Date: Fri 31 May 2019 Source: Vaxbeforetravel [edited] <https://www.vaxbeforetravel.com/level-1-travel-vaccine-requirements-updated-pilgrims-attending-hajj>

The Hajj, or annual pilgrimage to Mecca, Saudi Arabia, is scheduled for 9-14 Aug 2019, which enables those planning on attending this worldwide event have ample time to appropriately prepare for the trip. The Hajj is one of the world's largest mass gatherings each year and is associated with unique health risks.

More than 2 million Muslims from over 183 countries make Hajj each year, with approximately 11,000 Hajj pilgrims traveling from the United States.

Before attending the Hajj, both the US Centers for Disease Control and Prevention (CDC) and the Ministry of Health in the Kingdom of Saudi Arabia published vaccine requirements and travel recommendations. The CDC updated its Level 1 Travel Alert on 31 May 2019, saying those participating in the Hajj should be up-to-date on all routine vaccines, especially the measles-mumps-rubella (MMR).

The CDC says the measles virus is extremely contagious, and the crowded conditions during Hajj provide an ideal opportunity for measles transmission. As of 7 May 2019, the European Region reported 34 300 measles cases in 42 countries during 2019. For travellers who do not have evidence of measles immunity or who lack written documentation of measles vaccination, the CDC recommends 2 doses of MMR vaccine separated by at least 28 days, to be completed before travel.

Additionally, the Saudi Ministry of Health recommends that Hajj pilgrims confirm they have been vaccinated against these diseases:

- Yellow fever: all travellers arriving from countries or areas at risk of yellow fever transmission must present a valid yellow fever vaccination certificate, stating vaccinated against the disease before the arrival of the Kingdom no later than 10 days and not more than 10 years. The Stamaril vaccine is available in the USA.

- Meningococcal meningitis: visitors are required to submit a valid vaccination certificate with a tetravalent (ACYW135) meningococcal vaccine administered no less than 10 days prior to arrival to Saudi Arabia.

- Poliomyelitis: travellers arriving from countries with circulating wild or vaccine-derived poliovirus (cVDPV2) and from countries at risk of polio reintroduction, are required to submit a valid polio vaccination certificate. - Seasonal influenza: the Ministry of Health in the kingdom of Saudi Arabia recommends that all pilgrims get vaccinated against the 2018/19 seasonal influenza.

Previously, on [15 Apr 2019], a joint declaration regarding vaccinations was issued at the Afghanistan-Pakistan Eminent Ulama Conference. In his opening address, His Excellency the Deputy of Al Azhar Al Sharif, Dr Saleh Abbas Goma Saleh, called upon parents to vaccinate their children to protect them from harm. "The family bears the responsibility of the proper upbringing of, and caring for children and maintaining their health," he said.

The CDC suggests scheduling a visit with a travel vaccine specialist at least 4 to 6 weeks before departure. Travel vaccine counselling sessions can be scheduled at Vax-Before-Travel [<https://www.vaxbeforetravel.com/vax-before-travel/appointment>].

The CDC Vaccine Price List provides the private sector vaccine prices for general information, and vaccine financial support programs can be found at Vaccine Discounts. And, pack enough prescription and over-the-counter medicines to last your entire trip.

The CDC says if you develop a fever and symptoms of respiratory illness within 14 days after traveling from countries in or near the Arabian Peninsula, you should call a healthcare provider and mention your recent international travel.

Americans traveling abroad can enrol with the nearest US embassy or consulate through the Smart Traveler Enrollment Program [<https://travel.state.gov/content/travel/en/international-travel/before-you-go/step.html>] to receive the latest safety updates and assistance in an emergency.  [Byline: Don Ward Hackett]
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[Saudi Arabia issues its requirements for entry into Saudi Arabia for the Hajj, which are updated annually.

The Hajj requirements for 2019 can be found at
<https://www.saudiembassy.net/hajj-requirements>. - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Saudi Arabia: <http://healthmap.org/promed/p/131>]

Date: 26 May 2019
Source: Saudi MOH 23-26 May 2019 [edited]
<https://www.moh.gov.sa/en/CCC/events/national/Pages/2019.aspx>

In the past 4 days since the last update, there have been a total of 3 newly confirmed cases of MERS-CoV infection including 2 deaths reported from Saudi Arabia.
Date: Sun 21 Apr 2019 14:40 IST
Source Business-Standard [edited]
<https://www.business-standard.com/article/pti-stories/health-ministry-left-with-no-vaccines-for-haj-pilgrims-119042100274_1.html>

Following the ban on the Ghaziabad-based pharmaceutical company Biomed Pvt Ltd, the ministry is now looking for options to arrange the vaccines in time for vaccinating the pilgrims, the sources said. Around 1.27 lakh people are expected to go for the annual Hajj pilgrimage in July this year [2019] for which the ministry will have to arrange for at least 1.47 lakh doses. [A lakh is a unit in the Indian numbering system equal to one hundred thousand (100,000).] Extra vaccines are kept as some are rendered ineffective in the process of delivery to the states.

The Health Ministry is already in talks with 2 firms which import the vaccines, the sources said. Those going to Saudi Arabia for the purpose of Umrah or pilgrimage are required to submit a certificate of vaccination with the quadrivalent (ACYW135) vaccine against meningitis, proving the vaccine was administered no more than 3 years ago and no less than 10 days before arrival in the country.

