HEALTH at HAJJ & Umrah

Before Travel

Pre-Hajj Health Tips:

•Taking the necessary vaccinations, especially the elderly and those suffering from chronic diseases. Herein is an elaborate account of the required vaccinations, to be enumerated later on, as well as the timing of taking such vaccinations prior to setting out for the Hajj Holy Sites.

• Seeing a doctor before travelling to verify of your health stability, and ability to perform the Hajj rites.

• Taking sufficient medications, especially in case you suffer from one of the diseases that require you to take medications regularly, such as heart diseases, hypertension, kidney diseases, asthma and diabetes.

• Bringing enough cloths, since you’d better change your cloths regularly and repetitively to maintain your hygiene. Cloths are recommended to be light and loose.

• Carrying a detailed report of the medical diagnosis of your case, and the required medications and doses, to help follow up your case when need be.

• Be sure that your personal bag includes the necessary cleaning tools and supplies (towel, shavers, tooth paste and brush, umbrella, loose cotton cloths, moisturizing creams, etc.).

• By sure that your medical bag includes wound-sterilizing tools, heatsink, and painkillers.

• In case you’re a diabetic, be sure to have a blood sugar measurement device.

• It is advisable to move your legs every now and again while sitting in the plain or bus, and walk for a while every hour or two hours, to avoid kibe (swollen feet).

• In case you’re a tuberculosis patient, you have to undergo all the necessary medical tests and submit the results that prove infection could not be transmitted from you to other pilgrims. Pilgrimage is not recommended until after you complete treatment, and get recovered.In case you’re suffering from persistent cough for more than two weeks, you have to undergo the necessary before travelling to be sure that you don’t have tuberculosis.Means of transport (planes, buses, etc.) are among the most vulnerable places of infection transmission (through coughing, sneezing, speaking, etc.). So be sure to use handkerchiefs when coughing or sneezing, or even face-masks when need be.Hajj Vaccinations:It is of high importance to take vaccinations (according to the table shown below) longenough before Hajj. It is indispensably necessary for protecting yourself as well as fellow pilgrims. Some of these vaccinations are compulsory and some are optional. And in all cases, you should consult a doctor before taking the vaccination.

Vaccination TARGET GROUP TIMING NOTES
Meningococcal vacination All pilgrims and children over two, as well as pregnant women At least 10 days before Hajj Compulsory for 3 years immunity
Vaccination against yellow fever Pilgrims hailing from places affected by the disease, such as African semi-desert regions and some South American countries At least 10 days before Hajj Upto ten year immunity
Vaccination against seasonal influenza All pilgrims especially the elders, those suffering from chronic disease,patients with immunodifeciency(natural and acquired alike)as well as patients with metabolic diseases, obese persons, and pregnant woman(beginning with the fourth month). Six weeks before Hajj
vaccination against pnemonia Patients with such diseases as sickle cell anemia renal failure immunodeficiency, and splenectomy. It could be given, also, to the elders and those suffering from chronic diseases in the liver, heart and lungs
Polio vaccination Pilgrims of all age groups hailing from all regions stricken by polioAt least 10 days before Hajj Another dose is given to the pilgrim when arriving to the kingdom
Be sure to carry about the card that proved that you have taken the necessary vaccinations when arriving at the Saudi ports (land, sea and air ports).Negligence of vaccinations, or obtaining certificates of fake vaccination are not to be tolerated. All such attempts are punishable by law

During Hajj

Health Tips to Be Followed During Hajj:

First: Health Tips for Hajj and Umrah Pilgrims:

Pilgrims, when coming for Hajj or Umrah, are supposed to abide by a variety of health tips and guidelines,by following which they will be against infectious and communicable diseases, Allah willing. Following are some of such tips:

1. Hygiene and General Cleanliness Tips:

Maintaining personal hygiene, bathing regularly, and washing hands well by using waterand soap, or other disinfectants used for handwashing, especially after coughing and sneezing.

• Using handkerchiefs when coughing or sneezing by covering the nose and mouth, and then eliminating them in the trash. In case there are no handkerchiefs at hand, use the upper arms rather than hands.

• Using a face-mask, especially in crowded places, and changing it every now and then.

• In case there are no handkerchiefs at hand, use the upper arms, rather than hands, for covering the nose and mouth when coughing or sneezing.

• Wash your hands well, using water and soap, or the hand-sterilising gel, especially after bathing, after coughing and sneezing, before eating, and when coming back to your residence.

• Paying close attention to the oral and dental cleanliness.

• Eliminating wastes in the trash.

• Changing cloths with new ones every now and then.

• Paying close attention to the cleanliness of your residence, on a daily basis.

• Avoiding spitting on the floor, since it is a hazardous source of infection.Even though hand-washing is always necessary, it is even more necessary during Hajj.Don’t spit on the floor. It is a hazardous source of infection transmission.Face-masks are recommended at crowded and congested places, especially during circumlocution of the Ka’ba (Tawaf), stoning (Rajm), and walking between Safa and Marwa (Sa’i). They should be changed regularly (every six hours), or when dirty, in accordance with the guidelines provided by the manufacturer, along with washing hands with water and soap when taking them off.

