Hajj and Umrah are annual Islamic pilgrimages to the holy city of Makkah or Mecca in the Kingdom of Saudi Arabia. They are some of the most significant religious gatherings in the world and give rise to the largest movements of people across the globe – just in 2018, more than 2 million Muslim pilgrims gathered at Mecca to carry out rituals that would confer humility upon them and unite them as one.
The cube-shaped Kaaba is the singularly most sacred site in Islam and is the point of gathering of all pilgrims during the five-day Hajj pilgrimage. The structure is encircled by both Hajj and Umrah pilgrims while they perform the integral ritual of Tawaf.
While Hajj is only to be undertaken on specific days during a certain Islamic month, Umrah can be performed anytime. All Muslims must undertake Hajj at least once in their life and the process is rigorous, long and requires fitness and grit from those undertaking it. Umrah, on the other hand, is far shorter and has more elements of enjoyment.
Health Regulations for those Arriving from Singapore
For both pilgrimages, the Kingdom of Saudi Arabia has established a few health requirements which must be met before one can gain a visa for entry into the country and subsequently into Mecca. This has been done to prevent outbreaks in a space that is likely to be densely populated by pilgrims and which thus has more of a risk of transmission of diseases.
Meningococcal (Quadrivalent) Vaccine
A certificate of vaccination with the quadrivalent meningococcal vaccine (MenACWY) must be furnished during your application of a visa to Saudi Arabia for the Hajj and Umrah pilgrimages . The vaccination certificate is valid for 3 years and the vaccination must have been performed at least 10 days before the date of arrival into Saudi Arabia.
Meningococcal Meningitis can be transmitted from one individual to another through infected air droplets, saliva, or other secretions. The infection spreads easily when an infected person comes into close proximity or has long term contact with others. This makes Hajj and Umrah pilgrims particularly vulnerable to the disease, as they will be housed in close proximity to others for an extended period and are more likely to contract the disease from an infected pilgrim.
There has been a history of meningococcal meningitis outbreaks in Mecca affecting those on their Hajj and Umrah pilgrimages. The risk of these outbreaks recurring remains, especially if infected pilgrims from countries in the Meningitis Belt (semi-arid area of Sub-Saharan Africa) travel to Mecca and spread the disease to other pilgrims. This is the primary reason why vaccination against the four main strains of the disease (with quadrivalent conjugate vaccine) has been established as a visa requirement.
Influenza Vaccine
The influenza vaccine is also recommended by the Saudi Arabian Embassy for those entering the country for the Hajj and Umrah pilgrimages. Particularly, those at increased risk of severe influenza diseases, including pregnant women, children under 5 years, the elderly, and individuals with underlying health conditions such as HIV/AIDS, asthma, and chronic heart or lung diseases are highly recommended to get this vaccine.
This is largely because a huge number of pilgrims will be gathered together in close proximity to one another during the period of their pilgrimage and incur the risk of contracting the flu even if a handful of pilgrims have been infected. They also remain in the same space for an extended period of time. This magnifies the risk of catching the flu from an infected pilgrim as the flu can be easily spread through droplets in the air from sneezing and coughing.
Pneumococcal Vaccine
Since pneumococcal infection is a bacterial infection that is spread by coughing, sneezing and contact with nasal fluids, it is recommended for pilgrims above 65 years of age. In a space that is densely populated with pilgrims, those who are particularly vulnerable to contracting pneumonia or other forms of pneumococcal disease may find it beneficial to receive the vaccine as a preventative measure.
Since symptoms of infection include high fever, cough, and shortness of breath, the disease can be particularly debilitating to older persons.
Pneumococcal vaccination is recommended for all persons with chronic illnesses such as asthma, diabetes, heart and pulmonary diseases and for elderly people above 65 years of age.
Health Regulations for those Arriving from Other Countries
Yellow Fever Vaccine
The International Health Regulations established in 2005 stipulate that travellers who arrive from countries at risk of yellow fever must have been vaccinated against the disease at least 10 days before they arrived at the at-risk country. They must provide a valid yellow fever certificate that has been approved by the World Health Organisation as proof of vaccination when arriving in Saudi Arabia.
If the pilgrim does not have such a certificate, he will be put under surveillance for 6 days from the date of vaccination or the last date of potential exposure to infection, whichever is earlier.
The following countries or areas have a risk of yellow fever transmission:
| Angola Argentina Benin Bolivia Brazil Burkina Faso Burundi Cameroon Central African Republic Chad Colombia Congo Cote d’Ivoire Democratic Republic of the Congo Ecuador |
Equatorial Guinea Ethiopia French Guyana Gabon Gambia Ghana Guinea Guinea Bissau Guyana Kenya Liberia Mali Mauritania Niger Nigeria |
Panama Paraguay Peru Rwanda Senegal Sierra Leone South Sudan Sudan Suriname Togo Trinidad and Tobago Uganda Venezuela |
Ciprofloxacin Tablets for Chemoprophylaxis of Meningococcal Meningitis
Pilgrims who are arriving from countries in the African meningitis belt are required to provide evidence of vaccination against Meningococcal Meningitis (MenACWY), but they will also be administered ciprofloxacin tablets (500mg) upon entry to Saudi Arabia as an additional precaution. This will help to lower the rate of carriers in Saudi Arabia as well as reduce the possibility of any breakouts of meningococcal meningitis within the pool of Hajj or Umrah pilgrims.
