Due to the vaccination requirements for travelling to Mecca, Saudi Arabia, and the preparedness plans put in place by the host country addressing the management of health hazards during and after the Hajj, the overall risk for EU/EEA citizens of becoming infected with a contagious disease during the 2018 Hajj in Saudi Arabia is considered to be low. The risk of communicable disease outbreaks is highest for food- and waterborne diseases and respiratory illnesses, but the risk is not considered higher than can generally be expected for international mass gatherings of this size. MERS-CoV activity continues to be reported in the Arabian Peninsula, specifically from Saudi Arabia, and therefore imported cases may be detected in Europe following the Hajj. The risk of transmission of other vaccine-preventable and vector-borne diseases is considered to be low. The national health authorities in countries from where Muslims embark on the Hajj pilgrimage to Mecca should apply appropriate strategies for the prevention and control of communicable diseases before, during and after the completion of the Hajj.
Advice for those traveling to the Hajj
• Seek help from healthcare providers on vaccination visa and entry requirements for Saudi Arabia;
Follow recommendations issued by the ministry of health of Saudi Arabia  and WHO .
• Ensure you are up to date with routine vaccinations, including boosters as recommended in your EU
country of residence. See ECDC vaccine schedule site .
During the Hajj
• Pay attention to personal, food and water hygiene to decrease the risk of gastrointestinal illnesses.
• Practice respiratory hygiene and cough etiquette to reduce the risk of respiratory infections.
• Visit only licensed barbers for shaving.
Avoid close contact with animals, mainly camels, when visiting farms, markets, or barn areas.
• Only use antibiotics according to the advice of certified health professional.
After the Hajj
• If you have symptoms suggestive of gastrointestinal, respiratory or any other type of infection upon
Return, make sure you mention your travel history to your healthcare provider.
• Due to the continuing reports of MERS-CoV disease in Saudi Arabia, seek immediate medical advice if
You have a fever (38 ºC and over), cough or difficulty in breathing.
• Report your travel history and previous hospitalization to your healthcare provider if you require
admission within one year of travel to another country (or if hospitalized in another state), to
ensure that the possible acquisition of antimicrobial-resistant (AMR) bacteria is considered and that
appropriate measures can be implemented following national guidelines to prevent the spread
Based on the general risks during mass gathering events, and following the internal procedures
applied for those events, ECDC will conduct enhanced epidemic intelligence surveillance for communicable
diseases between 12 and 31 August 2018.
The risk of importation of communicable disease to Saudi Arabia by pilgrims participating in the Hajj relates to ongoing endemic infections and outbreaks in the country of origin of pilgrims. The following outbreaks should be considered of relevance: • Cholera outbreaks are currently occurring in many countries especially in the Horn of Africa and the Gulf of Aden, including Yemen, Somalia, and Ethiopia. Outbreaks are also reported in the Democratic Republic of the Congo, Kenya, Tanzania, and Nigeria.
As of 3 July 2018, Poliomyelitis, with wild poliovirus cases has been reported in Afghanistan (eight cases) and Pakistan (three cases). Circulating vaccine-derived poliovirus type 2 was reported in: Nigeria (one case), the Democratic Republic of Congo (seven cases), Somalia (four cases: circulating vaccine-derived poliovirus type 2 and 3); circulating vaccine-derived poliovirus type 1 was identified in Papua New Guinea (one case). Although Nigeria has not reported cases of wild poliovirus in the last two years, it is still regarded as an endemic country . • Yellow fever, chikungunya, and dengue are associated with ongoing outbreaks in many countries. This increases the possibility of the introduction of these viruses through viraemic travelers. ECDC monitors these global outbreaks through open source event-based surveillance; the list of countries below may not be exhaustive. Dengue is endemic in many countries and has been reported in over 128 countries. Reporting of arbovirus infections can differ across countries in relation of their surveillance system. It should be noted that the underreporting of arboviruses is considered to occur in sub-Saharan Africa. Yellow fever is endemic in tropical and subtropical areas of Africa and Central and South America (including Trinidad). Between 12 September 2017 and 3 June 2018, 1 903 suspected yellow fever cases, including 47 deaths, were reported in Nigeria. Between July 2017 and week 19-2018, the ministry of health in Brazil reported 1 266 confirmed human cases of yellow fever, including 415 deaths . Dengue is found in tropical and subtropical climates worldwide, mostly in urban and semi-urban areas. Cases of dengue have recently been reported in the Americas, south-east Asia and the Pacific Island nations.