2. Shaving and Hair cutting Tips:

When shaving or hair cutting, be sure to follow certain health tips and instructions to protect yourself against such infectious diseases as hepatitis (B) and © and AIDS. Such tips include:

• Choose a suitable barber, and never go to street barbers.

• Once-use shavers are recommended. Keep away from all other kinds of shavers, including the ones which have their razors changed after every shave.

• Never share others with such personal tools as the brushes used to remove hair, sponges, etc.

• Ask the barber to wash his hands well (by using water and soap) before shaving or hair cutting.

• Remember that using your own shavers, and not sharing others with theirs, is the best way to protect yourself against the infection of hepatitis (B) and ©, and maybe AIDS.

3. Protection Against Food Poisoning During Hajj:

• Wash fruits and vegetables well before eating.

• Verify of the expiry date when buying canned foods and drinks.

• Keep away from the uncovered food, since it is exposed to insects and pollution.

• Wash your hands well before and after preparing food.

• Wash your hands well before and after eating.

• Cooked food should be eaten immediately after cooking, and, when need be, it could be kept in the fridge.

• Avoid storing cooked food in buses for long when moving from on Hajj site to another. This is one of the major triggers of food poisoning during Hajj.Remember that storing cooked food for more than two hours in the room/bus temperature may lead to the growing of bacteria causing food poisoning.

4. Tips for Protection Against Heat Exhaustion and Sun Strokes:

• Drink enough liquids (water, juices, etc.) regularly.

• Avoid exposure to the sun for long, and use an umbrella when necessary. Light colored umbrellas are recommended.

• Avoid making excessive effort, and keep to take sufficient sleep after performing each of the Hajj rituals, so as to restore your energy.

• Loose, light colored cloths are recommended. Don’t use heavy cloths.

Areas of Frequent Heat Injuries:

Heat injuries are frequent in these areas:

• Tawaf (circumlocution of the Ka’ba), especially at midday times.

• Sa’i (walking between Safa and Marwa), especially in cases of crowding and high temperature.

• Arafat at midday time.

• Mina (placesof slaughtering the sacrificial animals and stoning), due to the long distance and congestion.On the onset of the signs and symptoms of heat exhaustion or sun strokes (high body temperature, headache, dizziness, nausea, fatigue, thirst, and/or cramping of the abdominal and leg muscles), you should:–Getting away from the sunny to a shady place.–Cooling the body by cold water.–Taking enough sleep.–Taking antipathetic and painkillers when necessary.–Heading for the nearest health centres in severe cases.

5. Tips for Patients with Chronic Diseases:

• Consult your doctor before setting out for Hajj, to assess your health situation.

• Take with you sufficient medications, and keep them properly.

• Take medicines on time.

• Adhere to the doctor’s instructions, such as following a certain diet.

• Put on the wrist strap (or the information card), which shows your name, age, disease, the kind of treatment, address and contact information.

• You’d better tell your fellow pilgrims about your disease and proper medications, so that they can help you when necessity be.

• Avoid making too much effort, and use the Hajj legal concessions (like assigning someone to do the stoning ritual on your behalf), when the conditions of such concessions are true.• Head for the nearest health centre when necessity be.

• For more information on chronic diseases, check out the chronic diseases section in the Main Menu. Second: Common Diseases during Hajj: When performing the Hajj and Umrah rites, pilgrims are vulnerable to the diseases commonly associated with the Hajj season, including:

• Respiratory diseases.

• Gastrointestinal (digestive) diseases.

• Food poisoning.

• Dermatology (skin diseases)

• Dry eye.

• Sun strokes and heat exhaustion.Respiratory Diseases:Among the common diseases during Hajj are: Oryza (cold), seasonal influenza and bronchitis. They are transmitted through the droplets of coughing, sneezing or speaking.Prevention and Reduction of Spread:

• Putting on face-masks, especially in crowded and congested places, and changing them every now and then, in accordance with the manufacturer’s instructions.

• Using handkerchiefs to cover the nose and mouth when coughing or sneezing, and disposing them in the trash. In case there aren’t handkerchiefs at hand, use, instead, the upper arms rather than the hands.

• Don’t touch your eyes, nose or hands with the hands until after washing them well.

• Greeting others by shaking hands only.

• Don’t drink ice water.• Keep away from the air conditioner when sweated.On the incidence of any of these diseases, follow these tips:

• Take enough sleep, and drink much liquids containing Vitamin C, such as lemonade and orange juice.

• Take antipathetic and painkillers.