The following countries or areas are in the African Meningitis Belt:
| Benin Burkina Faso Cameroon Central African Republic Chad Cote d’Ivoire |
Eritrea Ethiopia Gambia Guinea Guinea-Bissau Mali |
Niger Nigeria Senegal Sudan |
Poliomyelitis Vaccine
Travellers who are arriving from polio-endemic countries – specifically Afghanistan, Chad, Nigeria and Pakistan – must produce proof of polio vaccination at least 5 weeks prior to departure in order to apply for a visa for entry into Saudi Arabia. Those who arrive from recently endemic countries with a high risk of re-importation of poliovirus as well as those arriving from re-established transmission countries, will also be required to produce this proof of polio vaccination. Travellers from the categoeries mentioned above will need to receive 1 dose of OPV (poliomyelitis vaccine) at border points once they arrive in Saudi Arabia. This is regardless of the age of the travellers or their vaccination status.
Polio cases related to wild poliovirus importation or to circulating vaccine-derived poliovirus have been registered during the past 12 months in the following countries: Chad, Kenya, Niger, Somalia and Yemen.
The following are some of the countries or areas that are polio-endemic, have a re-established risk of transmission or a high risk of re-importation of poliovirus (please check with your local immigration authority on updated countries or areas):
| Afghanistan Angola Cameroon Central African Republic Chad China |
Democratic Republic of the Congo Ethiopia Indonesia Mozambique Myanmar Niger |
Nigeria Pakistan Papua New Guinea Somalia Yemen |
Other Regulations for Pilgrims from all Countries
Food
Hajj and Umrah pilgrims are not allowed to bring fresh food into Saudi Arabia. Only food that has been properly canner or sealed or food stored in containers with easy access for inspection is allowed in small quantities, sufficient for one person for the duration of his or her trip.
Health Advice and Tips for Pilgrims
Outbreak of MERS
The Middle East Respiratory Syndrome or MERS is a viral respiratory disease that was first reported in Saudi Arabia in 2012. The disease has been reported in human beings as well as camels and is likely to have originated from animals.
Currently, there is no vaccine to prevent MERS, so Saudi Arabia recommends that those above 65 years, those with chronic diseases such as heart disease and diabetes, those with immune deficiency, malignancy and terminal illnesses, pregnant women and children below 12 years postpone the performance of the Hajj and Umrah for their own safety.
Since MERS is believed to be contracted upon contact with Arabian camels or dromedaries, contact with these camels should be avoided and any raw camel products such as camel milk must also not be consumed. Consumption of any type of raw milk or food that may be contaminated with animal secretions should also be avoided, unless you are certain that it is. Upon visiting barns, farms or markets where animals may be housed or raw animal products may be present, wash your hands thoroughly with soap and water.
The Saudi Ministry of Health also advises all pilgrims to comply with common public health guidelines to curb the spread of respiratory infectious disease. The guidelines are as follows:
- Wash hands with soap and water or sanitize with alcohol gel or disinfectant, especially after coughing and sneezing
- Use disposable tissues when coughing or sneezing and dispose of them in a waste basket
- Try to avoid hand contact with the eyes, nose and mouth.
- Avoid direct contact with infected persons (people with symptoms such as cough, sneezing, expectoration, vomiting, and diarrhoea) and do not share any personal items with them
- Wear masks, especially in crowded places
- Maintain good personal hygiene
Dengue
Dengue fever, a disease which is spread through the bite of an infected mosquito, is endemic to the city of Mecca. The several million pilgrims who head to Mecca for Hajj or Umrah are therefore susceptible to contracting the infection if they get bitten by even a single infected mosquito.
Pilgrims are encouraged to take measures to prevent or avoid mosquito bites, especially when after dusk or before dawn, when they are journeying on foot outdoors or sleeping in tents. Below are some of the measures one can take to avoid getting bitten:
- Apply mosquito repellent that contains DEET on all exposed parts of your skin, especially if you are venturing outdoors after dusk and before dawn
- If possible, sleep in rooms which are air-conditioned or where windows and doors are protected with gauze that prevents the entry of mosquitos
- Cover your bed or sleeping area with a mosquito net, especially if you are sleeping outdoors
- Apply permethrin to any mosquito nets that you are using and treat your clothes with permethrin
- Wear loose long-sleeved shirts and long pants, especially when you venture outdoors after dusk and before dawn
Routine Immunisations
All pilgrims are recommended to be updated on their routine immunisations before entering Saudi Arabia. These immunisations include Measles, Mumps and Rubella, Diphtheria, Tetanus and Pertussis, Hepatitis B and any others that may be included in their country’s immunisation schedule.
Being updated on these immunisations will keep pilgrims from contracting any vaccine-preventable diseases and drastically reduce the probability of any outbreaks of vaccine-preventable diseases within the pool of Hajj and Umrah pilgrims in Mecca.
If you are not sure which routine immunisations you have received, visit your GP or travel health professional to ensure that you are protected before you embark on your pilgrimage.
