Special travellers

Travel is not contraindicated for uncomplicated pregnancies, but choosing a destination should include a careful risk assessment. Second trimester travel is generally favorable as the risk of complications is low. A gynecologist should be consulted before travel. Adequate obstetric and neonatal care at destination must be ensured for emergencies. Check for sufficient insurance coverage for mother and baby.

Air travel
Most airlines allow pregnant travellers to fly up to 36 weeks of gestation, and up to 32 weeks in the case of multiple pregnancy. Clarify with the airline in advance. From the 28th week of gestation, a letter from one’s gynecologist stating the fitness to fly, due date, and contact details is required. The risk of thromboembolic events (thrombosis) is increased during pregnancy. Due to the increased risk of thrombosis, you should do small exercises to stimulate blood circulation, drink plenty of fluids and wear compression stockings.

Travel Destination

• Malaria: Malaria during pregnancy can be very dangerous for the mother and unborn child. Therefore, travel to malaria risk areas during pregnancy is discouraged. If travel is unavoidable, mosquito bite protection and medical malaria prophylaxis are crucial. A doctor should be consulted about which drug can be used, given that safety data on the use of malaria prevention drugs during pregnancy are uncertain. Breastfed infants need their own malaria medication as transfer of antimalarial drugs through breast milk is insufficient. Fever (>37.5°C) during and after travel is considered a medical emergency and a medical consultation to rule out malaria or other serious infections should take place immediately.
  
• Zika: Infection during pregnancy can lead to congenital Zika syndrome, leading to nervous system malformations of the fetus. Travel to Zika risk areas during an outbreak and unprotected sex with a partner at risk of infection is discouraged for pregnant women and those planning to become pregnant. Check the CDC website for updated risk area information (https://wwwnc.cdc.gov/travel/page/zika-information).
  
• Insect protection: Skin repellents containing DEET (20-30%) and permethrin for mosquito nets and textiles are strongly recommended during pregnancy. Sleep under a mosquito net and wear light-coloured clothing with long sleeves and trousers, especially at dusk and during nighttime.
  
  

Vaccinations
Inactivated vaccines should be delayed to the 2nd trimester if possible. Boosters against whooping cough (dTpa) and influenza are recommended during every pregnancy. Live vaccines are generally contraindicated, and conception should be delayed by 4 weeks. Pregnancy is considered a precaution for yellow fever vaccination and requires careful benefit-risk assessment by a specialist. Breastfeeding, especially in children under the age of 6 months, is a contraindication for yellow fever vaccination due to the risk of encephalitis of the infant.

Hygiene
Ensure optimal food, water, and hand hygiene and avoid raw fish, meat, and unpasteurized milk and dairy products. Certain diseases transmitted by contaminated food or water (e.g. listeriosis, hepatitis E, toxoplasmosis) can be particularly serious during pregnancy. Ensure prompt and adequate rehydration in case of gastroenteritis, as dehydration can place the fetus in danger.

Medications
Many medications are not allowed during pregnancy and breastfeeding. An information sheet on the first-aid kit for pregnant and breastfeeding women is available. A doctor should be consulted about suitable drugs for common complaints during travel.

Stays at high altitudes/scuba diving
Pregnant women should avoid altitudes above 2500 m as they are at higher risk of high altitude sickness and complications. Scuba diving is not recommended as it could cause a potentially fatal gas embolism for the fetus.

Breastfeeding
Exclusive breastfeeding protects infants from contamination during food or milk formula handling. No water supplementation is required, even in hot environments. During air travel, breastfeeding helps to prevent infants from ear pain due to cabin pressure changes. Avoid mastitis by correct hygiene during breastfeeding and milk pumping.

Advanced age alone is no reason to refrain from travelling. However, bear in mind that the body can no longer acclimatize so quickly and that hectic travel programs are therefore not suitable for older people.

Before the journey

• Choose your destination and travel companion carefully. Find out whether there are doctors, hospitals and pharmacies in the destination. What about accessibility at your holiday destination? Inform the travel agency and/or airline in advance if you have any special needs (e.g. wheelchair users, people with walking disabilities, oxygen equipment). If necessary, book a room suitable for the disabled.
  
• Visit to your family doctor: clarification of your general state of health. If you have any pre-existing medical conditions, you should discuss your travel plans with your family doctor before finalizing your booking. Emergency documents should be carried in English.
  
• Medication: Obtaining sufficient quantities of the medication you regularly take and information (in English if possible) on its use and dosage (medication list). Due to a time difference, you may have to take your medication at a different time (e.g. blood sugar-lowering medication and insulin). Discuss this in advance with your doctor in charge. If liquid medication is required, you must check with the airline whether transport in hand luggage is permitted. Strong painkillers from the opiate group may not be imported into certain countries; it is advisable to take a medical certificate in English with you and to obtain information from the embassy of the country in question (Link). Most medicines should be protected from direct sunlight and insulin and biologicals must be refrigerated. Distribute your medication between hand luggage and checked suitcases.
  
• Vaccinations:
  
  • Have your vaccination card checked and, if necessary, catch up on or complete your vaccinations.
    
