From the Guidelines
All pilgrims traveling to Saudi Arabia for Hajj should receive both hepatitis A and hepatitis B vaccines if they are not already immune. The hepatitis A vaccine is given as two doses, 6-12 months apart, with the first dose ideally administered at least 2-4 weeks before travel 1. The hepatitis B vaccine is typically given as three doses over 6 months (at 0,1, and 6 months), though an accelerated schedule is available if time is limited before travel 1. These vaccines are particularly important for Hajj pilgrims due to the crowded conditions and potential exposure to contaminated food or water (hepatitis A) and the risk of blood exposure during ritual head shaving or other procedures (hepatitis B).
Key Points to Consider
- Hepatitis A is transmitted through the fecal-oral route, while hepatitis B spreads through blood and bodily fluids 1.
- Both vaccines are safe and can be administered simultaneously at different injection sites.
- Even if the complete series cannot be finished before travel, partial vaccination provides some protection and the series should be completed as scheduled upon return.
- International travelers to countries with high or intermediate levels of endemic hepatitis B virus infection, such as Saudi Arabia, are at increased risk and should receive the hepatitis B vaccine 1.
- The risk of hepatitis A and B infection during Hajj is significant due to the large crowds and potential for exposure to contaminated food, water, and blood 1.
From the Research
Hepatitis A and B Vaccines for Hajj Pilgrims
- Pilgrims traveling to Saudi Arabia for Hajj are at risk of contracting hepatitis A and B due to unique conditions such as shared living accommodations, food from street vendors, and shared toilet facilities 2.
- The risk of hepatitis B is also increased due to practices such as head shaving or trimming by fellow pilgrims or street barbers who may re-use their razors 2.
- Cuts to the hands and feet while sacrificing cattle and walking barefooted may further increase the risk of parenteral viral hepatitis 2.
Recommended Vaccinations
- Hepatitis A and B vaccines are recommended for pilgrims traveling to Saudi Arabia for Hajj to protect against these diseases 2.
- The combined hepatitis A and B vaccine has been shown to be immunogenic, effective, and safe, with anti-HAV seropositivity rates ranging from 96.2% to 100% and anti-HBs seroprotection rates from 82% to 100% 3.
- The vaccine offers satisfactory long-term immunogenicity rates, expected duration of protection, and a safety profile similar to monovalent hepatitis A or B vaccines 3.
Special Considerations
- Individuals with certain medical conditions, such as HIV, may require special consideration when receiving hepatitis A and B vaccines 4.
- Hepatitis B vaccination is recommended for all HIV-positive persons lacking prior immunity, but immune reactivity to hepatitis B vaccines may be suboptimal in terms of patients' rate of response, antibody titer, and durability 4.