The Hajj, taking place annually in the Islamic month of Dhu al-Hijjah, is a major pilgrimage in Mecca attracting millions. Umrah, a less mandatory pilgrimage, can be performed any time of the year. Health guidelines by Saudi Arabia’s Ministry of Health (MoH KSA) mandate vaccinations and precautions against diseases like MERS-CoV (Middle East respiratory syndrome). All pilgrims wishing to perform the Hajj & Umrah pilgrimages must meet all requirements.
Must have vaccinations for Hajj & Umrah
ACWY (Meningitis)
All travellers aged over one year, arriving for Umrah or Hajj, are required to submit a valid vaccination certificate with an ACWY meningococcal vaccine received at least 10 days prior to the planned arrival to Hajj and Umrah areas.
This vaccine is also recommended for personal protection against groups A, C, W and Y meningococcal disease (see also recommended vaccines).
Vaccination with ONE of the following vaccines is acceptable:
- Quadrivalent (ACWY) polysaccharide vaccine within the last three years.
- Quadrivalent (ACWY) conjugate vaccine within the last five years.
If vaccine type is not indicated on the certificate, it will be considered valid for three years.
Details of the vaccine name and type (i.e. conjugate vaccine) should be recorded in a patient held vaccine record showing the individual’s full name. It is advisable that the proof of vaccination record is issued by the individual’s doctor, nurse or pharmacist and should accurately reflect the details of the vaccine administered and be authenticated with the healthcare provider’s official stamp.
If an individual is in possession of an International Certificate of Vaccination or Prophylaxis (ICVP) booklet, meningococcal ACWY vaccine can be recorded in the ‘Other Vaccinations’ pages.
MoH KSA states they may administer prophylactic antibiotics to some travellers arriving from countries with or at risk of frequent meningitis epidemics or outbreaks.
Polio
Available in a combination with Diphtheria & Tetanus.
MoH KSA states that travellers regardless of age or vaccination status from countries reporting cases of wild poliovirus type 1 (WPV1) or circulating vaccine-derived poliovirus type 1 (cVDPV1) are required to submit a polio vaccination certificate with at least one dose of bivalent oral polio vaccine (bOPV) or inactivated polio vaccine (IPV) within the previous 12 months and not less than four weeks prior to arrival.
Travellers from countries reporting cases of circulating vaccine derived poliovirus type 2 (cVDPV2)or Acute Flaccid Paralysis (AFP), are required to be vaccinated with at least one dose of IPV within the previous 12 months and at least four weeks prior to arrival.
Travellers from countries reporting positive environmental sources samples of circulating vaccine derived polio virus 2 (cVDPV2), including the UK, are recommended to be vaccinated with at least one dose of IPV within the previous 12 months and at least four weeks prior to arrival, however there is no polio vaccination certificate requirement.
If IPV is not available, it is acceptable to submit a polio vaccination certificate with at least one dose of oral polio vaccine (OPV) within the previous six months and not less than four weeks prior to arrival.
A polio certificate requirement will only apply to UK pilgrims if they are travelling to KSA via a country reporting WPV1, cVDPV1 or cases of cVDPV2 or Acute Flaccid Paralysis, and not if they are travelling directly to KSA from the UK.
Other recommended vaccines
Hepatitis B
Hepatitis B virus is found in body fluids and can be transmitted either through the skin (percutaneously) or by sexual contact. Percutaneous transmission can occur through the use of contaminated medical, dental, or other instruments; all pilgrims should consider receiving hepatitis B vaccine prior to travel.
One of the Hajj rites for men is head shaving. The KSA authorities provide licensed barbers with a new blade for each pilgrim. However, unlicensed barbers may not conform to this. Pilgrims should avoid shaving with a previously used blade, as this could result in transmission of hepatitis B and other blood-borne infections such as hepatitis C or HIV for which there are no vaccines. Pilgrims can consider taking with them a disposable razor for personal use during this rite.
Meningococcal disease
Meningococcal disease may result in meningitis (infection of the lining of the brain) or septicaemia (blood poisoning) or a combination of both. Less common manifestations of meningococcal disease include myocarditis (inflammation of the heart), pericarditis (inflammation of the sac that surrounds the heart), arthritis, pharyngitis (sore throat) or conjunctivitis (pink eye). Large outbreaks of meningococcal disease, including meningitis and septicaemia, have occurred during previous Hajj pilgrimages and spread to other countries by returning pilgrims.
