This publication in the Weekly Epidemiological Record is to inform visitors of the full requirements for entry into Saudi Arabia; it does not imply an endorsement by WHO of all measures stipulated. The Ministry of Health of Saudi Arabia has issued the following requirements and recommendations for entry visas for the Hajj and Umra seasons in 2016.
I. Yellow fever (A) In accordance with the International Health Regulations 2005, 1 all travellers arriving from countries or areas at risk of yellow fever transmission (see list below) must present a valid yellow fever vaccination certificate. The validity of the yellow fever vaccination certificate extends for the life of the person vaccinated, beginning 10 days after the date of vaccination.2 showing that vaccination was administered at least 10 days before arrival at the border. In the absence of such a certificate, the individual will be placed under strict surveillance until the certificate become valid or until a period not exceeding 6 days from the last date of potential exposure to infection have lapsed, whichever is earlier. Health offices at entry points will be responsible for notifying the appropriate Director General of Health Affairs in the region or governorate about the temporary place of residence of the visitor.
The following countries/areas are at risk of yellow fever transmission (as defined by International travel and health, 20163 ). Africa Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, South Sudan, Sudan, Togo and Uganda. Americas Argentina, the Bolivarian Republic of Venezuela, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Paraguay, Peru, the Plurinational State of Bolivia, Suriname and Trinidad and Tobago. (B) Aircraft, ships and other means of transportation arriving from countries affected by yellow fever are requested to submit a certificate indicating that disinsection was applied in accordance with methods recommended by WHO. In accordance with the International Health Regulations 2005, all arriving ships will be requested to provide to the competent authority a valid Ship Sanitation Certificate. Ships arriving from areas at risk of yellow fever transmission may also be required to submit to inspection to ensure they are free of yellow fever vectors, or disinsected, as a condition of granting free pratique (including permission to enter a port, to embark or disembark and to discharge or load cargo or stores).
II. Meningococcal meningitis
- Visitors from all countries
Visitors arriving for the purpose of Umra, Hajj or for seasonal work are required to submit a certificate of vaccination with the tetravalent (ACYW135) vaccine against meningitis, proving the vaccine was administered not more than 3 years and not less than 10 days prior to arrival in Saudi Arabia.4 Both polysaccharide and conjugate vaccines are valid options: the first confers a protection of at least 3 years; the latter at least 8 years. The vaccine should have been administered not more than 3 and 8 years respectively, prior to entry into the country. The responsible authorities in the visitor’s country of origin should ensure that adults and children aged over 2 years are given 1 dose of the tetravalent (ACYW135) vaccine and state clearly the name of the vaccine used on the vaccination card.
- Visitors from countries in the African meningitis belt
For visitors arriving from countries in the African meningitis belt: Benin, Burkina Faso, Cameroon, Chad, Central African Republic, Côte d’Ivoire, Eritrea, Ethiopia, Gambia, Guinea, Guinea-Bissau, Mali, Niger, Nigeria, Senegal, Sudan and South Sudan, the above stated requirements apply. In addition, 1 tablet (500 mg) of ciprofloxacin chemoprophylaxis will be administered to adults (excluding pregnant women) and children over 12 years of age at port of entry to lower the rate of carriers.
- Interior pilgrims and the Hajj workers
Vaccination with tetravalent (ACYW135) vaccine is required for the following:
– all citizens and residents of Medina and Mecca who have not been vaccinated during the past 3 years with a polysaccharide vaccine or 8 years with a conjugate vaccine;
– all citizens and residents undertaking the Hajj who have not been vaccinated in the past 3 years with a polysaccharide vaccine or 8 years with a conjugate vaccine;
– all Hajj workers, including individuals working at entry points or in direct contact with pilgrims, who have not been vaccinated in the past 3 years with a polysaccharide vaccine or 8 years with a conjugate vaccine.
Regardless of age and vaccination status, proof of receipt of a dose of oral polio vaccine (OPV), or inactivated poliovirus vaccine (IPV), within the previous 12 months and at least 4 weeks prior to departure, is required to apply for an entry visa to Saudi Arabia for travellers arriving from the following countries, territories or areas (as of 1 July 2016): (A) those who have uninterrupted indigenous virus transmission: Afghanistan and Pakistan (as of 1 July 2016); (B) those who have had transmission of a circulating vaccine-derived poliovirus within the past 12 months: Guinea, Lao People’s Democratic Republic, Madagascar, Myanmar, Nigeria and Ukraine. C) those which remain vulnerable to polio: Iraq, Somalia, Syrian Arab Republic and Yemen. All travellers from these countries will also receive 1 dose of OPV at border points on arrival in Saudi Arabia. Saudi Arabia encourages vaccination of travellers from polio-free countries which remain at particular risk of importations, such as India and Indonesia.