• See a doctor on the onset of acute symptoms.Tuberculosis and Hajj:Tuberculosis is one of the diseases that could be easily transmitted during Hajj, because of the overcrowding, and because some pilgrims hail from places stricken by this disease. It is transmitted through the droplets of coughing, sneezing or speaking. Therefore, the Saudi Ministry of Health calls upon tuberculosis patients to put their Hajj off for later years, except in these cases:

• The result of spitting is negative, which indicates the diseases is unlikely to be transmitted.

• Tuberculosis is unable to resist antibiotics.

• The patient is a strict adherent to the medicine schedule.In case you’re suffering from continuing cough for more than two weeks, you have to undergo the necessary tests before travelling for Hajj, to be sure you don’t have tuberculosis.

Prevention and Reduction of Spread of Tuberculosis during Hajj:

• Put on a face-mask, especially in crowded and congested places.

• Keep, as much as possible, away from overcrowded places.

• Use handkerchiefs to cover the nose and mouth when coughing or sneezing, and disposing them in the trash.

• Wash your hands well every now and then.

• Keep your residence always well ventilated.

• In case there is a fellow Hajj coughing all the time, tell the doctor of your Hajj Mission.

• In case you have tuberculosis, tell the doctor of you Hajj Mission to follow you up during Hajj.

• When getting back home, after Hajj, it is advisable to see your doctor to undergo the necessary tests, to ensure that you haven’t been infected with tuberculosis during Hajj.Using face-masks, especially in overcrowded places, and changing them every now and then (in accordance with the manufacturer’s instructions) helps protect you from the infectious diseases transmitted through coughing or sneezing.Digestive Diseases:There is a set of diseases affecting the digestive system commonly associated with Hajj, such as diarrhoea, constipation, nausea and vomiting. In order to avoid complications, you’d better adhere to the

following tips and instructions:

Diarrhoea:

• Keep away from fatty foods.

• Verify of the cleanliness of food, and cook it well, and don’t buy foods from street vendors (See the Prevention of Food Poisoning).

• Drink much liquid to avoid dehydration.

• Head for the nearest health centre if diarrhoea persists. Constipation:

• Eat much fresh fruit and vegetables.

• Drink much liquid. Nausea and Vomiting:

• Don’t eat and drink too much, especially fatty foods, until nausea and vomiting stop.

• Drink frequently to avoid dehydration.

• See a doctor in case vomiting is severe or persisting.

Food Poisoning during Hajj:

Many pilgrims are prone to food poisoning, especially the kind of poisoning caused by salmonella, which leads to acute inflammation in the intestine and colon, and entails such symptoms as stomach ache, headache, high temperature, diarrhoea and vomiting.

Infection can be transmitted through:

• Negligence of cleaning vegetables before having them.

• Negligence of washing hands before preparing (or having) food.

• Negligence of cooking meat well.

• Drinking unpasteurised milk.

• Eating some foods uncooked (such as eggs), or some foods which contain uncooked eggs as an ingredient (such as mayonnaise), when kept in improper temperature.

• Eating “shawarma” without taking the necessary health precautions. It has been proven as the cause of many injuries. Prevention:

• Wash your hands well before and after eating.

• Wash fruits and vegetables well before having them.

• Avoid keeping cooked food in buses when moving from one Hajj site to another. It is regarded as one of the major causes of food poisoning during Hajj.

• Keep in mind that keeping uncooked food in the room temperature for more than two hours leads to the growing of bacteria causing food poisoning.

• Cooked food should be eaten directly, or kept in the fridge when need be.

• Using pure water for drinking and cooking, and canned mineral water is preferred. In case you’re unsure whether or not the water is pure enough, it should be boiled before use.

• Don’t drink water from taps, or unclean ice cubes.

• Make sure that the milk you’re having is pasteurised. Canned juices are preferred also.

• Verify of the expiry date of products, and be sure that the contents don’t leak.

• Keep damageable foods (such as milk products and tuna) in the fridge, before and after opening cans.

• It is advisable to buy automatically packaged foods, and keep away from uncovered foods, or those prepared long time ago.

• Make sure that food is well cooked, to kill bacteria.• Don’t by foods from street vendors.

• You’d better eat fruits with thick crust, such as bananas and oranges, to be certain that they are clean and uncontaminated.• Use clean utensils and plates. Paper plates and cups are preferred.

• Remember that when food has a different colour or smell, this indicates that the foodies spoilt and poisoned.Remember that keeping uncooked food in the room temperature for more than two hours leads to the growing of bacteria causing food poisoning.Dermatological Diseases:Among the most common diseases during the Hajj is exfoliation (between thighs). Prevention:

• Maintaining the personal hygiene and regular bathing.

• Using powder and other moisturising cream when needed.

• Walking in strides to avoid exfoliation as much as possible.

• Keeping in-between thigh area clean and dry. Xerophthalmia (Eye Dryness):It is caused by the dust, dryness of the weather and direct exposure to the sun. Prevention:

• Using sunglasses.

• Being interested in bringing an additional pair of sunglasses in the event that you damaged or lost the other one; it is recommended that its rim be plastic.

