningococcal disease (meningitis), influenza (the flu) and other respiratory viruses; in addition, the potential for accidental injury is increased. In order to help pilgrims have a safe and healthy journey, the government of Saudi Arabia has established certain requirements for visitors, listed below. CDC also recommends travelers to Saudi Arabia consider additional measures to reduce their risk of getting sick or injured.

Vaccinations Required by the Government of Saudi Arabia

Only pilgrims with valid vaccination certificates will be allowed to enter the cities of Mecca and Medina to perform Hajj. Those without these certificates will either be denied entry or may be required to receive vaccination upon arrival.

• All children over 2 years of age and all adult pilgrims are required to provide proof of vaccination with a quadrivalent (A/C/Y/W-135) meningococcal vaccine, issued not more than 3 years previously, and not less than 10 days before arrival in Saudi Arabia.
• Documentation of polio vaccination must be presented for infants and children up to fifteen (15) years of age. However, the government of Saudi Arabia has indicated that, regardless of vaccination history, all travelers up to 15 years of age arriving in Saudi Arabia will also be required to receive a dose of oral polio vaccine (OPV) when they arrive.
• All pilgrims will be screened for diseases notifiable under the International Health Regulations, including dengue fever, meningococcal meningitis, and yellow fever.

CDC-Recommended Vaccinations

Quadrivalent (A/C/Y/W-135) Meningococcal Vaccine

In addition to the Saudi government requirement, CDC also recommends meningococcal vaccine because of outbreaks of meningitis associated with the Hajj in 1987 and 2000. For persons aged 2-55 years, meningococcal conjugate vaccine (Menactra®, manufactured by sanofi pasteur, Swiftwater, Pennsylvania) is the recommended vaccine. Meningococcal polysaccharide vaccine (Menomune®, manufactured by sanofi pasteur) may be used in persons over 55 years old and is an acceptable alternative for persons 2-55 years old.

Routine Vaccines

Travelers should also be up-to-date on routine immunizations prior to departure (e.g., polio, measles, mumps, rubella, tetanus, diphtheria, and pertussis). These vaccines are necessary for protection from diseases that are still common in many parts of the world, even though they rarely occur in the United States. For details, see routine vaccine schedules below:

• Recommended Adult Immunization Schedule — United States, 2007-2008
• Recommended Childhood and Adolescent Immunization Schedule — United States, 2007
• Vaccine Recommendations for Infants and Children

The U.S. routine schedule for childhood immunizations may need to be adjusted if a child is traveling. Some vaccines may be given in an accelerated schedule or earlier than normal. Those traveling with infants and children should discuss their travel plans with a health-care provider who is familiar with advising for children and travel.

Influenza Vaccine

In general, anyone who wants to reduce their chances of getting the flu should be vaccinated, if they are 6 months old or older. Annual vaccination is particularly important for travelers in the following groups, because they are at high risk for severe complications if they get the flu:

• Children aged 6 months until their 5th birthday,
• Women who will be pregnant during the influenza season,
• People 50 years of age and older,
• Adults and children with certain chronic medical conditions or immunosuppression,
• Children 6 months through 18 years of age on long term aspirin therapy,
• Health care workers,
• Healthy adults and children who live with or care for children aged < 5 years and adults > 50 years, and
• Healthy adults and children who live with or care for those at high risk for complications from flu.

