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Saudi Arabia
Summary of recommendationsMedicationsImmunizations
Hajj pilgrimageRecent outbreaksOther infections
Food and water precautionsInsect and Tick ProtectionGeneral advice
Ambulance and Emergency ServicesMedical facilitiesTraveling with children
Travel and pregnancyMapsEmbassy/Consulate Location
Safety information

 

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Summary of recommendations:

All travelers should visit either their personal physician or a travel health clinic 4-8 weeks before departure.

Malaria: Prophylaxis with Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycycline is recommended for Al Bahah, Al Madinah, Asir (excluding the high altitude areas above 2000 m), Jizan, Makkah, Najran, and Tabuk province. No malaria risk in urban areas of Jeddah, Mecca, Medina, and Ta'if.
Vaccinations:

Meningococcal

Recommended for all travelers. Required during the Hajj (annual pilgrimage to Mecca).

Polio

Required for travelers under age 15 arriving from countries where polio still occurs. One-time booster recommended for any adult traveler who completed the childhood series but never had polio vaccine as an adult.

Hepatitis A

Recommended for all travelers

Influenza

Recommended for all travelers during the Hajj season

Typhoid

For travelers who may eat or drink outside major restaurants and hotels

Yellow fever

Required for all travelers arriving from a yellow-fever-infected area in Africa or the Americas. Not recommended otherwise.

Hepatitis B

Recommended for all travelers

Rabies

For travelers at high risk for animal bites or involved in any activities that might bring them into direct contact with bats

Measles, mumps, rubella (MMR)

Two doses recommended for all travelers born after 1956, if not previously given

Tetanus-diphtheria

Revaccination recommended every 10 years

Medications

Travelers' diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions, as outlined below. All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.

Most cases of travelers' diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.

If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.

Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.

Malaria in Saudi Arabia: prophylaxis is recommended for Al Bahah, Al Madinah, Asir (excluding the high altitude areas above 2000 m), Jizan, Makkah, Najran, and Tabuk province. There is no risk in the urban areas of Jeddah, Mecca, Medina, and Ta'if. Malaria is endemic to the low-lying coastal plains of southwest Saudi Arabia, primarily in the Jizan region extending up the coast to the rural area surrounding Jeddah, though not Jeddah itself. Either mefloquine (Lariam), atovaquone/proguanil (Malarone)(PDF), or doxycycline may be given. Mefloquine is taken once weekly in a dosage of 250 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Mefloquine may cause mild neuropsychiatric symptoms, including nausea, vomiting, dizziness, insomnia, and nightmares. Rarely, severe reactions occur, including depression, anxiety, psychosis, hallucinations, and seizures. Mefloquine should not be given to anyone with a history of seizures, psychiatric illness, cardiac conduction disorders, or allergy to quinine or quinidine. Those taking mefloquine (Lariam) should read the Lariam Medication Guide (PDF). Atovaquone/proguanil (Malarone) is a combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side-effects, which are typically mild, may include abdominal pain, nausea, vomiting, headache, diarrhea, or dizziness. Serious adverse reactions are rare. Doxycycline is effective, but may cause an exaggerated sunburn reaction, which limits its usefulness in the tropics.

Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours. See malaria for details. Symptoms of malaria sometimes do not occur for months or even years after exposure.

Insect protection measures are essential.

For further information on malaria in Saudi Arabia, go to WHO-EMRO Roll Back Malaria and the World Health Organization - Eastern Mediterranean Region.

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Immunizations

The following are the recommended vaccinations for Saudi Arabia:

Meningococcal vaccine (quadrivalent) is strongly recommended for all travelers to Saudi Arabia (see "Recent outbreaks"). Quadrivalent meningococcal vaccine is required for all travelers during the annual pilgrimage to Mecca (the Hajj), to be given not more than 3 years and not less than 10 days before arrival in Saudi Arabia, and must be documented on a certificate of vaccination. A single dose is sufficient for adults and children greater than two years of age. Children between 3 months and 2 years of age must be given two doses of vaccine separated by three months. The quadrivalent vaccine, which protects against four different groups of meningococcus, is the only type marketed in the United States, but vaccines which protect against only one or two groups of meningococcus are sometimes used in other countries. Meningococcal vaccine has few side-effects. Mild redness at the injection site may occur. Young children may develop transient fever.

