Hajj and Umrah

The Ministry of Health of Kingdom of Saudi Arabia issue their requirements and recommendations for Hajj and Umrah annually

Key messages

• Hajj, the annual pilgrimage to Makkah (Mecca), in the Kingdom of Saudi Arabia (KSA) is one of the largest gatherings of its kind in the world.

• Performing the rituals of the Hajj and Umrah is demanding and often involves walking long distances in hot weather. Pilgrims must ensure that they are as physically fit as possible.

• Pilgrims are usually required to have vaccinations prior to attending Hajj/Umrah; these can change yearly. Those required and recommended for Hajj 1445H and Umrah 1445 (2024) are listed on the Ministry of Health, Kingdom of Saudi Arabia website [1, 2]. See also our KSA Country Information page.

• Pilgrims should be advised of the importance of checking the British Foreign, Commonwealth & Development Office (FCDO) for up to date travel advisories.

• Pilgrims should be advised to practise good hand hygiene and to avoid activities that promote exchange of respiratory secretions, such as sharing drinks and eating utensils.

• Influenza is easily transmitted in crowded conditions. Pilgrims in clinical risk groups for influenza should receive influenza vaccine annually from their usual healthcare provider, when available, as this may still confer some protection for their pilgrimage. Influenza vaccine for those not in clinical risk groups would need to be accessed from a private clinic or pharmacy service.

Overview

Usually approximately three million Muslims from around the world gather in Makkah for Hajj each year. All adult, able bodied Muslims are required to undertake Hajj at least once in their lifetime if they can afford to do so [3].

Umrah is a shorter, non-compulsory pilgrimage for Muslims, which is performed as part of the Hajj ritual, but can also be undertaken independently at any time.

Due to the large crowds, mass gatherings such as Hajj and Umrah are associated with unique health risks [3].

Each year, the Ministry of Health (MoH) of the Kingdom of Saudi Arabia (KSA) issues the requirements and recommendations for entry visas relevant to pilgrims and seasonal workers who intend to visit KSA during forthcoming Hajj and Umrah season. Details of the requirements and recommendations for Hajj and Umrah 1445H (2024), including required and recommended vaccinations and general health advice are available from the Kingdom of Saudi Arabia Ministry of Health [1, 2]. Requirements and recommendations may differ from year to year.

Hajj, the annual pilgrimage to Makkah (Mecca) in KSA occurs between the 8th and 12th day of the twelfth month of the Islamic calendar and is one of the largest mass gatherings in the world. Hajj 1445H (2024) is expected to start in June when temperatures may be high. Care will be needed to avoid heat-related illness.

UK residents and British nationals resident in Saudi Arabia can find information on how to register to apply to perform Hajj and Umrah - 1445H (2024) through the official Ministry of Hajj and Umrah Nusuk Hajj platform. This is the only official method of applying to perform Hajj.

A comprehensive guide for applying to perform Umrah, including information for those applying from outside of Saudi Arabia, has been produced by the Ministry of Hajj and Umrah; the Council of British Hajjis' also provide regular Umrah updates.

The Foreign, Commonwealth and Development Office (FCDO) official social media channels @ukinsaudiarabia also provide information and guidance [4].

Health advice for KSA can be found on our Saudi Arabia Country Information page. The information on the country page should be tailored to individual pilgrims and seasonal workers.

Pre-pilgrimage preparation

Pilgrims should seek pre-travel health advice from their health care provider or travel clinic at least four to six weeks prior to travel. Information on health risks for destinations throughout the world can be found on the Country Information pages.

Performing the rituals of Hajj is demanding and involves walking great distances usually in hot weather. MoH KSA advises that pilgrims consider their physical ability and health conditions before considering attending Hajj and Umrah. Pilgrims should ensure that they are physically fit before travelling, and those with pre-existing medical conditions should discuss the suitability of travel with their doctor. In some situations, deferment of Hajj should be considered when the risks to the pilgrim are assessed to be high.

Those on prescribed medications should ensure they have a sufficient supply to cover their time abroad with some extra in case of delays, carry a copy of their prescription and consider carrying documentation of their health condition [1], see our medicines and travel factsheet.

Pilgrims should ensure they are up to date with all routine immunisations and for any vaccines required or appropriate for their trip (see below).

Mass gatherings can amplify the transmission of the respiratory infections. All individuals should follow current UK recommendations to reduce their risk of respiratory infections including COVID-19 and passing it on to others. Travellers who are at increased risk of severe COVID-19 disease should assess their individual circumstances and consider whether postponing travel would be appropriate, see also Vaccination section below.

Women who wish to delay menstruation to avoid having their periods during the Hajj should discuss this with their healthcare provider well in advance of travel.