• Not using contacting lens only after referring to your oculist.

• Using moisturising eye drops after referring to your oculist. Hajj General Tip:

• Not to kindle fires inside the tents and to use the places designated for cooking.

• Not to sleep on the pavements and roadsides for the pilgrims’ safety.

• Not to get on top of the buses and vehicles.

• Not to jostle and shove during rush times, as this expose all especially the elderly and women for danger.

• To ad hereto the directives issued by the Ministry of Health and other governmental bodies.

• To head to the nearest health facility when needed.

• To use toilet to defecate and urinate in order for the infectious epidemics not to spread.

• Not to slaughter the sacrifice in places not prepare for that such as the roads and by the tents. Hence, this exposes all for the diseases and odour and slaughtering should be in the designated places. Chronic Diseases: Generally speaking, the pilgrims injured with chronic diseases can easily and smoothly perform the rituals if they were to follow the following tips:

• To see the doctor before going on pilgrimage to evaluate your health conditions and prescribe the proper medicine when needed.

• To be interested in bringing an enough amount of the prescribed medicines, storing in a proper way and in a proper, easily reachable place.

• To take medicines on time and adhere to the doctor’s other guidelines, with the diet included.

• To be interested in informing the nearest of you in the residence place and the doctor of the convoy with your disease and the medicines which you take to help when needed.

• To make a point of putting ring around the wrist or a card showing your name, age, nationality, the nature of your diseases, residence place, and contact numbers.

• To make a point of holding a detailed medical report on the illness case and the prescribed medicine.

• To adopt the legitimate license whenever its condition are met; if you felt that you are unable to continue some of the Hajj rites such as Jamarat-stoning: you can ask someone to do it instead.

• To stop doing anything when you begin to feel tiredness and overly strained, and take some rest.

• To head to the nearest health centre if you did not feel well even after taking rest or the medicine.

• To follow the prescribed diet for you and keep away from all the bad nutritional habits, which could worsen your case such as having the tea , coffee, or fat foods to excess,Remember that the Hajj is a precious opportunity to give up smoking, you should capitalise on successfully.

Source:Ministry of Health

Post-Hajj Health Tips:

A considerable number of pilgrims undergo some of the common symptoms after the Hajj such as:

strain, muscle pains and aches, headache, cold, laziness, irregular sleep, and complexion-darkening. And such symptoms result from exposure to sunlight beams, excessive movement without adequate fitness, and getting infected with cold and influenza.Here are some pieces of advice related to your health and the health of those living along after returning to your country safely.If you were suffering from flu, make a point of not transmitting the infection to others through sneezing or coughing; and this is through following these preventive procedures:

•Using handkerchiefs to cover the nose and mouth when sneezing or coughing, then throw them away in the wastepaper basket.

• Making a point of washing hands repeatedly in a correct way.And you should do the following:

• Taking a great deal of rest and drinking fluids, as this helps you recover, God willing.

• Taking analgesics when needed.

• Seeing a doctor when necessary.

• If you found out during the Hajj that you would suffer from a specific disease such as diabetes or hypertension, make a point of seeing a doctor and taking the necessary steps after returning from the Hajj.You must have noticed during the Hajj period the importance of physical fitness and keeping up to the ideal weight, so make the Hajj journey a motive to advance the general health and physical fitness.

Source:Ministry of Health

WOMEN & CHILDRENS HEALTH

Women and Children during Hajj:

The Hajj is a hard journey and requires great effort and woman have their own status during the hajj; they could be pregnant, experience the menstrual period or suffer because of their physical configuration from excessive hardship.

Menstrual Period:

If the woman to go on the hajj would like to use PMS pills in order to perform the hajj rites properly, they should follow the following tips:To consult a gynaecologist before going on the Hajj with enough time space (7 days at minimum or according to the gynaecologist’s tips), to make sure of how to take the pills and the proper dose. The goal of these medicines is to stop the blood from coming down; hence woman must make a point of having them at their specific time according to the gynaecologist’s tips. There are some side effects for such pills of which there are nausea, headache, pains in the breast areas, mood swings, and nervousness. Each woman has their own nature, so they must consult the gynaecologist to recognise suitable medicines, helping them perform the Hajj rites smoothly and easily.

Pregnant Women and Hajj:

It is recommended postponing the Hajj for the pregnant woman for the following reasons:They could experience some complications such as inflammations or be vulnerable to any infection due to immunodeficiency and overcrowding. They are likely to sustain sun strokes. They are likely be vulnerable to physical exhaustion as a result of walking for long distances, which could lead to the sustaining of contractions in the lower area of the abdomen and backaches. They are likely to sustain physical injuries as a result of the overcrowding, which could lead to complications affecting the pregnancy safety and fetus life. They are likely to sustain severe drought because of not having enough amount of fluids.The pregnant should postpone Hajj in the following cases:Preterm birth disease history Early miscarriage cases. Suffering from pregnancy diabetes.