Meningococcal vaccine is highly effective in preventing meningitis, but does not protect people from becoming asymptomatic carriers of meningococcus who may then transmit the organism to others. The Centers for Disease Control studied the rate of meningococcal acquisition among pilgrims to Mecca in March 2001. Fewer than 3% of those flying directly from Saudi Arabia to New York were found to carry meningococcus. The CDC therefore does not recommend prophylactic antibiotics for pilgrims from the United States. Visitors arriving from countries in the African meningitis belt during the Hajj season are required upon arrival to take an antibiotic to lower their meningococcal carrier rate. Ciprofloxacin tablets will be given to adults, rifampin to children, and a ceftriaxone injection to pregnant women. See Eurosurveillance for further information.

Hepatitis A vaccine is recommended for all travelers over one year of age. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF). Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.

Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.

Typhoid vaccine is recommended for all travelers, with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.

Polio immunization is recommended, due recent reports of polio in Saudi Arabia. Proof of vaccination is required for travelers under the age of 15 arriving from countries reporting wild poliovirus, including Afghanistan, Angola, Bangladesh, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Namibia, Nepal, Niger, Nigeria, Pakistan, Somalia, Sudan, and Yemen. Any adult who received the recommended childhood immunizations but never had a booster as an adult should be given a single dose of inactivated polio vaccine. All children should be up-to-date in their polio immunizations and any adult who never completed the initial series of immunizations should do so before departure. Side-effects are uncommon and may include pain at the injection site. Since inactivated polio vaccine includes trace amounts of streptomycin, neomycin and polymyxin B, individuals allergic to these antibiotics should not receive the vaccine.

Influenza vaccine is recommended for all pilgrims during the Hajj season, especially the elderly and those with pre-existing medical conditions. Influenza vaccine may cause soreness at the injection site, low-grade fevers, malaise, and muscle aches. Severe reactions are rare. Influenza vaccine should not be given to pregnant women during the first trimester or those allergic to eggs.

Yellow fever vaccine is required for all travelers arriving from a yellow-fever-infected country in Africa or the Americas, but is not recommended or required otherwise. Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center, which will give each vaccinee a fully validated International Certificate of Vaccination. During the Hajj season, in the absence of such a certificate, the traveler 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. Yellow fever vaccine should not in general be given to those who are younger than nine months of age, pregnant, immunocompromised, or allergic to eggs. It should also not be given to those with a history of thymus disease or thymectomy.

Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF). A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.

Rabies vaccine is recommended only for those at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers living in areas with a high risk of exposure, and for travelers involved in any activities that might bring them into direct contact with bats. A complete preexposure series consists of three doses of vaccine injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions.

Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water and local health authorities should be contacted immediately for possible post-exposure treatment, whether or not the person has been immunized against rabies.

Tetanus-diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.

Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.

Cholera vaccine is not recommended. Cholera is not being reported from Saudi Arabia at this time.

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Hajj pilgrimage

Due to the recent outbreak of infections caused by the Middle East respiratory syndrome coronavirus (MERS-CoV), the government of Saudi Arabia is urging elderly and chronically ill Muslims not to perform the Haj pilgrimage this year.

All pilgrims over 2 years old must receive quadrivalent meningococcal vaccine no more than 3 years and no less than 10 days before arrival in Saudi Arabia, and must show proof of meningococcal vaccination on a valid certificate of vaccination (International Certificate of Vaccination or Prophylaxis) before entering the cities of Mecca and Medina to perform the Hajj.

All pilgraims arriving from countries where yellow fever occurs must submit proof of vaccination at least 10 days and no more than 10 years before arrival.

The U.S. Centers for Disease Control also recommends that all pilgrims should be immunized against influenza, hepatitis A, hepatitis B, and typhoid fever, and should be up-to-date on all routine vaccines, such as measles-mumps-rubella, polio, tetanus, diphtheria, and pertussis.

Children under age 12, pregnant women, those over age 65, and those with chronic diseases should stay away from the annual Hajj pilgrimage.

For further information about health risks during the Hajj, go to Eurosurveillance, the Centers for Disease Control, and the Royal Embassy of Saudi Arabia.

As of November 21, 2009, a total of four foreign pilgrims had died from infection with the novel H1N1 influenza virus.

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Recent outbreaks

An outbreak of infections caused by a novel coronavirus, known as the Middle East respiratory syndrome coronavirus (MERS-CoV), was reported from Saudi Arabia in June 2012. There was a large upswing in the number of cases beginning in March 2014, leading to a national total of 691 cases and 284 deaths by early June (see ProMED-mail, Eurosurveillance, the World Health Organization, and the Centers for Disease Control).

