ECDC Public health guidance related to infectious diseases during Hajj 2023
Overview
This year, the annual Islamic Hajj pilgrimage will take place between 26 June and 1 July in Saudi Arabia. Pilgrims aged 12 years and above will be allowed to attend. On average, the pilgrimage attracts over two million people, 0.6 million of whom are from Saudi Arabia and around 1.5 million from other countries across the world. In 2021 and 2022, restrictions were applied due to the COVID-19 pandemic, limiting the number of pilgrims.
The Ministry of Health of Saudi Arabia has issued a list of requirements and recommendations for this event. The main recommendations of relevance for travellers coming from EU/EEA countries are listed below. In addition, preventive measures are foreseen by the Saudi Arabian authorities at points of entry, related to diseases such as COVID-19 (vaccine requirement), meningococcal meningitis, poliomyelitis (additional vaccination at point of entry if coming from countries with detected WPV1 or cVDPV1), Yellow fever (valid certificate requested), Zika virus disease and dengue fever (valid certificate).
Before the Hajj
Required vaccinations for pilgrims from all countries:
- COVID-19: from 12 years of age, approved vaccines are listed here.
- Meningococcal disease: quadrivalent vaccine (serogroups A,C, Y and W135) given within three years
prior to arrival if vaccinated with polysaccharide vaccine, and within five years if vaccinated with conjugate
vaccine. If there is no clear indication of the type of vaccine in the certificate it will be considered valid for
three years only. - Poliomyelitis and Yellow fever vaccinations are required for travellers coming from affected countries
or areas at risk, based on a list of criteria and a list of countries/areas as stated on the website of the
Saudi Ministry of Health.
Recommended vaccinations
- Poliomyelitis: at least one dose of IPV* or OPV** (if IPV is not available) is recommended for travellers coming from countries reporting positive environmental samples of cVDPV2 (no EU/EEA countries listed, for
details please visit the website of the Saudi Ministry of Health.
*bOPV or IPV dose administered within 12 months and no less than four weeks prior to arrival.
** OPV dose administered within six months and no less than four weeks prior to arrival.
- Seasonal influenza vaccine is recommended for people coming to Hajj from all countries, in particular for
those considered at risk, such as pregnant women, children below five years of age, the elderly, individuals
with chronic medical conditions (such as chronic cardiac, pulmonary, renal, metabolic, neurodevelopmental,
liver, or hematologic diseases) and individuals with immunosuppressive conditions (such as HIV/AIDS, those receiving chemotherapy or steroids for malignancy). - Updated vaccination against diphtheria, tetanus, pertussis, polio, measles, varicella and mumps.
Other recommendations
Pilgrims are advised to consider their physical ability and health conditions, keeping in mind that there is an increased risk of infectious diseases for the elderly and those with severe chronic diseases such as advanced cancers, heart and respiratory diseases, advanced liver or kidney diseases, and senility. Those with chronic conditions should have documentation on their health condition and bring a sufficient amount of medicines in their original packaging.
During the stay
Personal and food hygiene recommendations include:
- Wash hands with soap and water or a disinfectant, especially after coughing and sneezing, after using
toilets, before handling and consuming food, and after touching animals. - Use disposable tissues when coughing or sneezing and dispose of used tissues in a wastebasket.
- Wear regular face masks when in crowded places.
- Avoid contact with those who appear ill and avoid sharing their personal belongings.
- Avoid visits and contact with camels in farms, markets, or barns, and avoid drinking unpasteurised milk or eating raw meat or animal products that have not been thoroughly cooked.
- Pilgrims are recommended to take necessary measures to avoid mosquito bites during the day and evening, which includes wearing protective clothing (preferably light-coloured) that covers as much of the body as possible; using physical barriers such as window screens and closed doors; and applying insect repellent (as per the label instructions on the product) to skin or clothing that contains DEET, IR3535 or Icaridin.
After the Hajj
Travellers returning from the Hajj should seek medical attention immediately if they experience symptoms suggestive of any type of infection - e.g. gastrointestinal or respiratory. They should also mention their travel history to their healthcare provider.
Due to the presence of MERS-CoV disease in Saudi Arabia, people returning from the Hajj should be made aware of the need to seek immediate medical advice if they have a fever (38ºC and over), cough or difficulties breathing within 14 days of their return.
Travel history and previous hospitalisation should be reported to the healthcare provider if a person returning from the Hajj requires hospitalisation within one year of returning. This is to ensure that the possible acquisition of antimicrobial-resistant (AMR) bacteria will be considered and that appropriate measures can be taken in accordance with national guidelines for the prevention of AMR.
Outbreaks of MERS-CoV were last reported from the Arabian Peninsula in 2022. To date, no new cases have been reported with disease onset in 2023.
ECDC assessment
The risk to EU/EEA citizens of infection with communicable diseases during the 2023 Hajj is considered to be low,
due to the vaccination requirements for travelling to Mecca and the Saudi Arabian preparedness plans that address
the management of health hazards before, during, and after Hajj. The risk of infection is considered to be moderate for people with underlying conditions, the elderly and pregnant women, with a moderate probability of infection and moderate impact. As with other mass gathering events, the risk of communicable disease outbreaks is highest for respiratory and food- and waterborne diseases, and vector-borne diseases.
The risk of vaccine-preventable and vector-borne diseases is considered low if preventive measures are applied. A risk of infection and importation of cases to Europe after the Hajj remains. ECDC published a rapid risk assessment on Hajj on 2 July 2019; the risks and advice to pilgrims attending the Hajj remain valid for this year.