  • Basic immunization: All persons should have basic vaccination protection against diphtheria, tetanus (tetanus) and polio (poliomyelitis). The diphtheria-tetanus vaccination must also be boosted every 20 years for people aged between 25 and 65 and every 10 years for people aged 65 and over. Polio vaccinations must be boosted every 10 years when travelling to Africa and certain countries in Asia.
    
  • Vaccination against hepatitis A is recommended for most countries in which you are travelling (see information on the country page at www.healthytravel.ch) and a vaccination against abdominal typhoid fever may be recommended for long journeys under poor hygienic conditions.
    
  • A yellow fever vaccination is recommended for certain journeys to Africa and South America or for journeys with legal transit regulations. Some countries also have special entry regulations regarding yellow fever (see www.healthytravel.ch). It should be noted that the incidence of severe side effects from a yellow fever vaccination is higher in older people and the indication must therefore be carefully clarified. You can obtain precise recommendations from your family doctor, a tropical doctor or a travel medicine center.
    
  • In special situations, e.g. long-term journeys, a vaccination recommendation against rabies or hepatitis B may also be added.
  • Flu vaccination: Get vaccinated against flu before the flu season (northern hemisphere from December to April, southern hemisphere from May to September), for planned cruises and for all travelers to the tropics, as there is a year-round risk. Long-term travelers to the south should be vaccinated with the southern hemisphere vaccine before the winter there (only available in large travel centers).
    
  • Pneumococcal vaccination is recommended for people aged 65 and over or for people with serious pre-existing illnesses.
    
  • Deep vein thrombosis: In general, people >60 years of age have a moderately increased risk of thrombosis, which can be further increased by pre-existing diseases in the circulatory system. Travelling >5 hours further increases the risk. Knee-length support stockings ("flight socks", available in specialist shops, pharmacies or travel medicine centers) can reduce this risk. Your doctor may recommend thrombosis prophylaxis with injections (Fragmin®, Fraxiparine®, Arixtra®, etc.).
    
  • Malaria: The recommendations regarding malaria prophylaxis also apply to senior citizens. The risk of malaria increases with age, but the side effects of malaria medication are less frequent. Also remember to optimize insect protection. If you have a fever in a country with malaria, consult a doctor immediately!
    
  • Insurance cover: Clarify your cover in the event of illness or accident, including the assumption of any repatriation costs. If necessary, take out additional health and repatriation insurance. Remember that accidents are the most frequent cause of death among travelers!
    

During the journey

• Carry clearly labelled daily used medication in your hand luggage (in the original packaging). Both the brand name and the generic name should be printed on the packaging.
  
• In addition to flight socks, the following measures help to reduce the risk of deep vein thrombosis: Exercising the legs, regular fluid intake, avoiding coffee and alcohol.
  
• Travelers’ diarrhea: is common and can be more severe in older people, so follow optimal water and food hygiene.
  
• Travel sickness: Sensitivity decreases with age. If you have a predisposition, you can discuss taking medication with your doctor before travelling.
  
• Jet lag: symptoms increase with age. Dividing a long journey into different sections with rest days in between can be helpful. As a general rule, you should adjust your sleep/wake cycle and meal times to your new surroundings as quickly as possible. If possible, spend time in sunlight.
  
• Climate: Don't forget to drink when travelling to warm regions, even if you don't feel thirsty. Sufficient fluid intake is very important, as the feeling of thirst is reduced in old age! Use good sun protection and stay in the shade. Please note that taking certain medications can increase the skin's sensitivity to light.
  

After the journey

If you have a fever after travelling in a malaria area: See a doctor immediately! Fever of any kind can be a sign of malaria. However, this infectious disease can also manifest itself with other symptoms, such as confusion etc., especially at an advanced age.

Further information / references

• Centres for Disease Control and Prevention (CDC), Senior Citizens: https://wwwnc.cdc.gov/travel/page/senior-citizens
  
• NaTHNaC - Older travelers: https://travelhealthpro.org.uk/factsheet/70/older-travellers
  
• Government of Canada, Older travelers: https://travel.gc.ca/travelling/health-safety/older-travellers

Pilgrimages are a very important aspect of many people’s lives. However, as with all international mass gatherings, pilgrimages bear health risks and thus require preparation. The Hajj is physically exhausting, therefore a medical assessment is recommended for those suffering from chronic conditions. The Kingdom of Saudi Arabia advises elderly and seriously ill people, pregnant women, and children to postpone or retain from undertaking the Hajj and the Umrah.

Before departure
Check for updated health, vaccination and entry requirements and general recommendations on:

• Ministry of Health in Saudi Arabia (www.moh.gov.sa),
  
• Ministry of Hajj, Kingdom of Saudi Arabia (www.hajinformation.com), and
  
• The Embassy of the Kingdom of Saudi Arabia (www.saudiembassy.net/hajj-and-umrah-health-requirements).
  

Check for sufficient international insurance coverage.