Coronaviruses are the cause of the common cold. A coronavirus was also the cause of SARS (severe acute respiratory syndrome), which caused a global epidemic in 2003. The MERS virus may cause a life-threatening respiratory infection, as well as kidney and other organ failure. The mortality rate is about 30%. There is no vaccine or treatment.

The reservoir of the virus appears to be camels, but it is unclear how the virus spreads from camels to humans. More than two-thirds of those infected report no direct contact with camels. Some of the cases are related to person-to-person transmission, chiefly in health care facilities or among family members caring for infected patients. The risk of person-to-person transmission in other settings appears to be much lower. No travel restrictions are recommended for Saudi Arabia at this time. Travelers should protect themselves by washing their hands often with soap and water or with an alcohol-based hand sanitizer, and by avoiding close contact with sick people and with camels. Travelers who develop fever, cough, or shortness of breath within 14 days of travel to the Arabian Peninsula or neighboring countries should seek immediate medical attention. Evaluation of symptomatic travelers should include collection of specimens for PCR testing, including both nasopharyngeal swabs and lower respiratory specimens, such as sputum or bronchoalveolar lavage. Lower respiratory specimens appear to be more sensitive then nasopharyngeal swabs.

Cases of dengue fever, a flu-like illness sometimes complicated by hemorrhage or shock, are reported annually from Saudi Arabia. The most recent was reported from Jeddah in April 2013, causing more than 300 cases. A dengeu outbreak occurred in Jeddah in Februay 2011 after flooding, causing 61 confirmed or suspected cases. A dengue outbreak was reported from Jeddah and Jizan in early 2010, causing 750 cases in Jeddah and 156 cases in Jizan as of late April. Additonal cases were reported from Jeddah in December 2010, predominantly from the eastern district of Quwaizah. In April 2009, an outbreak was reported from Jeddah, Mecca, and Taif, all located in Mecca province. As of June 2009, a total of 691 cases had been reported from Jeddah. An additional 10 cases were reported from Jeddah in December 2009, after flooding. In March 2006, a major dengue outbreak occurred in Jeddah, chiefly affecting the districts of Ghulail, Al-Balad, Al-Muntazahat, Al-Thaalba and Al-Hindawiya. A total of 1308 cases were identified nationwide by the end of the year, including at least five fatalities (see ProMED-mail; March 18 and May 28, 2006, and June 22, 2009). The number of cases fell to 243 in 2007, but rose to 811 in 2008. Dengue is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. No vaccine is available at this time. The cornerstone of prevention is insect protection measures, as below.

An outbreak of H5N1 avian influenza ("bird flu") was reported in March 2007 among birds in Eastern Province, followed by outbreaks on a number of commercial poultry farms in the Riyadh region in November-December 2007. No human cases have been reported to date.

Most travelers are at extremely low risk for avian influenza, including Hajj pilgrims, since almost all human cases in other countries have occurred in those who have had direct contact with live, infected poultry, or sustained, intimate contact with family members suffering from the disease. The Centers for Disease Control and the World Health Organization do not advise against travel to countries affected by avian influenza, but recommend that travelers should avoid exposure to live poultry, including visits to poultry farms and open markets with live birds; should not touch any surfaces that might be contaminated with feces from poultry or other animals; and should make sure all poultry and egg products are thoroughly cooked. A vaccine for avian influenza was recently approved by the U.S. Food and Drug Administration (FDA), but produces adequate antibody levels in fewer than half of recipients and is not commercially available. The vaccines for human influenza do not protect against avian influenza. For further information, go to the World Health Organization, Health Canada, the Centers for Disease Control, and ProMED-mail.

An outbreak of meningococcal disease was reported in the year 2000 among travelers returning from the annual pilgrimage to Mecca (Hajj). Approximately 400 cases were identified. In 2001, 18 cases were identified among pilgrims returning to western Europe. See CDC and Eurosurveillance for further information.

