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Saudi Arabia

Capital: Riyadh

Time Zone: +3 hours GMT. No daylight savings time in 2014.
Tel. Country Code: 966
USADirect Tel.: 1
Electrical Standards: Electrical current is 220/50 (volts/hz). North American Style Adaptor Plug. Grounding Adaptor Plug D.

Travel Advisory - Saudi Arabia

There is a low risk of malaria in North Africa and the Middle East, but other insect-transmitted diseases, such as leishmaniasis and viral infections, are potential threats. Safe water precautions, safe needle, and insect-bite prevention measures are important.

Dr. Rose Recommends for Travel to Saudi Arabia

Resource Links

World Health Organization
Travel Health Services
Country Insights
Travel Warnings
Consular Information
Foreign Commonweatlh Office


American Embassy
Collector Road M
Diplomatic Quarter
Tel: [966] (1) 488-3800
Fax: [966] (1) 483-0773
American Citizen Services
ACS E-mail Inquiries, send to:

U.S. Consulate General
Saudi Arabia
Palestine Road
Tel: [966] (2) 667-0080

• Canadian Embassy
Diplomatic Quarter
Tel: [966] (1) 488-2288
Emergency toll-free to Ottawa: 800-814-0139
Fax: [966] (1) 488-1997

• British Embassy
Tel: [966] (0) 1 488 0077
Fax: [966] (0) 1 488 2373

Entry Requirements

HIV Test: Required for applicants for residency/work permits.

Required Vaccinations: All pilgrims over 2 years old must get a vaccine to protect against meningococcal disease. This requirement means that you —
• Need to have had your vaccine no more than 3 years and no less than 10 days before you arrive in Saudi Arabia.
• Must show proof of meningococcal vaccination on a valid certificate of vaccination (International Certificate of Vaccination or Prophylaxis) before you can enter the cities of Mecca and Medina to perform the Hajj. If you do not have this proof of vaccination, you may be denied entry.
• This vaccine MUST be a quadrivalent (A/C/Y/W-135) meningococcal vaccine.

In addition to the Saudi government requirement, CDC recommends quadrivalent meningococcal vaccine because of outbreaks of meningitis associated with the Hajj in 1987 and 2000. There are two types of quadrivalent meningococcal vaccine: meningococcal conjugate vaccine, which is recommended for people aged 2–55, and meningococcal polysaccharide vaccine, which is recommended for people over 55 but can be given to people aged 2–55.

Poliomyelitis: Pilgrims under 15 years of age who enter Saudi Arabia from polio-affected countries are required to receive the oral polio vaccine before applying for an entry visa. The Saudi government will also, regardless of vaccination history, give these travelers a dose of oral polio vaccine (OPV) when they arrive. While this requirement does not apply to pilgrims traveling from the United States, it is still a good idea to talk to your doctor and make sure that you have been fully vaccinated against polio.

Yellow Fever: All travellers arriving from countries where yellow fever is known to occur must provide a valid yellow fever vaccination certificate showing that they have had their vaccine no less than 10 days and not more than 10 years before their arrival to Saudi Arabia.

Passport Information


A passport valid for at least six months and a visa are required for entry. Visas are issued for business and work, to visit close relatives, and for transit and religious visits. Visas for tourism are issued only for approved tour groups following organized itineraries. Airport and seaport visas are not available. All visas require a sponsor, can take several months to process, and must be obtained prior to arrival. In the past, American citizens have reported they were refused a Saudi visa because their passports reflected travel to Israel or indicated they were born in Israel , although this has not happened recently. Women visitors and residents are required to be met by their sponsor upon arrival. Women traveling alone, who are not met by sponsors, have experienced delays before being allowed to enter the country or to continue on other flights.

Visitors to Saudi Arabia should generally obtain a meningitis vaccination prior to arrival. A medical report or physical examination is required to obtain work and residence permits.
We strongly recommend that American citizens who also have Saudi nationality enter Saudi Arabia with either a Saudi passport or U.S. passport and Saudi visa, but not with a Laissez Passer.