Heart and hypertension diseases or kidney patients and others Health Tips for the Pregnant Woman:

To consult an obstetrician in order to know if you could go on the Hajj without sustaining any health complications. To make sure of consulting the obstetrician if they could be vaccinated against the meningitis and influenza before at least ten days of the Hajj. To make sure of bringing all the necessary medicines as enough as all the Hajj period along. To make a point of wearing the proper, snug clothes and shoes. To have an enough amount of fluids. To walk for little period every an hour or two to avoid the venous thrombosis of legs To avoid crowding and to choose the proper times to perform the rites. When you feel bleeding, abdominal contractions, migraine, or high temperature, you should head to the nearest health centre or hospital. To avoid any excessive physical effort and apply the legitimate license according to its conditions when necessary such as using the wheel chair during Tawaf (circumlocution) and Sa’i (walking) when feeling strain.

Infants and Children during the Hajj:

It is recommended not to be accompanied by children who are not at puberty during the Hajj for the following reason:Children are more vulnerable to get infected with diseases such as respiratory tract and digestive tract infections, or gastroenteritis. Children are more vulnerable to lose fluids than adults either because of the high temperature or the little water they consume. Exhaustion tires children during the Hajj and could suppress their appetite; hence leading to the loss of the body’s fluids. Children are more vulnerable to get lost because of the overcrowding during the hajj.

Tips the Parents must know when bringing their children along:

Generally speaking, parents must be interested in making their children adhere to the general health tips during the Hajj (you can refer to the main list of the website) and they must specifically be interested in the following: Making a point of putting a bracelet around the child’s wrist showing their full name. residence place, telephone number, and the name of the convoy. Making sure that the child has taken the main vaccinations. It is recommended that the child take Escherichia coli bacterium (Haemophilia influenza) ten days before travelling if it were among the main vaccinations. Having fluids to excess to avoid drought. Washing hands continuously.Making sure of the cleanliness and dryness of the in-between thighs’ area to prevent exfoliation. Making sure of the food cleanliness. Not bringing children along to overcrowded places as much as possible. Wearing face-masks in the overcrowded places. It is recommended to see a doctor when any health problems occur such as diarrhoea, vomit and high temperature. If your children accompanied you for the Hajj, make sure of giving them the main vaccinations, in addition to other Hajj-related vaccinations.

Source: Ministry of Hajj & Umrah

HEALTH TIPS (CHRONIC DISEASES)

Chronic Diseases and Hajj:

Meningitis

Meningitis is the inflammation of the membranes that surround and protect the brain and spinal cord. It can be caused by many different organisms including bacteria and viruses.

Common Causes

There are many different causes of meningitis. The two most common organisms are viral and bacterial.

• Bacterial meningitis is life-threatening.

• Viral meningitis is rarely life-threatening, but can leave you with lifelong after-effects.

• All causes of meningitis are serious and need medical attention.

• Meningitis can affect anyone, of any age, at any time, however there are at risk groups.

• Meningitis can strike quickly and without warning, so urgent medical attention is essential.

• Vaccines are the only way to prevent meningitis, and until we have vaccines to prevent all types you need to know the signs and symptoms to look out for and the action to take.

• Most people will make a good recovery, but some will suffer life-long after-effects and complications Meningitis facts

• Every year around 2,500 cases of bacterial meningitis, and possibly double that of viral meningitis, occur in the UK.

• 10% of cases result in death.

• 15% of those who survive meningitis are left with severe after-effects such as brain damage, hearing and sight loss, and where septicaemia (blood poisoning) has occurred, loss of limbs and scarring.

• Meningitis kills more UK children under the age of five than any other infectious disease.During the joyous time of pilgrimage to Hajj or Umrah, millions of people from all over the world come together in Makkah, Saudi Arabia. Because of the crowded conditions at ceremonies, accommodation sites and on public transport, those people (pilgrims) are at extra risk of contracting infectious diseases, including meningitis. This leaflet provides important information about bacterial and viral meningitis. It explains the facts behind the fear, why it is important to be vaccinated, and how to recognise the signs and symptoms of this life-threatening disease.Meningitis can affect anyone of any age, or ethnic background. Knowing the signs and symptoms, and taking the appropriate action, can save lives.We are here to answer any questions you might have and to support anyone affected by the disease. We use the Language Line service, which allows us to communicate in over 100 languages. We can also provide translated documents about the disease.Can Meningitis be prevented?A travel vaccine is available to prevent some groups of pneumococcal disease. Group A causes epidemics in Sub-Saharan Africa and results in thousands of deaths each year. In recent years, group W135 has caused outbreaks in pilgrims travelling to the Hajj in Saudi Arabia, and it is now a legal requirement that these visitors are vaccinated against W135.The vaccine protects against groups A, C, W135 and Y, and is available for travellers to ‘at risk’ areas of the world. Always check with your GP or travel clinic for the most up-to-date vaccine information.Adults need to have the vaccine at least three weeks before they travel. Young children may need more than one dose ofa vaccine, so allow enough time before travelling.Always check that your vaccinations are up to date before you travel.There is no vaccine to prevent disease caused by pneumococcal group B, which is the most common cause of bacterial meningitis in the UK.It is important that you know the signs and symptoms.