Other Recommended Vaccines for Saudi Arabia

Hepatitis A vaccine

Hepatitis B vaccine

Typhoid vaccine

Polio vaccine or adult booster

Other Recommendations for Travelers

Tips to reduce the chances of illness and heat injury―

• Because of the large crowds expected during the pilgrimage and the extreme heat and extensive walking, there is a potential risk for heat injury which includes heat exhaustion, heat stroke, and heat cramps, especially for children, the elderly, or people with health problems.
• Drink plenty of water to prevent dehydration.
  • An adult should drink about two liters of water each day (about eight, 8-ounce glasses) to stay hydrated. In extreme temperatures, two to four 8-ounce glasses of fluid an hour will help keep you hydrated and decrease the risks for heat exhaustion or heat stroke.
  • Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles.  Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
• Wash your hands often with soap and water, especially before eating. If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol).
• Do not eat food purchased from street vendors; make sure food is fully cooked; and avoid dairy products, unless you know they have been pasteurized.
• Avoid exposure to bloodborne diseases by not sharing sharp objects, such as razors, with others.
• Remember to take with you enough of the prescription medications you take every day or regularly, as well as a letter from your doctor about the medications. Carry them in their original prescription bottles and always in your carry-on luggage. Be sure to follow security guidelines, if the medicines are liquids.
• Wear sunscreen of at least 15 SPF to prevent sunburn, and wear sunglasses with UV protection to prevent sun damage to your eyes.
• Wear a head covering to reduce heat exposure.

Safety Tips

• Make a photocopy of your passport to carry with you at all times.
• Develop plans for where to meet if you become separated from the group with whom you are traveling.
• The U.S. Department of State provides a free travel registration service to U.S. citizens who are traveling or living in another country. Registration allows a traveler to record information about his or her upcoming trip abroad that the Department of State can use to assist in case of an emergency. See the [[forward label=([]) link=([])]]U.S. Department of State’s Travel Registration site.
• See the Tips for Traveling Abroad page on the U.S. Department of State website for more safety tips.
• See the Warden Message: Saudi Arabia Annual Hajj from the U.S. Embassy Riyadh posted by the Overseas Security Advisory Council.

Additional Information about Meningococcal Disease

The bacteria that cause meningococcal disease are spread through close, direct contact with an infected person that leads to exchange of saliva or respiratory and throat secretions.
Meningococcal bacteria are not spread by casual contact or by simply breathing the air where a person with meningococcal disease has been.

Symptoms of Meningococcal Disease

• High fever, headache, and stiff neck (symptoms can develop over several hours, or they may take 1 to 2 days to appear).
• Other symptoms may include nausea, vomiting, sensitivity to light, confusion, and sleepiness.
• Patients with meningiococcal blood infections can have fever and a rash.
• In newborns and small infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect, and the infant may only appear slow or inactive, or be irritable, have vomiting, or be feeding poorly.
• As the disease progresses, patients of any age may have seizures.

People with these symptoms should get medical attention right away.

Risk factors for getting meningococcal disease include―

• Immune system problems, such as lack of a spleen
• Respiratory infections, such as the flu
• Smoking or being around people while they smoke
• Indoor crowding
• Close contact with an infected person (in the same house or day-care center)
• Direct contact with the oral secretions, such as saliva, of a person who is sick with meningococcal disease

People who have close contact with a patient with meningococcal disease or their oral secretions are at increased risk of getting the disease and should consult a health-care provider regarding antibiotics to prevent illness.

More Information

During your trip, if you are not feeling well, you should get medical attention. A U.S. consular officer can assist in locating appropriate medical services and notifying family or friends. For more information see Seeking Health Care Abroad (CDC Health Information for International Travel 2008). If you do not feel well after you return from your trip, you should get medical attention and mention that you have recently traveled.
For general health information about travel to the Saudi Arabia, see the Health Information for Travelers to Saudi Arabia destination page.
For information about security while traveling to Saudi Arabia, see the U.S. Department of State website:

• Travel Warning
• Regional Information
• Tips for Traveling Abroad

The information contained in this document is for U.S. travelers. If you are not traveling directly from the U.S. to Saudi Arabia, requirements may differ. A note about Yellow Fever Vaccine: Proof of yellow fever vaccine administration is required for travelers entering Saudi Arabia who are coming from countries/areas where there is a risk of yellow fever transmission. This requirement does not apply for travelers coming from the U.S., since there is no risk of yellow fever transmission the U.S.

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.