ACWY quadrivalent vaccine for hajj pilgrimage Meningococcal infection can cause meningitis, septicaemia or both.

Five strains of meningococcal bacteria (A, B, C, W135 and Y) cause most cases. Although it occurs in all countries, it is much more common in certain areas, for example there are epidemics in the meningitis belt of subSaharan Africa, usually due to meningococcal A or W135 bacteria, and from time to time there are outbreaks in other countries. Large epidemics of meningococcal disease have also been linked to the Hajj pilgrimage, at first due to A-strain and then in 2000 and 2001 due to W135[1]. Many cases of meningococcal disease also occurred world-wide after pilgrims returned to their own countries[2]. Because of these epidemics, quadrivalent ACWY vaccination has been a compulsory entry requirement into Saudi Arabia for pilgrims on Hajj and Umrah, and for other travellers in Hajj season since 2002. It protects against meningitis and septicaemia caused by four different strains: A, C, W135 and Y. Vaccination is also recommended for travel to sub-Saharan Africa and certain other countries, especially if travellers will be living or working with local people or visiting during an outbreak. Pilgrims on Hajj or Umrah are required to present a certificate of vaccination with ACWY, issued at least 10 days, but not more than 3 years before arrival. This also applies to seasonal workers in Hajj areas. What vaccines are available? There are two ACWY vaccines available. The old one (ACWY Vax), a polysaccharide vaccine, is based on meningococcal sugars, and sugarbased vaccines do not work very well in young children. The newer one (Menveo) is a conjugate vaccine, with the meningococcal sugars linked to a protein, and protein vaccines work very well even in babies. Although both vaccines are suitable for travel, the Department of Health recommends that children over 5 years of age and adults are vaccinated with Menveo because it provides better and longer lasting protection. Children under 5 should always be vaccinated with Menveo. For babies under one year of age, two doses one month apart are needed for protection, but older children and adults should receive a single dose[3].

Meningitis Meningitis is a very real and serious risk for you and your family. You could also bring the meningitis germs back to your family and friends at home. A dangerous strain of meningitis has affected travellers to the Hajj in the previous years, and some people have died after contracting it. Pilgrims going to Hajj or Umrah are required by the Government of Saudi Arabia to have a valid certificate of vaccination every two years against meningitis before they are issued with a visa. If you were vaccinated more than two years ago, you will need to get re-vaccinated otherwise your visa application will be turned down. Please make sure that: you get the right vaccine. You need to make sure your doctor gives you the ' quadrivalent ' meningococcal vaccine (ACWY Vac) which protects against four different strains of meningitis: A, C, W135 and Y. if you are planning to take children under the age of two years to Hajj or Umrah you will need to get them vaccinated with two doses of ACWY vaccine, ideally three months apart . you and your family get this vaccine even if you have had a different meningitis vaccine in the past. Neither the meningitis vaccine your child(ren) will have had as part of their routine vaccinations (called Men C), nor the vaccine previously recommended for travel will give you the protection you need. you get a certificate after having had the vaccination providing it's given within the last two years. Talk to your doctor if you are in any doubt or phone NHS Direct on 0845 46 47* *Calls charged at local rates. NHS Direct can provide confidential interpreters, in many languages including Urdu, Bengali, Punjabi, Gujarati, Arabic,Turkish and Somali,

within minutes of your call. All you need to do is state in English the language you would prefer to use. Why do I need this quadrivalent immunisation for Hajj? The W135 strain of meningitis is deadly and differs from other meningitis strains usually caught in the UK. Previous vaccination against meningitis A and C does not protect you against the W135 strain. Receiving the quadrivalent meningitis vaccination will not only protect you, but will substantially reduce the risk of infecting your friends, family and community on your return. The Saudi Arabian Government has made vaccination against the ACWY strains a visa entry requirement, so you may be refused entry if you do not have a valid certificate showing that you have received the quadrivalent meningitis vaccination within the last two years. Pilgrims are strongly advised to book an appointment with their GP three or more weeks before travel to allow time for the practice to order the ACWY vaccine, and to allow sufficient time for it to become fully effective. And if you are planning to take children under the age of two years, you should book about four months in advance. Please take a copy of this leaflet with you to your GP.

An official certificate of vaccination must be obtained from the vaccinator, clearly indicating your full name as it appears in your passport, date of vaccination, signature and official stamp of the vaccinator for the following two very important reasons: a) This certificate is mandatory legal requirement without which your Hajj and Umra visa application will be rejected by the Saudi Embassy. b) You are protected against this disease for 3 years from the time of vaccination. Should you wish to perform Hajj and Umrah again within those 3 years, revaccination will be un-necessary.