The Ministry of Health of Saudi Arabia recommends that international pilgrims be vaccinated against seasonal influenza with the most recently available vaccines (i.e. those for the southern hemisphere 2016) prior to arrival, particularly those at increased risk of severe influenza diseases including pregnant women, children aged over 5 years, the elderly, and individuals with pre-existing health conditions such as asthma, chronic heart or lung diseases and HIV/AIDS infection. In Saudi Arabia, seasonal influenza vaccination is recommended for internal pilgrims, particularly those with pre-existing health conditions as described above, as well as for all health-care workers in the Hajj premises.
V. Zika virus disease and dengue
The Aedes aegypti mosquito has not been detected in the Hajj and Umra areas for many years, however this mosquito is present in surrounding cities. The Ministry of Health recommends travellers for Hajj and Umra to take insect bite avoidance measures during daytime and night time hours to reduce the risk of infection with Dengue and other mosquito borne diseases. Zika virus has not been detected in Saudi Arabia. Travellers arriving from Zika epidemic and endemic countries are recommended to take insect bite avoidance measures during daytime and night time hours to reduce the risk of introduction of Zika virus in the country. Further advice is available at WHO website.5
VI. Health education
Health authorities in countries of origin are required to provide information to travellers on symptoms of infectious disease, methods of transmission, complications, and means of prevention. Intense heat have adverse effects on health. Hajj and Umra performers need to be reminded to avoid direct sun exposure, avoid the most densely crowded places, avoid strenuous activity and rest frequently. When the option exists, performance of rituals at nonpeak hours is encouraged. Hajj and Umra performers are advised to drink enough fluid to be able to maintain usual urine production and that older travellers should take particular care to consume extra fluids in hot conditions. Also, consumption of salt-containing food and drink that helps to replenish the electrolytes should be recommended in case of heat exhaustion and after excessive sweating. Countries are encouraged to consider the physical ability and health conditions of individuals applying for Hajj and Umra. Those with severe medical conditions such as terminal cancers, advanced cardiac or respiratory, liver or kidney diseases and senility should be exempted from these religious duties.
Hajj and Umra performers are not permitted to bring fresh food into Saudi Arabia. Only properly canned or VIII. International outbreaks response The Saudi Ministry of Health recommends that visitors aged over 65 years and those with chronic diseases, such as heart disease, kidney disease, respiratory disease, diabetes, and pilgrims with immune deficiency (congenital and acquired), malignancy and terminal illnesses, pregnant women and children aged under 12 years planning to come for the performance of Hajj and Umra in 2016, to postpone their visit for their own safety. To prevent the spread of respiratory infectious diseases, the Ministry of Health of Saudi Arabia also advises all travellers to comply with common public health recommendations, such as:
– to wash hands with soap and water or disinfectant, especially after coughing and sneezing, after using the toilet, before handling and consuming food, and after touching animals;
– to use disposable tissues when coughing or sneezing and to dispose of them afterwards in waste baskets;
– to avoid, as much as possible, hand contact with the eyes, nose and mouth;
– to wear masks, especially when in crowded places;
– to avoid direct contact with persons who appear to be ill with coughing, sneezing, expectorating, vomiting, diarrhoea, and not to share personal belongings;
– to maintain good personal hygiene;
– to avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas;
– to avoid contact with sick animals;
– to avoid drinking raw camel milk or camel urine or eating meat that has not been properly cooked.
Updating immunization against vaccine-preventable diseases in all travellers is strongly recommended. Preparation for international travel provides the opportunity to review the immunization status of travellers. Travellers who are incompletely immunized can be offered routine vaccinations recommended in national immunization schedules (these usually include diphtheria, tetanus, pertussis, polio, measles and mumps), in addition to those needed for the specific travel (e.g. meningococcal vaccination for Hajj). In the event of a public health emergency of international health concern, or in the case of any disease outbreak subject to notification under the International Health Regulations 2005,1 the health authorities in Saudi Arabia will undertake additional preventive precautions (not included in the measures mentioned above) following consultation with WHO and necessary to avoid the spread of infection during the pilgrimage or on return to their country of origin.