Pilgrims should identify in-country healthcare resources in advance of their trip, and ensure they have adequate health insurance should they fall ill. Sharia compliant health insurance is available.

Pilgrims should also pack a first aid kit to help them manage common issues such as cuts and grazes, headaches and travellers' diarrhoea.

Vaccination

Pilgrims should be up-to-date with immunisations routinely administered in the United Kingdom (UK) including measles, mumps and rubella (MMR) and diphtheria-tetanus-polio vaccine [5]. Information on required and recommended vaccinations for pilgrims visiting KSA can also be found on our Country Information page.

Required vaccinations

Meningococcal disease

All travellers aged over one year, arriving for Umrah, Hajj or for seasonal work in Hajj zones, are required to submit a valid vaccination certificate with a quadrivalent (ACWY) meningococcal vaccine received at least 10 days prior to the planned arrival to Hajj and Umrah areas [1, 2].

This vaccine is also recommended for personal protection against groups A, C, W and Y meningococcal disease.

Vaccination with ONE of the following vaccines is acceptable:

• Quadrivalent (ACWY) polysaccharide vaccine within the last three years (this vaccine has not been available in the UK for over three years)
• Quadrivalent (ACWY) conjugate vaccine within the last five years

If vaccine type is not indicated on the certificate, it will be considered valid for three years [1, 2].

Details of the vaccine name and type (i.e. conjugate vaccine) should be recorded in a patient held vaccine record showing the individual's full name. It is advisable that the proof of vaccination record is issued by the individual's doctor, nurse or pharmacist and should accurately reflect the details of the vaccine administered and be authenticated with the healthcare provider's official stamp.

Patient vaccination record cards and/or blank ACWY certificates may be available to health professionals from the vaccine provider. Alternatively, if an individual is in possession of an International Certificate of Vaccination or Prophylaxis (ICVP) booklet, meningococcal ACWY vaccine can be recorded in the 'Other Vaccinations' pages.

MoH KSA state they may administer prophylactic antibiotics to some travellers arriving from countries with or at risk of frequent meningitis epidemics or outbreaks [1, 2].

Meningococcal disease may result in meningitis (infection of the lining of the brain) or septicaemia (blood poisoning) or a combination of both. Less common manifestations of meningococcal disease include myocarditis (inflammation of the heart), pericarditis (inflammation of the sac that surrounds the heart), arthritis, pharyngitis (sore throat) or conjunctivitis (pink eye) [6]. Large outbreaks of meningococcal disease, including meningitis and septicaemia, have occurred during previous Hajj and spread to family members and communities on return [7].

In addition to vaccination, pilgrims should be advised to practice good hand hygiene and to avoid activities that promote exchange of respiratory secretions, such as sharing drinks and eating utensils [8, 9].

The meningococcal ACWY vaccines do not protect against all the causes of meningitis and septicaemia; any pilgrim who becomes unwell, including with conjunctivitis, after returning from the Hajj or Umrah should contact their GP, NHS 111 or local hospital.

Poliomyelitis (polio)

A polio certificate requirement will only apply to UK pilgrims if they are travelling to KSA via a country reporting wild poliovirus type 1 (WPV1), circulating vaccine-derived poliovirus type 1 (cVDPV1) or cases of circulating vaccine derived poliovirus type 2 (cVDPV2) or Acute Flaccid Paralysis, and not if they are travelling directly to KSA from the UK.

See Appendix 1: Tables 1 and 2 in Health Requirements and Recommendations for Travelers to Saudi Arabia for Hajj - 1445H (2024)* and Health requirements and Recommendations for Travelers to Saudi for Umrah-1445H(2024)* for country details [1, 2].

*Please note: the status of countries is based on the reporting of wild and circulating vaccine derived polio virus and may change following the WHO Emergency Committee for polio reports. The UK is no longer reporting positive environmental samples of cVDPV2. See latest updates of the WHO Statement of the meeting of the IHR Emergency Committee for polio.

Travellers from countries reporting positive environmental sources samples of circulating vaccine derived polio virus 2 (cVDPV2) are recommended to be vaccinated with at least one dose of IPV within the previous 12 months and at least four weeks prior to arrival, however there is no polio vaccination certificate requirement. If IPV is not available, it is acceptable to be vaccinated with at least one dose of oral polio vaccine (OPV) within the previous six months and not less than four weeks prior to arrival [1, 2].

Yellow fever

All travellers above nine months of age visiting KSA for Hajj and Umrah arriving from countries or areas at risk for transmission of yellow fever (YF) as stated in Appendix 2 Health Requirements and Recommendations for Travellers to Saudi Arabia for Hajj and Umrah - 1445H (2024), must present a valid International Certificate of Vaccination or Prophylaxis documenting YF vaccination [1, 2].

