Hajj

Each year some 2 million Muslims perform the Hajj, the annual pilgrimage to Mecca. Each Muslim is duty bound to perform one Hajj in their lifetime. Islam stipulates the pilgrim be both healthy and of appropriate means before considering the Hajj. Mecca is located in the south west region of Saudi Arabia, the climate is hot and humid. The Hajj brings travellers from 140 countries worldwide to perform demanding rituals in highly overcrowded conditions. Many of the pilgrims are from the developing world where particular diseases may be endemic.

Health care facilities

Free health care is provided for all pilgrims. There are seven modern, fully equipped hospitals and 73 medical centres providing 24 hour access.

Blood borne diseases

Male pilgrims are at real risk of contracting a blood borne disease such as hepatitis B. Most men have their head shaved at the completion of the Hajj. Razors are often reused and grazes or abrasions from razor nicks are often seen. The MOH now operates and regulate headshaving areas to government standards.

Meningococcal disease

During the Hajj the physically overcrowded conditions, the high humidity and dense air pollution are thought to contribute to meningococcal carrier rates as high as 80%. In March 2000, 300 cases of meningitis W135 were reported in Saudi Arabia and nine other countries. These cases involved Hajjies or their close contacts. The Kingdom is now mandating quadrivalent (ACWY) vaccine for all travellers entering the country for the Hajj, all seasonal staff and local population. The vaccine should be administered at least 10 days prior to travel. Young children between 2 months and 3 years old need 2 doses of the vaccine, 3 months apart.

Respiratory infections

The severe congestion and proximity of pilgrims performing religious rites predisposes to airborne infection. Upper respiratory tract infection is very common. Complications, hospitalisations, and deaths from influenza are greatest in the extremes of age and in those with other health problems. Pilgrims should consider influenza immunisation and the over 65s should have the pneumococcal vaccine.

Diarrhoeal disease

There is a high prevalence of travellers diarrhoea in Hajjies and Saudi Arabia is considered endemic for hepatitis A with 90% of the adults being immune due to natural infection. Hepatitis A vaccination should be given and pilgrims should consider taking a diarrhoea treatment kit containing antibiotics such as ciprofloxacin, loperamide and advice on avoiding dehydration.

Other health risks

Stampedes have been widely reported at the Hajj. In 2006 362 pilgrims died during a stampede. Pilgrims should be warned to be especially cautious in the more confined areas.

Sunburn is common, men wear special garments that expose parts of their upper body. Sun screens should purchased pre travel and should be fragrance free (fragrance of any kind is not permitted during the Hajj). Full thickness burns on the soles of feet have been described from standing on scorching marble floors in the midday sun.