For further information on entry/exit requirements, travelers may contact the following Saudi government offices in the U.S.:

Royal Embassy of Saudi Arabia, 601 New Hampshire Avenue NW, Washington, DC 20037, telephone (202) 342-3800. 
The Embassy home page is

Saudi Consulate General in Houston: 5718 Westheimer, Suite 1500 , Houston, TX 77057, tel: (713) 785-5577
Saudi Consulate General in Los Angeles: Sawtelle Courtyard Building , 2045 Sawtelle Blvd., Los Angeles, CA 90025, tel: (310) 479-6000
Saudi Consulate General in New York: 866 United Nations Plaza, Suite 480 , New York, NY 10017, tel: (212) 752-2740

Visit the Embassy of Saudi Arabia website at for the most current and complete visa information.

Saudi Arabia is a monarchy ruled by a king chosen from and by members of the Al Saud family. The king rules through royal decrees issued in conjunction with the Council of Ministers, and with advice from the Consultative Council. The king appoints members of both councils. Islamic law is the basis of the authority of the monarchy and provides the foundation of the conservative customs and social practices of this country. Saudi Arabia has a modern and well-developed infrastructure, and facilities for travelers are widely available. 

Vaccinations: Recommended and Routine

Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.

Hepatitis B: Recommended for all travelers who might be exposed to blood or bodily fluids from unprotected sex with a high-risk partner; from injecting drug use with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes; from contact with open skin sores. Recommended for any traveler requesting protection against hepatitis B virus.

Influenza: Vaccination recommended for all travelers >6 months of age who have not received a seasonal flu shot in the previous 12 months.
• To limit the spread of 2009 H1N1 flu and to reduce the risk of flu exposure for people at increased risk of flu complications, Saudi Arabia recommends that pilgrims should be at least 12 years old and not over 65 years of age. Saudi Arabia also recommendations that pilgrims refrain from performing Umrah or the Hajj if they have chronic diseases such as heart, liver, or kidney diseases, complications of diabetes, obesity, or any other diseases or conditions that affect a person’s overall health and immunity. In addition, the Ministry of Health recommends that pilgrims should be vaccinated against the 2009 H1N1 flu vaccine when it becomes available.

Meningococcal (Meningitis): Quadrivalent meningococcal vaccine (against serogroups A,C,Y, W-135) 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.

All arrivals from countries within the African Meningitis Belt (Benin; Burkina Faso; Cameroon; Chad; Central African Republic; Cote d’Ivoire; Eritrea; Ethiopia; Gambia; Guinea; Guinea-Bissau; Mali; Niger; Nigeria; Senegal and Sudan) will also be administered antibiotic treatment at the point of entry as an added precaution.

Polio: A one-time dose of IPV vaccine is recommended for any traveler >age 18 who completed the primary childhood series but never received an additional dose of polio vaccine as an adult. Available data do not indicate the need for more than a single lifetime booster dose with IPV (Inactivated Polio Vaccine).
• Pilgrims under 15 years of age who enter Saudi Arabia from polio-affected countries are required to receive the oral polio vaccine before applying for an entry visa. The Saudi government will also, regardless of vaccination history, give these travelers a dose of oral polio vaccine (OPV) when they arrive. This requirement does not apply to pilgrims traveling from the United States.

Rabies: Recommended for travelers spending time in remote locations, or outdoors in rural areas where there is an increased the risk of animal bites. Pre-exposure vaccination eliminates the need for rabies immune globulin in the event of a high-risk animal bite, but does not eliminate the need for additional treatment with rabies vaccine.

Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.

Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers.

Yellow Fever: A yellow fever vaccination certificate is required for all travelers >1 year of age arriving from any country in the yellow fever endemic zones. Vaccination is not recommended or required otherwise.

Hospitals / Doctors

Good modern medical care and medicines are available in several hospitals and health centers in the major cities of Saudi Arabia, but only adequate medical care may be available in the outlying areas.
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers diarrhea or other infections; they should bring drugs for malaria prophylaxis, if needed according to their itinerary. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country - the equivalent drugs may not be available or may be of uncertain quality.
• Travelers are advised to obtain travel insurance that provides for medical evacuation to more advanced medical facility in another country in the event of serious illness or injury or the need for additional specialty care.