An outbreak of Rift Valley fever was reported from Jizan and Asir provinces in the southwestern part of the country in September 2000, resulting in 884 cases and 124 deaths as of February 2001. See the Weekly Epidemiological Record, Emerging Infectious Diseases, and Centers for Disease Control for further information. Rift Valley fever is a viral infection that primarily affects domesticated animals, especially sheep and goats, but may involve humans as well. The disease is usually transmitted by mosquitoes, but may also be acquired by direct exposure to infected animals or their tissues. Aerosol transmission has been documented. Most cases occur in people who work with livestock. The outbreak in Saudi Arabia was notable for a high frequency of complications, including liver failure, kidney failure, hemorrhagic manifestations, loss of vision (retinitis), and inflammation of the brain (encephalitis). See M. Al-Hazmi et al. "Epidemic Rift Valley Fever in Saudi Arabia"; Clinical Infectious Diseases 2003; 36:245-52. There is no treatment at present except supportive care. Travelers to affected areas are advised to follow insect protection measures, as described below, and to avoid contact with livestock.

Visceral leishmaniasis was reported in seven men who had served in Saudi Arabia during Operation Desert Storm in 1990-1991 (see Viscerotropic Leishmaniasis in Persons Returning from Operation Desert Storm -- 1990 - 1991, MMWR February 28, 1992 / 41(08); 131-134). It occurs chiefly in the southwestern part of the country. Cutaneous leishmaniasis was diagnosed in 16 military personnel during the same period. In March 2011, an outbreak of cutaneous leishmaniasis reported among 30 workers of a cleaning company in Albadaye'a governorate of Qassim (see ProMED-mail).

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Other infections

Because of the frequency of respiratory infections, including bacterial pneumonia, influenza, and tuberculosis, among pilgrims during the Hajj, the Health Ministry advises all pilgrims to wear face masks.

Other infections include

  • Brucellosis (outbreak reported from Jizan in July 2004)
  • Schistosomiasis (acquired by swimming or wading in bodies of fresh water, such as lakes or streams; risk is low in Saudi Arabia, but don't swim in fresh water unless chlorinated)
  • Onchocerciasis (southwestern part of the country)
  • Crimean-Congo hemorrhagic fever
  • Alkhurma virus infections (chiefly occurs in those involved in the slaughtering or processing of slaughtered sheep; four cases reported from Jeddah in November-December 2009; see ProMED-mail, May 9, 2002, and January 6, 2010)
  • Plague (small outbreak in 1994 caused by eating raw camel liver)
  • Foot-and-mouth disease (no risk to humans, but may cause a debilitating illness in cattle, pigs, sheep, and goats, resulting in devastating losses in milk and meat production; humans may spread the disease if their clothing, shoes, or personal effects become contaminated)
  • HIV (human immunodeficiency virus) (travelers not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions)

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Food and water precautions

Do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, sea bass, and a large number of tropical reef fish.

All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if accompanied by nausea, vomiting, cramps, fever or blood in the stool. Antibiotics which have been shown to be effective include ciprofloxacin (Cipro), levofloxacin (Levaquin), rifaximin (Xifaxan), or azithromycin (Zithromax). Either loperamide (Imodium) or diphenoxylate (Lomotil) should be taken in addition to the antibiotic to reduce diarrhea and prevent dehydration.

If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.

Visitors and pilgrims are not allowed to carry food into the country during the annual pilgrimage and Umra seasons.

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Insect and Tick Protection

Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accomodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night. In rural or forested areas, perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.

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General advice

Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity.Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.

Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.S. State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.

Pack a personal medical kit, customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag, discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.

Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.

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Ambulance and Emergency Services

For an ambulance (Red Crescent) in Saudi Arabia, call 997.

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Medical facilities

Many expatriates go to the King Faisal Specialist Hospital, which offers a broad array of modern medical services, including a 24-hour emergency room, and has been accredited by the Joint Commission International (Riyadh; tel. 966-1-464-7272, emergency room tel. 966-1-442-3398; website http://www.kfshrc.edu.sa/; also branch in Jeddah; tel. 966-2-667-7777; website http://www.kfshrcj.org/channels). Another option is the King Fahad National Guard Hospital (King Abdulaziz Medical City, Riyadh; tel. 252-0088; emergency room ext 3333; website http://www.ngha.med.sa). In Al Khobar, many travelers go to Saad Specialist Hospital (P.O. Box 30353, Al-Khobar 31952; tel. 966 (03) 882 8999 or +966 (03) 882 6666; website http://www.saadgroupmedicalservices.com/home/index.asp), which provides 24-hour emergency and ambulance services and has been accredited by the Joint Commission International.

