CDC Traveler’s Advice: Umrah, The Hajj and MERS

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Note: The Saudi MOH Coronavirus website has been intermittently unavailable for 24 hours, and is now returning an error message.  Crof picked up a media report suggesting 1 new MERS yesterday. This comes after 9 cases were reported on Monday.

 

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All able bodied Muslims are required to make at least one major pilgrimage to Mecca during their lifetime, at the time of the hajj. This is known as the fifth pillar of Islam, and is one of the duties incumbent upon all Muslims.

 

The faithful may also make `lesser pilgrimages’, called  omra (or Umrah), at other times of the year. These minor pilgrimages don’t absolve the faithful of making the hajj journey unless they take place during Ramadan (this year: June 17h-July 17th).

 

As a result, the Kingdom of Saudi Arabia (KSA) receives more than 6 million religious pilgrims each year. Most will arrive during the month of Ramadan and during the Hajj ( which begins the last week of September this year), but Umrah pilgrims come and go by  the tens of thousands each month.

 

The concern is that mass gatherings like the Hajj, Chunyun (Chinese New Years-Spring Festival), Carnival in Rio, Mardi Gras, and the Super Bowl all bring together huge groups of people, and all have the potential to amplify the transmission of diseases.

 

While exotic diseases – like MERS and Avian flu – are viewed as potential threats, the spread of mosquito borne illnesses (like Dengue & Chikungunya), tuberculosis, mumps, measles, chickenpox, and  respiratory viruses like influenza & Rhinovirus are far more likely scenarios  (see EID Journal: Respiratory Viruses & Bacteria Among Pilgrims During The 2013 Hajj).

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Last week the CDC updated their Traveler’s Health page for those intending to travel to Saudi Arabia for Umrah or the Hajj, with advice that covers the gamut from avoiding foodborne illnesses to MERS.

 

Hajj and Umrah in Saudi Arabia

What can travelers do to protect themselves?

Before your trip:

• Schedule an appointment at least 4–6 weeks before your trip. Talk to your doctor or nurse about vaccines and medicines recommended for Saudi Arabia. See the Find a Clinic webpage for help in finding a travel medicine clinic near you.
  • The Meningitis (Meningococcal disease) vaccine is required if you are traveling to Saudi Arabia to take part in a pilgrimage.
  • CDC recommends all travelers be up-to-date on routine vaccines, including measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis, varicella (chickenpox), polio, and influenza.
  • Other recommended vaccines may include hepatitis A, typhoid, hepatitis B, and rabies.
    • If coming from a country other than the US, you may need a yellow fever or polio vaccine.
  • Medicine for malaria and travelers’ diarrhea may be also recommended.
• For the last several years, the Saudi Ministry of Health has recommended that the following groups postpone travel:
  • People older than 65 years
  • Children younger than 12 years
  • Pregnant women
  • People with chronic diseases (such as heart disease, kidney disease, diabetes, or respiratory disease)
  • People with weakened immune systems or who take drugs that suppress the immune system
  • People with cancer or terminal illness

• Consider purchasing travel health and medical evacuation insurance.
• Pack a travel health kit.
• Monitor travel warnings and alerts and read travel tips from the US Department of State.
• Enroll in the Smart Traveler Enrollment Program (STEP) .

Leave a copy of your itinerary, contact information, credit cards, and passport with someone at home.

During your trip:

Follow security and safety guidelines. Hajj is one of the largest mass gatherings in the world.

• • Avoid the most densely congested areas and perform rituals during non-peak hours. Know where emergency exits are and how to get to them..
  • Carry a photocopy of your passport and entry stamp.
  • Carry the contact information for the nearest US embassy or consulate in Saudi Arabia and local emergency service numbers.
  • Follow all local laws and social customs.
• Follow food and water safety guidelines: Eating contaminated food and drinking contaminated water can cause illnesses such as hepatitis A, typhoid fever, and travelers’ diarrhea. Read about how to prevent these diseases by visiting the Safe Food and Water page. Beware of food from street vendors, ice in drinks, and other foods and drinks that may be contaminated and cause travelers’ diarrhea.

• Prevent mosquito bites and use insect repellent: Diseases spread by mosquitoes, such as malaria and dengue, are a risk in Saudi Arabia. Read more about ways to prevent bug bites by visiting the Avoid Bug Bites page.
• Follow guidelines for hot climates: Dehydration and heat-related illnesses are common during Umrah and Hajj. Temperatures in Mecca can easily exceed 100°F in the summer and early fall. Drink plenty of (bottled!) water, keep cool, and wear sunscreen. Read more about how to prevent these conditions by visiting the Travel to Hot Climates and Sun Exposure pages.
• Use disposable, single-use blades for head shaving: Unclean blades can transmit disease. Male pilgrims should go to officially designated centers to be shaved, where barbers are licensed and use disposable, single-use blades.
• Avoid swimming in fresh water—lakes and rivers: Schistosomiasis is a parasitic infection that can be spread in fresh water that may cause serious health problems. It is a low risk in Saudi Arabia but still present.
• Choose safe transportation: Motor vehicle crashes are the #1 killer of healthy US citizens in foreign countries. Read about ways to prevent transportation injuries by visiting the Road Safety page.
• If you feel sick during your trip:
  • Talk to a doctor or nurse if you feel seriously ill, especially if you have a fever.
  • For more information about medical care abroad, see Getting Health Care Abroad.
  • Avoid contact with other people while you are sick.

After your trip:

• If you are not feeling well after your trip, you may need to see a doctor. If you need help finding a travel medicine specialist, see Find a Clinic. Be sure to tell your doctor about your travel, including where you went and what you did on your trip. Also tell your doctor if you were bitten or scratched by an animal while traveling.
• For more information, see Getting Sick after Travel.

Middle East Respiratory Syndrome

• The Middle East Respiratory Syndrome (MERS) outbreak is ongoing in the Arabian Peninsula. CDC has issued a MERS travel alert with health recommendations to reduce your risk of infection.
  • Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.
  • Avoid touching your eyes, nose, and mouth. Germs spread this way.
  • Avoid close contact with sick people.
• The World Health Organization considers people with diabetes, kidney failure, chronic lung disease, and/or weakened immune systems to be at high risk for severe disease from MERS and recommends that people with any of these conditions take additional precautions:
  • Avoid contact with camels.
  • Do not drink raw camel milk or raw camel urine.
  • Do not eat undercooked meat, particularly camel meat.
• At this time, CDC does not recommend that travelers change their plans because of MERS. Most instances of person-to-person spread of MERS have occurred in healthcare workers and other close contacts (such as family members and care givers) of people sick with MERS. Discuss travel plans with your doctor if you have concerns.
• For more information on travel health recommendations related to the MERS outbreak, please see the CDC MERS travel notice.

 

Even without an emerging coronavirus, the logistics of providing free medical care for several million pilgrims during the Hajj is a daunting one. Two years ago, in MERS, Mass Gatherings & Public Health, we looked at some of the immense  challenges that Saudi Arabia faces each year with the Hajj.

 

Emergence of medicine for mass gatherings: lessons from the Hajj

Prof Ziad A Memish MD , Gwen M Stephens MD, Prof Robert Steffen MD , Qanta A Ahmed MD

(Excerpt)

Within the immediate vicinity of the Hajj, there are 141 primary health-care centres and 24 hospitals with a total capacity of 4964 beds including 547 beds for critical care. The latest emergency management medical systems were installed in 136 health-care centres and staffed with 17 609 specialised personnel. More than 15 000 doctors and nurses provide services, all at no charge.