Holy vaccinations: If you are of the Muslim persuasion and plan to join a couple million fellow believers for the Hajj in Mecca, Saudi Arabia, between Dec. 29, 2006, and Jan. 3, 2007, better make sure you have your vaccination records up to date. When it comes to the potential of the annual gathering of Allah’s faithful to serve as a giant petri dish for the world’s most popular diseases, the Saudis don’t mess around. Sounds like a good place to get really sick:

The congregation of so many people from different parts of the world in unavoidably overcrowded conditions within a confined area for a short period of time presents many public health challenges. The combination of physical exertion, overcrowding and any pre-existing health conditions such as diabetes, heart disease, chronic chest conditions, renal and liver disease favour local and possibly international spread of communicable diseases, including meningococcal infections, influenza, tuberculosis and gastrointestinal infections.

This year’s vaccination requirements and advice have been issued by the Saudi Ministry of Hajj for the most serious communicable disease risks:

Meningococcal meningitis
All Hajj pilgrims are now required to submit proof of vaccination with the quadrivalent vaccine against meningococcal meningitis types A, C and W135Y as part of the Hajj visa application to Saudi Arabia. This should be recorded in a vaccination book showing the traveler’s full name.

Chemoprophylaxis against meningococcal infection will also be given to all people arriving in Saudi Arabia from countries in the African meningitis belt.

Polio
All travelers to Saudi Arabia are advised to ensure their polio vaccination is up to date. Travelers whose last dose of polio was more than ten years ago should receive a booster, using the trivalent tetanus, diphtheria and polio vaccine.

The WHO considers the following countries to be polio-affected (as of Oct. 4, 2006): Afghanistan, Angola, Bangladesh, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Namibia, Nepal, Sudan, Yemen.

Hepatitis B
Hepatitis B virus is found in body fluids and can be transmitted either through skin breakages or by close sexual contact. Transmission through the skin may occur through the use of contaminated medical, dental, or other instruments; all pilgrims should consider hepatitis B vaccine. One of the rites of Hajj is for men to have their head shaved. Although the Saudi authorities provide licensed barbers who use a new blade for each pilgrim, other barbers may not conform to such standards. Shaving with a previously used blade could carry a risk of hepatitis B and other bloodborne infections, and so communal use of a razor or blade to shave each other should be avoided. Pilgrims should consider taking with them a disposable razor for this purpose. This will also help to protect against hepatitis C virus infection.

Influenza
Recent studies have shown a high incidence of influenza infections during the Hajj, and so it would seem prudent to regard all Hajj pilgrims as at risk. The Ministry of Health of Saudi Arabia recommends that pilgrims be vaccinated against influenza before arrival, particularly those with pre-existing conditions (e.g., the elderly, people with chronic chest or heart diseases, or those with cardiac, hepatic or renal failure).

Vectorborne diseases
Yellow fever
All travelers arriving from countries endemic for yellow fever 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 six days from the day of vaccination or the last date of potential exposure to infection, whichever is earlier.

Saudi authorities also require that aircraft and other means of transportation arriving from areas infected with yellow fever are requested to submit a certificate indicating disinfection in accordance with international health regulations.

Malaria
Malaria is not normally present in Medina or Mecca, but is a risk in other areas of Saudi Arabia including the southwestern region and rural areas of the western region. Pilgrims may also plan further travel before or after Hajj to countries in Asia and Africa, and should seek advice about malaria prevention. Pilgrims are advised to practice insect bite avoidance measures that also protects against other vectorborne diseases.

Helluva way to get to heaven ….