Such a large human gathering is a Public Health concern as pilgrims live, travel and pray in extremely close quarters, creating the ideal atmosphere for communicable diseases to spread and possibly mutate.
These infections not only cause disease and death at Hajj but also cause post Hajj out breaks globally, as Hajjis return with different infections to their countries. As a result in a few months following Hajj epidemics of hepatitis A, typhoid, flu and respiratory, eye, skin and other infections are observed all over the world.
Most of these communicable infectious diseases are preventable with general health care measures and immunization, that’s why Saudi Government has made three vaccines compulsory and a has suggested (not compulsory) five other vaccination for Hajj and Ummrah.
Only pilgrims with valid vaccination certificates are allowed to enter the cities of Mekkah and Medina to perform Hajj. Those without these certificates will either be denied entry or may require vaccination upon arrival.
Meningococcal vaccine
There were several outbreaks of meningitis since year 1987 at Hajj, which caused serious illness, ICU admissions and death. So in 2000 Saudi government made it a visa requirement for all pilgrims to receive vaccine against meningitis and get a certificate for it. All children above two years and all adult pilgrims should get vaccinated against meningitis. The certificate should not be issued more than 3 years previously, and not less than 10 days before arrival in Saudi Arabia.
Flu vaccine
Flu vaccine is recommended for all ages above 6 months. Children, adults with nasal allergies and pregnant women require at least 2 doses at one month interval.
Polio vaccine
The Ministry of Health of Saudi Arabia advises that all travelers from Afghanistan, India, Pakistan and Nigeria, should receive at least one dose of oral polio vaccine before departure for Saudi Arabia. All travelers from these countries, regardless of age and previous immunization history, will also be required to receive an additional dose of oral polio vaccine upon arrival in Saudi Arabia. Polio is a highly infectious disease which can spread rapidly, particularly in crowded situations. While most people infected with the poliovirus do not develop polio, paralysis or other symptoms of polio infection, they can still spread the virus. For those who do develop symptoms like paralysis, there is no cure.
Vaccines against Hepatitis A, Pneumonia, Hepatitis B, Typhoid and Tetanus are recommended by the Saudi government.
Heaptitis A attacks the liver. Contaminated food and water are major source of infection. Hands soiled after using the toilet or changing a nappy, or swallowing water or food that has been contaminated by human faeces are the culprits for transmission for the hepatitis A virus. The vaccination against hepatitis A is available and safe to use.
With an estimated three to four million Muslims from around the world converging on Mekkah during Saudi's winter season respiratory disease is the leading cause of hospital admissions during Hajj, with pneumonia accounting for 39% of these admissions. Crowded conditions, dust, fumes and pollution - all of which are prevalent during Hajj - are aggravating factors for getting flu and pneumonia.
Hepatitis-B
Hepatitis B is a highly infectious disease that spreads from infected blood or body fluids. Hepatitis B and HIV can be transmitted either through skin breakages or by close sexual contact. Transmission through the skin may occur through the use of contaminated medical, dental, or other instruments including contaminated barber’s scissors or razors.
Typhoid
It is a bacterial infection. Typhoid is spread by contaminated food and water. Typhoid is preventable with the help of vaccination.
Tetanus
One should get a tetanus shot to be on the safer side since minor cuts and bruises due to falling or scratching are common during Hajj. If you are not vaccinated, make sure you get a shot immediately after getting injured. Tetanus, if it develops, has a very high death rate and very few are lucky to survive it.
Regular use of alcohol/ disinfectant scrubs protects from a lot of transmittable skin diseases, respiratory infections and other infections but even if you do not have access to such materials, simple hand washing with soap gives a lot of protection.
Use of facemask prevents transmission of respiratory infections
Seek medical advice immediately if you develop symptoms of fever, diarrhea or jaundice during or after Hajj or Ummrah. A persistent cough is also significant because of the reported high incidence of tuberculosis among pilgrims.
Patients with chronic diseases like sugar, blood pressure, asthma, heart diseases and renal failure should seek medical check up before leaving their country and use their medicines in timely manner with out negligence or delay to ensure smooth health during Hajj rituals.
Ideally the vaccination should start 4 to 5 months before leaving for Saudi Arabia if one wants to get vaccinated for all the diseases because:
1. Most vaccines require more than one dose to complete the schedule.
2. At one time a maximum of 3 vaccines / injections can be given.
3. There should be an interval of one month between any two rounds of vaccine. Vaccines start becoming active in the first week and usually take 3 to 4 weeks to gain full efficacy so whatever the schedule chosen; it should get completed at least one month before the flight for effective prevention
4. No vaccine except Flu vaccine should be given to pregnant or breast feeding mother.
Mostly people get single vaccination shots in the last week before their departure. Such vaccination programs usually turn out useless and don’t provide full protection during the stay at Saudi Arabia.
References:
1. http://footstepstohajj.wordpress.com/
2. www.cdc.gov/travel/contentHajj.aspx - 28k
3. www.ndsc.ie/hpsc/A-Z/VaccinePreventable/Vaccination/Guidance/File,2083,en.pdf –
5. www.eurosurveillance.org/ViewArticle.aspx?ArticleId=3087 - 33k
6. www.bradford.gov.uk/health_well-being_and_care/food_and_drink/Food+Borne+Illness/Advice_for_hajj/ -
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