• Allow plenty of time for vaccination before you travel.

• Make sure you carry the emergency contact information provided by your travel specialist,

• Keep this leaflet with you to remind you of the signs and symptoms of meningitis.What is meningitis?Meningitis’s inflammation of the layers that surround and protect the brain and spinal cord. The most common germs that cause meningitis are viruses and bacteria.Viral meningitis is usually a mild disease, but sufferers can be left with headaches, tiredness and memory loss.Bacterial meningitis is life-threatening and needs urgent medical attention. Most sufferers will recover, but many can be left with serious disabilities and one in 10 will die.Many different bacteria can cause meningitis. In the UK and other areas of the world, including Saudi Arabia and sub-Saharan Africa,meningitis is commonly caused by pneumococcal bacteria.What is pneumococcal septicaemia? Pneumococcal bacteria can cause both meningitis and septicaemia (blood poisoning). Together these conditions are known as pneumococcal disease. Pneumococcal septicaemia can happen with meningitis or on its own. Pneumococcal disease develops very quickly. It is important to know the signs and symptoms so that you can recognise it and get medical help quickly.Meningitis and septicaemia can affect anyone at any age, but babies and young children are most at risk.What are the signs and symptoms?Early signs and symptoms can be similar to common illnesses and can include fever, headache, feeling sick, vomiting, muscle pain and cold hands and feet.The common signs and symptoms of meningitis and septicaemia are listed opposite.For a copy of our symptoms card, which you can keep in your purse or wallet, please call 0800 028 18 28.Common signs and symptoms of meningitis and septicaemia Children and adults Meningitis

• Fever

• Severe headache

• Vomiting• Dislike bright lights• Stiff neck, muscle pain

• drowsy, difficult to wake

• Confusion and irritability Septicaemia

• Fever, cold hands and feet

• Vomiting

• Severe muscle pain, not being able to stand• Spots or rash (see ‘The glass test’ over the page)

• Stomach cramps and diarrhoea

• Drowsy, difficult to wake

• Confusion and irritability Babies and toddlers may also have pale blotchy skin, rapid breathing, an unusual cry, dislike being picked up, and be difficult to wake Symptoms can appear in any order and some may not appear at all.Meningitis and septicaemia often happen together. Make sure you know all the signs and symptoms.Trust your instincts If you suspect meningitis or septicaemia, get medical help immediately.What to do if you suspect meningitis or septicaemia

• If you are on Hajj or Umrah, make sure you get immediate medical attention.

• Describe the symptoms carefully and say that you thinkit might be meningitis or septicaemia.

• If you have seen a doctor but are still worried, don’t be afraid to ask for medical help again.

• If you are in the UK, contact your GP or go to the nearest accident and emergency department.How are the germs spread?The germs that cause bacterial meningitis usually live harmlessly in the back of the throat. Most of us will carry them at some time without becoming ill, and they help us to build up natural protection against the disease. However, the germs can sometimes invade the body and cause disease.The germs are passed from person to person through coughing, sneezing and intimate kissing. They spread more easily in crowded places, such as during pilgrimage.Most cases of meningitis happen alone, but when there is a case of pneumococcal disease there is a small chance that more cases can happen. If you have had close contact with someone who has meningitis, you might need antibiotics to reduce the risk of more cases developing. In the UK, the local health protection unit identifies close contacts and will explain what action needs to be taken.Treating meningitis Bacterial meningitis and septicaemia need urgent hospital treatment with antibiotics. Recognising and treating the disease early will improve the chance of survival and a good outcome.After meningitis and septicaemia Although some people who have had meningitis or septicaemia make a good recovery, many are left with serious after-effects and complications. These include deafness, blindness, loss of limbs, learning difficulties and behavioural problems. The effect of the disease may also cause people to lose their jobs and their relationships to break down.When someone has meningitis, their family and the people around them will also be affected.

For more information on after-effects and the help we can offer, call the Meningitis Trust Freephone helpline on 0800 028 18 28 or visit our website at www.meningitis-trust.org.

Source:Meningitis Trust

KSA HEALTH REQUIREMENTS

Do I need any kind of vaccinations?

vHajj and Umrah visitors must have certificates for the following vaccinations before entering the Kingdom of Saudi Arabia:

Meningococcal Meningitis A certificate of vaccination against Meningococcal Meningitis is required from all visitors from all over the world arriving for the purpose of Umrah or Hajj. The certificate must have been issued not more than three years and not less than ten days before arrival to Saudi Arabia.The responsible authorities in the country from where the visitor comes must ensure that vaccination has been carried out as follows:

• Adults and children over the age of two years must receive the vaccination against meningococcal meningitis with the equivalent vaccine (serogroups A,C, Y and W135).