Vaccinations (See References)

• All pilgrims should be fully immunised for the routine vaccinations (diphtheria, tetanus, whooping cough, polio, measles, mumps, rubella, varicella) (see Swiss vaccination schedule)
• Meningococcal meningitis (A, C, W135, Y): All adults and children >1 y must have received the conjugate quadrivalent (A,C,W135,Y) meningococcal vaccination within the last 5 years and not less than 10 days prior to arrival. Proof of vaccination on the basis of an international vaccination certificate is mandatory when entering Saudi Arabia.
  
• Hepatitis A: Vaccination against hepatitis A is recommended for all pilgrims and travelers.
• Poliomyelitis:
  • The following applies to persons travelling directly from Switzerland to Saudi Arabia: After completion of basic immunisation according to the Swiss vaccination schedule, all pilgrims are recommended to receive booster vaccinations as follows:
    • Immunocompetent travellers <65 years: every 20 years
    • Immunocompetent travellers ≥65 years: every 10 years
    • Travellers with immunodeficiency: every 10 years

  • Persons travelling through a country where polio cases have been reported are required to provide proof of polio vaccination upon entry into Saudi Arabia: In this case, the inactivated polio vaccination (IPV) must have been administered within the last 12 months and at least 4 weeks prior to entry into Saudi Arabia. If no IPV vaccination is available, the oral polio vaccination (OPV) with at least one dose is accepted if it was administered within the last 6 months and at least 4 weeks prior to travelling to Saudi Arabia. In the absence of proof upon entry into Saudi Arabia, vaccination with an oral polio vaccine (OPV) will be given.

• Hepatitis B: Vaccination against hepatitis B is strongly recommended. The reason for this is, that Muslim men shave their heads after completing the Hajj pilgrimage. It is therefore essential that you take disposable razor blades with you and visit licensed barbers whose shops are clearly labelled as such in order to avoid infection with blood-borne pathogens (such as hepatitis B, C, HIV and others).

• COVID-19: According to the Kingdom of Saudi Arabia, all pilgrims ≥12 years of age are recommended to complete a vaccination against COVID-19 with a vaccine authorised in Saudi Arabia and receive a dose of the 2024 updated vaccine.

• Influenza: As crowding increases the risk for infection, vaccination is especially recommended for small children, pregnant women, elderly, and individuals with chronic health conditions.
  
• A yellow fever vaccination is obligatory when entering Saudi Arabia from countries or areas at risk of yellow fever (see Appendix 2 of the KSA document).
• For other vaccinations according to risk: see country page Saudi Arabia at www.healthytravel.ch.

Menstruation

As Muslim law prohibits menstruating women from performing tawaf, women might consider consulting their gynaecologist before the pilgrimage if they intend to postpone or avoid menstruation.

During the Hajj

• Heat: During the summer months, daytime temperatures can reach 50°C and cause heat-related illness. Avoid excessive sun exposure by using umbrellas and seeking shade, wear sunscreen and stay well hydrated.
  
• Hygiene: Ensure optimal food, water, and hand hygiene (wash hands with soap and disinfect, avoid raw and undercooked food, unpasteurised milk, or tap water). Practise respiratory hygiene (wear a mask, keep a distance from other pilgrims if possible) to reduce the risk of respiratory infections such as tuberculosis, COVID-19, MERS (Middle-East respiratory syndrome), and influenza.
  
• Diarrhea: Ensure prompt and adequate rehydration. Carry oral rehydration solution (ORS). In case of severe diarrhea or vomiting with inability to hydrate, seek medical care.
  
• Rabies: If bitten by an animal, wash the wound with soap, disinfect, and seek immediate medical care for post-exposure rabies prophylaxis.
  
• Mosquitos: Take measures to prevent mosquito bites, particularly during the day in order to prevent infections such as dengue.
  MERS-CoV is a viral infection that is present on the Arabic Peninsula. It can cause severe lung infection. The way it is transmitted is unclear, but it can occur between humans and likely with close contact to camels or camel products (e.g. milk). The following people are currently advised not to go on pilgrimage due to higher risk of MERS-CoV infection: persons >6 years, persons with chronic diseases (e.g. diabetes, immunodeficiency, cancer, heart, kidney or lung diseases), pregnant women, and children.
  
• Medical Care: Many medical facilities provide free healthcare for pilgrims. Alternatively, there are fee-charging private hospitals.

After the Hajj

Seek medical care if suffering from fever, respiratory or gastrointestinal symptoms, or any other health complaints following the pilgrimage.

References:

• Ministry of Health of Saudi Arabia: Health Requirements and Recommendations for Travelers to Saudi Arabia for Hajj – 1445H (2024): https://www.moh.gov.sa/HealthAwareness/Pilgrims_Health/Documents/Hajj-Health-Requirements-English-language.pdf 
  
• Ministry of Health of Saudi Arabia: Hajj Vaccinations 1445: Vaccinations for Pilgrims Coming from Outside the Kingdom:
  https://www.moh.gov.sa/en/HealthAwareness/Pilgrims_Health/Approved-Vaccines/Pages/Outside-the-Kingdom.aspx