A conjugated meningococcal ACWY vaccine is the preferred vaccine for all travellers because it not only protects against serious infection but also prevents vaccinated individuals from carrying the meningococcal bacteria and bringing it back with them.
UK Health Security Agency (UKHSA) recommends conjugated meningococcal ACWY vaccine as the preferred vaccine in all instances. Full details of meningococcal vaccines and schedules can be found in Immunisation against infectious disease (the Green Book) and the manufacturers Summary of Product Characteristics.
The UK’s Joint Committee on Vaccination and Immunisation reviewed information on length of protection following ACWY conjugate vaccine and advised that for travellers at continued risk, boosting every five years would be a sensible approach until data becomes available. These vaccines do not protect against all the causes of meningitis and septicaemia; any pilgrim who becomes unwell after returning from the Hajj or Umrah should contact their GP, NHS 111 or local hospital.
In addition to vaccination, pilgrims should be advised to practice good hand hygiene and to avoid activities that promote exchange of respiratory secretions, such as sharing drinks and eating utensils.
Rabies
There is a risk of rabies in KSA. Pilgrims should be advised of the importance of avoiding contact with wild or domestic animals and to seek urgent emergency medical treatment if any potential exposure (animal bite, lick or scratch) occurs.
Pre-exposure vaccination can be considered. However, rabies vaccination prior to travel does not eliminate the need for post-exposure medical evaluation and additional doses of rabies vaccine. A three-dose course of pre-exposure rabies vaccine simplifies post exposure rabies treatment and removes need, for most travellers, for post exposure rabies immunoglobulin, which is in short supply worldwide.
Influenza
Influenza (the flu) is transmitted via the respiratory route and through contact (direct or indirect) with surfaces on which the virus has been deposited by sneezing or coughing. It is easily transmitted in crowded conditions.
Certain groups are considered at particular risk of complications from influenza. MoH KSA recommends that travellers arriving for Hajj or Umrah are vaccinated against influenza.
General Health
In the UK, the flu vaccine is available free for those in clinical risk groups and eligible pilgrims should receive influenza vaccine annually from their usual healthcare provider. Those who do not fall into any of these risk categories can still pay and be vaccinated at some high street pharmacies, or with us, but a vaccine may not be available in the UK summer months.
New winter season Flu vaccine for the northern hemisphere is usually available in the UK from late August-September at the earliest; pilgrims planning to undertake Hajj the following year should ensure they are vaccinated during the flu season before as this may still confer some protection. Southern Hemisphere influenza vaccine is not usually available in the UK.
Viral respiratory infection (known as Hajj cough) experienced by many pilgrims at the Hajj, can range from a mild inconvenience to a severe illness, and can interfere with performing the rites. Advice about influenza prevention can be found in our factsheet on influenza.
Pilgrims should ensure they are up to date with all routine immunisations, and ideally see their travel health expert at least four to six weeks prior to performing Hajj for advice on vaccinations, malaria chemoprophylaxis (if appropriate for travel before or after the pilgrimage), food and water precautions, risks from insect bites, heat exhaustion and injury prevention.
Performing the rituals of Hajj is demanding and involves walking great distances usually in hot weather. Pilgrims should ensure that they are physically fit before travelling, and pilgrims with pre-existing medical conditions should discuss the suitability of travel with their doctor. If on prescribed medications, they should ensure they have a sufficient supply to cover their time abroad with some extra in case of delays, and carry a copy of their prescription.
MoH KSA advises that pilgrims consider their physical ability and health conditions before considering attending Hajj and Umrah.
In some situations, deferment of Hajj should be considered when the risks to the pilgrim are assessed to be high.
Pilgrims should identify in-country healthcare resources in advance of their trip, and ensure they have adequate health insurance should they fall ill. Sharia compliant health insurance is available.
Pilgrims should also pack a first aid kit to help them manage common issues such as cuts and grazes, headaches and travellers’ diarrhoea.
Performing the rituals of the Hajj and Umrah is demanding and often involves walking long distances in hot weather. Pilgrims must ensure that they are as physically fit as possible.
Women’s Health
Women who wish to delay menstruation to avoid having their periods during the Hajj should discuss this with their healthcare provider well in advance of travel.
Details of the requirements and recommendations for Hajj 1444H, including required and recommended vaccinations, COVID-19 and general health advice are available on the Ministry of Hajj and Umrah Nusuk Hajj platform.