• Children between 3 months and 2 years of age must be given two doses of the A vaccine with a 3-month interval between the two doses.It must be ensured that all visitors from countries in the African meningitis belt have been vaccinated in their countries, not more than 3 years and not less than 10 days before arrival. This should be documented on the vaccination certificate. Visitors from these countries will be checked at entry points to ensure that they are vaccinated. Suspect cases shall be isolated and preventive measures will be taken in respect of their direct contacts. If the authenticity of the vaccination certificate is felt to be questionable, re vaccination is to be carried out.

Chemo prophylaxis will be administered to all visitors from these countries to lower the carrier rate among them.Yellow Fever All travellers arriving from countries known to be infected with yellow fever (as shown in the World Health Organisation [WHO] Weekly Epidemiological Record) must present a valid yellow fever vaccination certificate in accordance with the International Health Regulations. In the absence of such a certificate, the person will be vaccinated upon arrival and placed under strict surveillance for 6 days from the day of vaccination or the last date of potential exposure to infection –whichever is earlier.

Health offices available at entry points will be responsible for notifying the appropriate Director General of Health Affairs in the region about the place of residence of the visitor.Make sure you take your vaccination certificates with you to Saudi Arabia.Where do I go if I am ill? Are there any hospitals in Makkah?There are many hospitals which provide free healthcare for pilgrims. There are also some private, fee-charging hospitals.Are over-the-counter medicines available in Makkah? Where do I buy them?

Most over-the-counter medicine is available at pharmacies in Makkah. If you are used to a particular brand of medicine or if you take prescribed medication, it is recommended you bring adequate supplies of these.Source: Ministry of Hajj[Notice]Health Regulations for travellers to Saudi Arabia for Umrah & Pilgrimage (Hajj) -1434 (2013)[/notice]Health Regulations for travellers to Saudi Arabia for Umrah & Pilgrimage (Hajj) –1434 (2013)

First:

Regulations must be met by visitors to obtain an Entry Visa for Hajj and Umrah:1-Yellow Fevera) In accordance with the International Health Regulations 2005, all travellers arriving from countries or areas at risk of yellow fever (listed below) must present a valid yellow fever vaccination certificate showing that the person was vaccinated at least 10 days and at most 10 years before arrival at the border.

In case of the absence of such a certificate, the individual will be placed under strict surveillance for 6 days from the date of vaccination or the last date of potential exposure to infection, whichever is earlier. Health offices at entry points will be responsible for notifying the appropriate Director General of Health Affairs in the region or govern orate about the temporary place of residence of the visitor.b) Aircraft, ships and other means of transportation coming from countries affected by yellow fever are requested to submit certificate indicating that it applied disinfection 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 for yellow fever transmission may also be required to undergo inspection to ensure they are free of yellow fever vectors, or disinfected, as a condition for granting free passage (including permission to enter a port, to embark or disembark and to discharge or load cargo or stores).

The following countries/areas are at risk of yellow fever transmission (as defined by the International travel and health 2012):

In Africa:

Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Cote d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, Guinea, Guinea Bissau, Gambia, Ghana, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Rwanda, Senegal, Sierra Leon, Sudan, South Sudan, Togo, Uganda In South and Central America:Argentina, Bolivian Republic of Venezuela, Brazil, Colombia , Ecuador, French Guyana, Guyana, Panama, Paraguay, Peru, Bolivia, Suriname, Trinidad and Tobago 2-Meningococcal Meningitis

a) Visitors from all countries:Visitors arriving for the purpose of Umrah or pilgrimage (Hajj) or for seasonal work are required to submit a certificate of vaccination with the equivalent (ACYW135) vaccine against meningitis issued no more than 3 years and no less than 10 days before arrival in Saudi Arabia. The responsible authorities in the visitor’s country of origin should ensure that adults and children over the age of 2 years are given 1 dose of the equivalent polyacrylamide (ACYW135) vaccine.

b) Visitors from African Countries: For visitors arriving from countries in the African meningitis belt, namely Benin, Burkina Faso, Cameroon, Chad, Central African Republic, Côte d’Ivoire, Eritrea, Ethiopia, Gambia, Guinea, Guinea-Bissau, Mali, Niger, Nigeria, Senegal and the Sudan, in addition to the above stated requirements, ciprofloxacin tablets (500 mg) chemo prophylaxis will be administered at port of entry to lower the rate of carriers.

c) Interior pilgrims and the Hajj workers Vaccination with equivalent (ACYW135) vaccine is required for:

• All citizens and residents of Madinah and Makkah who have not been vaccinated during the past 3 years;

• All citizens and residents undertaking the Hajj;

• All Hajj workers who have not been vaccinated in the past 3 years

• Any individual working at entry points or in direct contact with pilgrims in Saudi Arabia.