There is no risk of YF in the UK. Therefore, this YF certificate requirement will only apply to UK pilgrims if they are travelling to KSA via a YF risk country and not if they are travelling directly to KSA from the UK.

Other vaccinations

General vaccination advice for KSA can be found on our Country Information page. The following vaccine-preventable diseases have particular relevance to Hajj and Umrah pilgrims.

COVID-19

Those who are invited for COVID-19 vaccination in the UK programme should take up the offer and ensure their vaccination is up to date. Information about the COVID-19 vaccination programme in the UK is available on the NHS website. UK Health Security Agency (UKHSA) Immunisation against infectious disease, the 'Green Book' COVID-19 chapter also gives detailed advice about the clinical risk groups and eligibility for COVID-19 vaccination.

KSA Ministry of Health recommend COVID-19 vaccination for travellers aged 12 years and over intending to perform or attend Hajj or Umrah. However, the COVID-19 vaccine in the UK is currently only available for those eligible for vaccination in the national programme.

Visitors to KSA must also be prepared to comply with any local COVID-19 preventive regulations and procedures required by the Public Health Authority, which could be applied at short notice.

Hepatitis B

Hepatitis B virus is found in body fluids and can be transmitted either through the skin (percutaneously) or by sexual contact. Transmission can occur through the use of contaminated medical, dental, or other instruments; pilgrims should consider receiving hepatitis B vaccine prior to travel.

One of the Hajj rites for men is head shaving. The KSA authorities provide licensed barbers with a new blade for each pilgrim. However, unlicensed barbers may not conform to this [10]. Pilgrims should avoid shaving with a previously used blade, as this could result in transmission of hepatitis B and other blood-borne infections such as hepatitis C or HIV for which there are no vaccines. Pilgrims can consider taking with them a disposable razor for personal use during this rite.

Rabies

There is a risk of rabies in KSA. Pilgrims should be advised of the importance of avoiding contact with wild or domestic animals and to seek urgent emergency medical treatment if any potential exposure (animal bite, lick or scratch) occurs. A rabies information leaflet is available for travellers.

Pre-exposure vaccination can be considered. However, rabies vaccination prior to travel does not eliminate the need for post-exposure medical evaluation and additional doses of rabies vaccine. A three-dose course of pre-exposure rabies vaccine simplifies post exposure rabies treatment and removes need, for most travellers, for post exposure rabies immunoglobulin, which is in short supply worldwide.

Influenza

Influenza is spread via the respiratory route and through contact (direct or indirect) with surfaces on which the virus has been deposited by sneezing or coughing. It is easily transmitted in crowded conditions and pilgrims may be exposed to influenza outside of the typical season if in contact with people from countries experiencing influenza outbreaks [11].

Certain groups are considered at particular risk of complications from influenza. MoH KSA recommends that travellers arriving for Hajj, Umrah or for seasonal work in Hajj areas are vaccinated against influenza [1, 2].

In the UK, influenza vaccine is available free for those in clinical risk groups including certain carers, household contacts and health and social care workers. Eligible pilgrims should receive influenza vaccine annually from their usual healthcare provider [12].

Those who do not fall into any of these risk categories can still pay and be vaccinated at some high street pharmacies, other retailers, or private travel clinics, but a vaccine may not be available in the UK late spring or summer months. New winter season influenza vaccine for the northern hemisphere is usually available in the UK from late August-September at the earliest; pilgrims planning to undertake Hajj the following year should ensure they are vaccinated during the flu season before as this may still confer some protection. Southern Hemisphere influenza vaccine is not usually available in the UK.

Viral respiratory infection (known as Hajj cough) experienced by many pilgrims at the Hajj, can range from a mild inconvenience to a severe illness, and can interfere with performing the rites. Advice about influenza prevention can be found in our factsheet on influenza.

Other health risks

Middle East respiratory syndrome coronavirus (MERS-CoV)

Middle East respiratory syndrome coronavirus (MERS-CoV) can cause severe illness and death [13]. It was first identified in KSA in 2012; most cases to date have occurred in the Arabian Peninsula and in KSA [14, 15]. UKHSA remains vigilant and closely monitors developments in the Middle East and in the rest of the world where new cases have emerged and continues to liaise with international colleagues to assess whether UKHSA recommendations need to change (see below) [15].

UKHSA recommends all travellers to:

• practice good general hygiene measures, such as regular handwashing with soap and water at all times, but especially before and after visiting farms, barns or market areas.
• avoid contact with camels as much as possible.
• avoid consumption of any type of raw milk or raw milk products, and any food that may be contaminated with animal secretions particularly from camels unless peeled and cleaned and/or thoroughly cooked.
• follow the advice of local health authorities; there are currently no travel restrictions in place.
• seek medical advice locally prior to travel back to the UK if symptoms develop (e.g. fever, cough or increasing breathlessness) within 14 days of travel so that appropriate clinical assessment, infection control measures and testing can be undertaken [15].