Biomed Pvt Ltd was a licensed indigenous manufacturer for meningococcal polysaccharide vaccine while 2 firms M/s Sanofi Pasteur India Pvt Lt, Mumbai and M/s GlaxoSmithKline Pharmaceuticals Ltd, Mumbai are importers for quadrivalent meningococcal meningitis conjugate vaccine in the country. "Earlier with Biomed Pvt Ltd providing the vaccines, government spent Rs 250 [about USD 3.60] for each vaccine but now if they have to buy from companies which import the vaccines, they may have to shell out around Rs 1500 [about USD 21.50] per dose. The Health Ministry is already in talks with the 2 firms which import the vaccines," the sources said.

Biomed Pvt Ltd was directed to stop the manufacture, sale, and distribution of all human vaccines including the quadrivalent meningococcal meningitis vaccine after type-2 polio virus was found in the sewage and stool samples in Maharashtra, Telangana, and Uttar Pradesh in September [2018]. The polio drops were sent for testing, which confirmed that some of them were contaminated with type-2 virus, a strain believed to have been eradicated in 2016.

The managing director of Biomed Pvt Ltd., which was supplying polio vaccines for only government-run immunisation programmes, was arrested after the central drug regulator filed a complaint and an FIR [first information report] was registered.

The destruction of traces of type-2 polio virus was ordered by the central drug regulator to all manufacturers in 2016.
======================
[The problem with oral polio vaccine manufactured by Biomed Pvt Ltd. being contaminated by poliovirus type 2 was discussed by ProMED-mail moderator MPP in Poliomyelitis update (46): (India, Papua New Guinea) trivalent vaccine, fatal http://promedmail.org/post/20181002.6065964.

Umrah and Hajj are pilgrimages to Mecca, Saudi Arabia, performed by Muslims. Umrah can be undertaken at any time of the year, in contrast to the Hajj. The days of Hajj in 2019 begin in the evening of Fri 9 Aug and end in the evening of Wed 14 Aug. The Hajj is a mandatory religious pilgrimage to Mecca, Saudi Arabia that must be carried out at least once in their lifetime by all adult Muslims who are physically and financially capable of undertaking the journey (<https://en.m.wikipedia.org/wiki/Hajj>); the Umrah is not compulsory (<https://en.wikipedia.org/wiki/Umrah>).

Saudi Arabia issues its requirements for entry into Saudi Arabia for the Hajj, which are updated annually. The Hajj requirements for 2019 can be found at <https://www.saudiembassy.net/hajj-requirements>. With regard to vaccinations, "The applicant must submit proof of vaccination for meningitis and ACYW135. For infants and children up to 15 years of age, a vaccination report is required for polio as well as meningitis and polio.

Children over 15 years of age should present the same vaccinations requested for adults:
============================
a. meningitis and ACYW135;
b. seasonal (or common) flu, which should be taken 2 weeks before applying for the visa;
c. H1N1 flu, if a vaccine is made available before Hajj season, and should be taken 2 weeks before applying for the visa;
d. infants and children up to 15 years of age should provide a vaccination report for meningococcal and polio;
e. children above 15 years of age should present the same vaccinations requested for adults;
f. health experts advise the following groups to postpone their plans for Hajj and Umrah this year for their own safety: The elderly, the terminally ill, pregnant women, and children." "Travelers must carry vaccination certificates with them for inspection by the Saudi Authority at port of entry." - ProMED Mod.ML]

[HealthMap/ProMED map of India: <http://healthmap.org/promed/p/142>]
Date: 8 Apr 2019
Source: Saudi MOH 6-8 Apr 2019 [edited]
<https://www.moh.gov.sa/en/CCC/events/national/Pages/2019.aspx>

Since the last update on 5 Apr 2019 [See MERS-CoV (40): Saudi Arabia (SH) http://promedmail.org/post/20190405.6406661], there have been a total of 6 newly confirmed cases of MERS-CoV infection reported by Saudi Arabia. In addition, there were 4 outcome reports, one fatality, and 3 recoveries, all previously confirmed cases. [note that information on 7 Apr 2019 events were reported today, 8 Apr 2019].
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[With the addition of these 6 newly confirmed cases, there have been a total of 127 cases of laboratory confirmed MERS-CoV infection reported by Saudi Arabia since 1 Jan 2019. Three of the newly confirmed cases were from Al Khafji, bringing the total number of cases reported from Al Khafji since 29 Mar 2019 to 9, with the 1st case classified as a primary case with a history of contact with camels, and the additional 8 cases classified as unspecified secondary cases.

The remaining 3 cases reported today [8 Apr 2019] include one case each from Makkah, Riyadh and Najran regions.

The HealthMap/ProMED map of Saudi Arabia can be found at
<http://healthmap.org/promed/p/131>.

A map showing the regions of Saudi Arabia can be found at
<http://www.geocurrents.info/cartography/customizable-maps-iran-saudi-arabia-malaysia-indonesia/attachment/regions-of-saudi-arabia-map>. - ProMED Mod.MPP]
Date: Thu 14 Feb 2019
Source: Saudi MOH 13-14 Feb 2019 [edited]
<https://www.moh.gov.sa/en/CCC/events/national/Pages/2019.aspx>

In the past 2 days since the last update [12 Feb 2019], there have been a total of 2 newly confirmed cases, 2 fatalities, and 2 recoveries reported by Saudi Arabia. In addition, there have been 5 cases previously listed as on home isolation that were changed to hospitalized, and 6 additional cases whose transmission classification was changed from the initial report.

Information on newly confirmed cases:
<https://www.moh.gov.sa/en/CCC/events/national/Documents/Epiwk7-19.pdf>
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