3-Poliomyelitis All travellers arriving from polio-endemic countries and re-established transmission countries, namely, Afghanistan, Chad, Nigeria and Pakistan regardless of age and vaccination status, should receive 1 dose of oral polio vaccine (OPV). Proof of polio vaccination at least 6 weeks prior to departure is required for visitors from polio-endemic and re-established transmission countries to apply forestry visa for Saudi Arabia and travellers will also receive 1 dose of OPV at borders points on arrival in Saudi Arabia. The same requirements are valid for travellers from recently endemic countries at high risk of re-importation of polio virus, i.e. India.All visitors age under 15 years travelling to Saudi Arabia from countries reporting polio following importation or due to circulating vaccine-derived polio virus in the past 12 months (as of mid-February, 2013, see list below) should be vaccinated against poliomyelitis with the OPV. Proof of OPV or IPV vaccination is required 6 weeks prior to the application for entry visa. Irrespective of previous immunisation history, all visitors under 15 years arriving in Saudi Arabia will also receive 1 dose of OPV at border points. Polio cases related to wild polio virus importation or to circulating vaccine-derived polio virus have been registered during the past 12 months in the following countries: Chad, Kenya, Niger, Somalia and Yemen.

4-Seasonal Influenza:

The Saudi Ministry of Health recommends that international pilgrims be vaccinated against seasonal influenza before arrival into the Kingdom of Saudi Arabia, particularly those at increased risk of severe influenza diseases, including pregnant women, children under 5 years, the elderly, and individuals with underlying health conditions such as HIV/AIDS, asthma, and chronic heart or lung diseases.

In Saudi Arabia, seasonal influenza vaccination is recommended for internal pilgrims, particularly those at risk described above, and all health-care workers in the Hajj premises.

Second:

Health Education Health authorities in countries of origin are required to provide information to pilgrims on infectious diseases symptoms, methods of transmission, complications, and means of prevention.

Third:

Food Material Hajj and Umrah performers are not allowed to bring fresh food in Saudi Arabia. Only properly canned or sealed food or food stored in containers with easy access for inspection is allowed in small quantities, sufficient for one person for the duration of his or her trip.

Fourth:

Responses to International Outbreaks 1-MERS-COV Precautions: The Saudi Ministry of Health recommends that elderly (above 65 years of age) and those with chronic diseases (e.g. heart disease,kidney disease, respiratory disease, diabetes) and pilgrims with immune deficiency (congenital and acquired), Malignancy and terminal illnesses, pregnant women and children (under 12) coming for Hajj and Umrah this year, to postpone the performance of the Hajj and Umrah for their own safety.The Saudi Ministry of Health also advises all pilgrims to comply with common public health guidelines to curb the spread of respiratory infectious disease, which can be summarised as follows:

A –Wash hands with soap and water or disinfectant, especially after coughing and sneezing.

B –Use disposable tissues when coughing or sneezing and dispose it in the waste basket.

C –Try as much as possible to avoid hand contact with the eyes, nose and mouth.

D –Avoid direct contact with the infected persons (people with symptoms such as cough, sneeze, expectoration, vomiting, and diarrhoea) and do not share their personal gadgets.

E-Wearing masks, especially when in crowded places.

F-Maintain good personal hygiene.

2-General Precautions: Updating immunisation against vaccine-preventable diseases in all travellers is strongly recommended. Preparation for international travel provides opportunity to review the immunisation status of travellers. Incompletely immunised travellers can be offered routine vaccinations recommended in national immunisation 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).

3. Emergency Precautions: 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, 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.

Source:Ministry of Hajj & Umrah

KSA ADVICE ON MERS (CORONA VIRUS)

1-MERS-COV Precautions:

The Saudi Ministry of Health recommends that elderly (above 65 years of age) and those with chronic diseases (e.g. heart disease, kidney disease, respiratory disease, diabetes) and pilgrims with immune deficiency (congenital and acquired), Malignancy and terminal illnesses, pregnant women and children (under 12) coming for Hajj and Umrah this year, to postpone the performance of the Hajj and Umrah for their own safety.The Saudi Ministry of Health also advises all pilgrims to comply with common public health guidelines to curb the spread of respiratory infectious disease, which can be summarised as follows:A–Wash hands with soap and water or disinfectant, especially after coughing and sneezing.

B –Use disposable tissues when coughing or sneezing and dispose it in the waste basket.

C –Try as much as possible to avoid hand contact with the eyes, nose and mouth.

D –Avoid direct contact with the infected persons (people with symptoms such as cough, sneeze, expectoration, vomiting, and diarrhoea) and do not share their personal gadgets.

E-Wearing masks, especially when in crowded places.

F-Maintain good personal hygiene.

2-General Precautions: Updating immunisation against vaccine-preventable diseases in all travellers is strongly recommended. Preparation for international travel provides opportunity to review the immunisation status of travellers. Incompletely immunised travellers can be offered routine vaccinations recommended in national immunisation 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).

3. Emergency Precautions: 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, 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.

Source: Ministry of Health, Saudi Arabia

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