For a guide to other hospitals, clinics, and physicians in Saudi Arabia, go to the U.S. Embassy website. Good modern medical care can be found in major cities, but may difficult to locate elsewhere. Many doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance. Life-threatening medical problems will require air evacuation to a country with state-of-the-art medical facilities.

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Traveling with children

Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed.

All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics. Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule).

The recommendations for malaria prophylaxis are the same for young children as for adults, except that (1) dosages are lower; and (2) doxycycline should be avoided. DEET-containing insect repellents are not advised for children under age two, so it's especially important to keep children in this age group well-covered to protect them from mosquito bites.

When traveling with young children, be particularly careful about what you allow them to eat and drink (see food and water precautions), because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever, which are transmitted by contaminated food and water, are not approved for children under age two. Baby foods and cows' milk may not be available in developing nations. Only commercially bottled milk with a printed expiration date should be used. Young children should be kept well-hydrated and protected from the sun at all times.

Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.

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Travel and pregnancy

International travel should be avoided by pregnant women with underlying medical conditions, such as diabetes or high blood pressure, or a history of complications during previous pregnancies, such as miscarriage or premature labor. For pregnant women in good health, the second trimester (18–24 weeks) is probably the safest time to go abroad and the third trimester the least safe, since it's far better not to have to deliver in a foreign country.

Before departure, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency obstetric care if necessary. In general, pregnant women should avoid traveling to countries which do not have modern facilities for the management of premature labor and other complications of pregnancy.

As a rule, pregnant women should avoid visiting areas where malaria occurs. Malaria may cause life-threatening illness in both the mother and the unborn child. None of the currently available prophylactic medications is 100% effective. Mefloquine (Lariam) is the drug of choice for malaria prophylaxis during pregnancy, but should not be given if possible in the first trimester. If travel to malarious areas is unavoidable, insect protection measures must be strictly followed at all times. The recommendations for DEET-containing insect repellents are the same for pregnant women as for other adults.

Strict attention to food and water precautions is especially important for the pregnant traveler because some infections, such as listeriosis, have grave consequences for the developing fetus. Additionally, many of the medications used to treat travelers' diarrhea may not be given during pregnancy. Quinolone antibiotics, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin), should not be given because of concern they might interfere with fetal joint development. Data are limited concerning trimethoprim-sulfamethoxazole, but the drug should probably be avoided during pregnancy, especially the first trimester. Options for treating travelers' diarrhea in pregnant women include azithromycin and third-generation cephalosporins. For symptomatic relief, the combination of kaolin and pectin (Kaopectate; Donnagel) appears to be safe, but loperamide (Imodium) should be used only when necessary. Adequate fluid intake is essential.

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Maps

Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names.

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Embassy/Consulate Location

(reproduced from the U.S. State Dept. Consular Information Sheet)

Americans living or traveling in Saudi Arabia are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website, https://travelregistration.state.gov, and to obtain updated information on travel and security within Saudi Arabia. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, you'll make it easier for the Embassy or Consulate to contact you in case of emergency. The U.S. Embassy in Riyadh, Saudi Arabia, is located at Collector Road M, Riyadh Diplomatic Quarter. The international mailing address is P.O. Box 94309, Riyadh 11693. Mail may also be sent via the U.S. Postal Service to: U.S. Embassy, Unit 61307, APO AE 09803-1307. The Embassy telephone number is (966) (1) 488-3800, fax (966) (1) 488-7275.

The U.S. Consulate General in Dhahran, Saudi Arabia, is located between Aramco Headquarters and the old Dhahran Airport at the King Fahd University of Petroleum and Minerals highway exit. The international mailing address is P.O. Box 38955, Doha-Dhahran 31942. Mail may also be sent via the U.S. Postal Service to: Unit 66803, APO AE 09858-6803. The telephone number is (966) (3) 330-3200, fax (966) (3) 330-0464.

The U.S. Consulate General in Jeddah, Saudi Arabia, is located on Palestine Road, Ruwais. The international mailing address is P.O. Box 149, Jeddah. Mail may also be sent via the U.S. Postal Service to: Unit 62112, APO AE 09811-2112. The telephone number is (966) (2) 667-0080, fax (966) (2) 669-3078 or 669-3098.

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Safety information

For information on safety and security, go to the U.S. Department of State, United Kingdom Foreign and Commonwealth Office, Foreign Affairs Canada, and the Australian Department of Foreign Affairs and Trade.

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