Should British pilgrims become unwell within 14 days of their return, they should seek advice by calling their GP or NHS 111 and mention which countries they have visited, so that appropriate measures and testing can be undertaken.

UKHSA provides further guidance for travellers to, and returning from the Middle East, alongside more detailed information for health professionals.

Travellers' diarrhoea

Diarrhoeal illnesses are transmitted by the consumption of contaminated food or water. Dehydration can occur with diarrhoea and is of particular risk in hot weather. Babies, infants, the elderly and those with chronic medical conditions are more vulnerable to dehydration.

All pilgrims are advised to take personal, food and water hygiene precautions:

• Wash hands before and after eating and after going to the toilet.
• Thoroughly clean and wash fresh vegetables and fruit.
• Cook food thoroughly and store at safe temperatures.
• Keep raw and cooked foods separated.

Pilgrims should also take with them oral rehydration therapy and self-treatment for diarrhoea. An antimotility agent, such as loperamide, can be carried. Information on treatment options can be found in our travellers' diarrhoea factsheet.

Vector-borne diseases

Malaria is not present in Medina or Makkah [Mecca] (or in the cities of Jeddah, Riyadh and Ta'if or areas of Asir province above 2,000m), but malaria is a risk in the south-western provinces of Saudi Arabia (including Asir province below 2,000m). Pilgrims planning further travel before or after Hajj or Umrah to malaria risk areas in KSA or Asia, Africa and Latin America, should seek advice about malaria prevention.

Other disease spread by biting insects or ticks are listed on the Country Information page. Pilgrims are advised to take necessary measures to avoid mosquito bites during the day and evening which include wearing protective clothing (preferably light-coloured) that covers as much of the body as possible; using physical barriers such as window screens and closed doors; and applying insect repellent to skin or clothing. This will help protect against vector-borne diseases, such as dengue.

Accidents and injuries

Minor injuries are relatively common, particularly to the feet. More serious injuries can occur as a result of road traffic accidents or stampedes as pilgrims undertake the stoning rite or other mass activities.

Pilgrims are advised to avoid peak times. Elderly and infirm people, who have decided to make their pilgrimage, may wish to consider appointing a proxy for the performance of some rites.

All pilgrims to Hajj and Umrah should have adequate health insurance.

Environmental hazards (cold, heat and sun)

Daytime temperatures in KSA, even during the winter months, can reach over 30°C. Associated risks include sunburn, dehydration, heat exhaustion and heat stroke. MoH KSA recommends all pilgrims, especially older individuals, to avoid direct sun exposure while performing rituals and to drink enough fluids. Medicines with the potential to exacerbate dehydration (e.g. diuretics) or interfere with heat exchange may need adjustment by treating physicians [1, 2]. Health guidelines from KSA MoH provide advice on heat related illness and the areas where heat related illness are more common [16].

If possible, travel to Makkah (Mecca) before the start of Hajj should be considered to allow a period of heat acclimatisation. Pilgrims should drink plenty of clean water (preferably bottled or boiled and cooled) to avoid dehydration.

Sun protection factor (SPF) of 30 or above, with four or five star UVA protection, should be applied liberally to exposed skin every two to three hours. Male pilgrims are not allowed to cover their heads, but an umbrella will provide shade from the sun.

Desert sand can reach very high temperatures; good quality footwear should be worn to avoid burning the feet. Footwear must be removed during times of prayer, to avoid losing them; pilgrims are advised to carry their shoes in a bag.

During the winter months the weather can be very cold overnight. If staying in basic accommodation, pilgrims should ensure they take appropriate bedding with them such as blankets and sleeping bags.

Food and water advice

The authorities in KSA do not permit entry Hajj and Umrah travellers to bring food into KSA except in properly canned or sealed containers [17]. All pilgrims are advised to take personal, food and water hygiene precautions.

Illness abroad or on return from Hajj or Umrah

Those who become ill during or in the weeks/months following their trip, particularly with fever, flu-like symptoms, rash and/or diarrhoea, should get medical help by calling NHS 111 or the GP centre by telephone. Travellers should tell their doctor about their travel abroad, and mention if they have been in contact with camels, consumed camel products, been in contact with or cared for anyone with respiratory symptoms, visited or been admitted to or worked in a healthcare facility.

Resources

• Council of British Hajjis
• Nusuk Hajj platform
• Kingdom of Saudi Arabia Ministry of Health
• Insect and tick bite avoidance
• UK Health Security Agency: Algorithm on public health investigation and management of possible cases of MERS-CoV
• UK Health Security Agency: Returning from the Middle East - Important information for travellers
• Sun protection