During your trip: Be aware of your surroundings. Hajj is one of the largest mass gatherings in the world. Know that your risk of accidental injury increases in large crowds. Locate the exit routes and medical facilities. Protect yourself against food or waterborne infections by eating and drinking safely during Hajj. Protect yourself from Middle East Respiratory Syndrome Corona virus (MERS-CoV) while you are travelling.
Avoid close contact with animals, particularly camels. Camels have been found to carry and transmit MERS-CoV to humans through contact with and consumption of meat and body fluids. If you must visit a farm or market, make sure you practice good hygiene and wash your hands before and after contact with animals.
Protect yourself and others from the spread of germs and flu-like illnesses. Wash frequently with soap and water. It’s a good idea to always keep some alcohol-based hand sanitizer with you if soap and water are not available.
Avoid touching your eyes, nose and mouth with your hands. Try to avoid contact with people who appear to be sick. Use only new razors for shaving. Choose a barber who uses disposable, single-use blades. Follow sun and heat safety tips. Heat-related illnesses and dehydration are common during the Hajj.
Hajj pilgrims should stay well hydrated, wear sunscreen, and seek shade when possible. Some rituals may also be performed at night to avoid daytime heat. Drive with caution. The leading cause of death among international travelers is traffic accidents. Follow road safety rules to avoid injuries. Take extra care when crossing roads and always wear a seatbelt when travelling in motor vehicles. For more information on road travel in Saudi Arabia, visit the Safety & Security section of the Arabia.
Protect at all times, drink water and beverages that are sealed or known to have been purified and eat food that is served piping hot or fruit that you have peeled yourself. For shaving, be aware that unclean razors can transmit viruses such as hepatitis B, hepatitis C, and HIV. Travelers should be shaved using disposable blades at officially designated centres, or use their own disposable blades and avoid sharing personal hygiene tools.
Try to avoid the most densely crowded areas during Hajj and, when options exist, perform rituals at non-peak hours.
What if I get sick? If you get sick while overseas or on your return, seek prompt medical attention. If you become unwell on your return to Nigeria be sure to advise your doctor of your recent travel to the Middle East.
Be aware of how to manage travelers’ diarrhoea, including drinking plenty of fluids made up with oral rehydration salts (ORS) to avoid dehydration. Be aware of the early symptoms of meningococcal disease which may include fever, headache, nausea and vomiting, weakness, neck stiffness and a rash. If you develop these symptoms you need to seek medical attention immediately. If you develop flu-like symptoms during the pilgrimage (fever, cough or shortness of breath) or other symptoms, such as vomiting or diarrhea, report your symptoms to the medical staff accompanying your group or to the local health services. If you notice these symptoms during the flight, tell the flight attendant before you land or the border services officer as you enter the country. They will notify a quarantine officer who can assess your symptoms.
Make sure you review the advice published each year on the Saudi Arabian Ministry of Health website which includes advice on the health requirements for receiving entry to Saudi Arabia for the Hajj.
Vaccinations: All travelers should be up to date with their routine vaccinations including those against measles, mumps and rubella (MMR), diphtheria, tetanus and pertussis (dTpa) and polio. For travelers who do not have evidence of measles immunity or who lack written documentation of measles vaccination, the CDC recommends 2 doses of MMR vaccine separated by at least 28 days, to be completed before travel.
Following outbreaks of meningococcal disease in past years, there is a requirement for all Hajj pilgrims to show proof of meningococcal vaccination before Hajj visas can be issued. Hajj pilgrims must have had a quadrivalent (A/C/Y/W135) meningococcal vaccination within the previous 3 years (for polysaccharide vaccines) or previous 8 years (for conjugate vaccines) and at least 10 days before arriving in Saudi Arabia.
Travelers from countries or areas at risk of Yellow Fever (including Nigeria) must also carry a valid Yellow Fever vaccination certificate. Seasonal is also recommended for pilgrims. You should also discuss with your GP or travel clinic the need for additional vaccines such as those against pneumococcal pneumonia, hepatitis A, hepatitis B and typhoid. Poliomyelitis: Travelers arriving from countries with circulating wild or vaccine-derived poliovirus (cVDPV2) and from countries at risk of polio reintroduction are required to submit a valid polio vaccination certificate. Vaccinations should be completed at least 2 weeks prior to departure.
Additional CDC Hajj travel insights: Tuberculosis: The crowded conditions during Hajj increase the probability of tuberculosis transmission. Risk is estimated to be about 10% in those with high level of exposure. Many pilgrims come from highly endemic areas and some arrive for Hajj with active pulmonary disease. Diarrheal disease: A pre-travel visit should include discussions about prevention, oral rehydration strategies, antimotility agents, and emergency antibiotic use for treatment of travelers’ diarrhea. Nasal ablution: Often called ‘istinshaaq’, is the practice of rinsing your nose with water before performing some rituals during the Hajj. Medical literature has identified cases of primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri transmitted as a result of nasal ablution. Nasal ablution is common during Hajj, and pilgrims are advised to use safe water to protect themselves from this potential risk.
At the end of Hajj, Muslim men shave their heads. The use of unclean blades can transmit blood borne pathogens, such as hepatitis B virus, hepatitis C virus, and HIV. Licensed barbers are tested for these blood borne pathogens and are required to use disposable, single-use blades. Unfortunately, unlicensed barbers continue to operate by the roadside, where they use non-sterile blades on multiple men. Male travelers should be advised to be shaved only at officially designated centers, which are clearly marked. People with chronic medical conditions should undergo a functional assessment before leaving for Hajj.
Close to 64 percent of admissions to intensive care units and deaths among pilgrims during Hajj are caused by cardiovascular conditions. Pilgrims with heart disease should carry a supply of all their medications, including copies of all prescriptions. The CDC suggests scheduling a visit with a travel vaccine specialist at least 4 to 6 weeks before departure.
Boil it, cook it, peel it or forget it. Easy to remember, impossible to do! May this period be filled with peace, love understanding and harmony in all communities in Nigeria. Happy Hajj travels to all Nigerian pilgrims.
Dr Ade Alakija
Q-life Family Clinic