All cities and major towns in Saudi Arabia have at least one modern hospital and usually several others with highly trained staff and state-of-the-art equipment. Poorer sections of the cities have older facilities, which nevertheless offer acceptable services. Hospitals are listed in telephone directories and the yellow pages, and addresses can be found in tourist publications. When choosing a hospital, your best bet is to seek recommendations from colleagues and friends.
There are several different types of hospital, including public and private hospitals and military establishments. Some hospitals in the private sector are luxuriously appointed and could easily pass as five-star hotel accommodation. Their prices are at a similar level.
Most of Saudi Arabia•s private hospitals have an out-patients• department and an accident and emergency unit, although casualties are likely to be directed towards public hospitals by the emergency services, e.g. in the case of road accidents.
Arabic and English are widely spoken, English being frequently used in private hospitals, where many staff and most patients are foreign.
Some of the hospitals are regionally renowned and internationally recognized for their quality. These include:

• King Faisal Specialist Hospital and Research Centre
Tel. [966] (1) 464 7272
All specialties; ambulance service and helipad; rated best medical facility in Saudi Arabia.

• King Fahad Hospital
Tel: [966] (2) 660-6111

• Saudi German Hospital-Jeddah
Tel: [966] (2) 6829000
Fax: [966] (2) 6835874
Private accredited hospital; most specialties; one of the best medical facilities in the country.

Destination Health Info for Travelers

AIDS/HIV: Saudi Arabia is ruled by the Al-Saud royal family according to a strict interpretation of Sharia, or Islamic law, and shuns open discussion of HIV/AIDS and other sexually-transmitted diseases. The prevalence of HIV in the adult population is estimated at 0.01%, the lowest reported in the world. About 20% of the these cases are in Saudi nationals, the remainder primarily in foreigner workers. The kingdom has a population of 22 million, including some six million foreigners, who are obligated to undergo medical examinations including blood tests before being allowed to live and work there. Those found to be infected with HIV/AIDS are deported immediately. About 45 percent of the HIV/AIDS cases in the kingdom are sexually transmitted and about 75 percent of those infected are male.
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with the body fluids of another person or their blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.

Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.

Animal Hazards: There is the risk of carpet viper bites (usually nonfatal in adults) in lowland areas of the Asir region in southern Saudi Arabia.

Avian Influenza (Bird Flu): An outbreak of H5N1 avian influenza was reported in March 2007 among birds in Eastern Province. No human cases have been reported to date. H5N1 avian influenza is predominantly a disease of birds. The virus does not pass easily from birds to people and does not to pass from person to person (except in very rare cases of close contact with an infected blood relative).
• The risk to humans from avian influenza is believed to be very low and no travel restrictions are advised, except travelers should avoid visiting animal markets, poultry farms and other places where they may come into close contact with live or dead poultry, or domestic, caged or wild birds and their excretions. In addition, travelers are advised to:
1. Cook poultry and egg dishes thoroughly. (Well-cooked poultry is safe to eat.)
2. Wash hands frequently with soap and water if around poultry.

• The World Health Organization (WHO) does not recommend travel restrictions to countries experiencing outbreaks of H5N1 avian influenza in birds, including those countries which have reported associated cases of human infection.

The usual vaccines against influenza are not protective against •bird flu.•
Oseltamivir (Tamiflu) is somewhat effective in the treatment of H5N1 avian influenza. It seems to be effective in some cases, but may fail in others. Recently, resistant strains have been reported. In addition, the dosage and duration of treatment appear to be different in severe H5N1 cases.

Cholera: Sporadic cases may occur, but the threat to tourists is very low. Cholera is an extremely rare disease in travelers from developed countries. Cholera vaccine is recommended only for relief workers or health care personnel who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who do not have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
• The main symptom of more severe cholera is copious watery diarrhea.
• Antibiotic therapy is a useful adjunct to fluid replacement in the treatment of cholera by substantially reducing the duration and volume of diarrhea and thereby lessening fluid requirements and shortening the duration of hospitalization.
• A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children. (NEJM:

Crime/Security/Civil Unrest: We advise you to reconsider your need to travel to Saudi Arabia due to the high threat of terrorist attack. If you are in Saudi Arabia and concerned for your safety, consider departing.
Previous attacks include:
In February 2007, four foreign nationals were killed when gunmen attacked their group in north-west Saudi Arabia near the city of Tabuk. The group had visited the ruins at Madain Saleh.
In February 2006, terrorists conducted a suicide car bomb attack on an oil processing facility at Abqaiq in the Eastern Province.
Over the past year, Saudi security officials have arrested many suspected Islamist militants.
• Civil Unrest/Political Tension: Although demonstrations are illegal in Saudi Arabia, political developments in the region and international events may prompt large demonstrations or civil unrest. These demonstrations could turn violent and should be avoided.
• Crime: The crime rate is low. Petty theft does occur, particularly in crowded places.
• Local Travel: Women are not permitted to drive vehicles or ride bicycles.

Piracy in the southern Red Sea and Gulf of Aden is increasing in frequency. All forms of shipping are attractive targets for Somali pirates, including commercial vessels, pleasure craft (yachts, etc.) and luxury cruise liners. We strongly advise travelers to maintain a high level of vigilance and to exercise extreme caution when anywhere near these waters.

Crimean-Congo Hemorrhagic Fever: The virus of Crimean-Congo hemorrhagic fever circulates in rural agricultural areas. A small number of human cases occur sporadically. This disease is usually transmitted by ticks and occasionally by exposure to infected animals (usually freshly slaughtered sheep, goats, and cattle). There is very low risk to the average visitor. All travelers, however, should take precautions to prevent tick bites or exposure to freshly slaughtered meat.

Dengue Fever: Throughout 2009, Saudi Arabia reported dengue cases in areas popular with travelers, including Jeddah and Mecca. Those planning to participate in the Hajj should take extra precautions to prevent dengue. For more information about staying safe and healthy during the Hajj, see the travel notice Health Requirements and Recommendations for Travel to Saudi Arabia during the 2009 Hajj:
An average of 200 cases are now reported a month in Jeddah.
• Dengue fever is a mosquito-transmitted, flu-like viral illness occurring in throughout much of Asia. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. A syndrome of hemorrhagic shock can occur in severe cases.
• Dengue is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours in water catchments and storage containers in and immediately around houses.
• All travelers are at risk and should take measures to prevent daytime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin and applying permethrin spray or solution to clothing and gear.
• There is no vaccination or medication to prevent or treat dengue.

A dengue fever map is at:

Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Travelers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E is endemic with a seroprevalence of 9.5% in the general population. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals, such as swine, and also deer and wild boar, may serve as a viral reservoirs. (HEV is one of the few viruses which has been shown to be transmitted directly from animals through food.) In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• Hepatitis B is hyperendemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at >8%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic at high level, with a prevalence of 1.8% in the general population. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C - an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.

Note: 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: Influenza is transmitted from November through March. The flu vaccine is recommended for all travelers over age 6 months.

Leishmaniasis: Transmission of cutaneous leishmaniasis occurs year-round (peaking from July through September) in the oases of the eastern and central emirates. A hyperendemic focus may exist near the Al-Hofuf oasis. Transmission of cutaneous leishmaniasis also occurs in the mountains of western emirates. (Cases were reported among American military personnel stationed in eastern Saudi Arabia during Operation Desert Storm.) Transmission of visceral leishmaniasis (kala azar) occurs year-round and is restricted to the southwestern Asir region.
The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite in the evening and at night. Contrary to what their name suggests, sandflies are not found on beaches. They are usually found in forests, the cracks of stone or mud walls, or animal burrows.
• All travelers should take measures to prevent sandfly bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, permethrin (spray or solution) to clothing and gear, and sleeping under a permethrin-treated bednet.

Malaria: There is a risk of malaria in the south western and western provinces of Saudi Arabia. There is no risk to very low risk in the cities of Mecca, Medina, Jeddah or the high-altitude areas of Asir province. Both vivax and falciparum malaria are reported.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline, or primaquine (G6-PD test required) is recommended when traveling to malarious areas.

A malaria map is located on the Fit for Travel website, which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland (HPS). Go to and select Malaria Map from the Saudi Arabia page on the Destinations menu.

Malaria is transmitted via the bite of an infected female Anopheles mosquito. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn. All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents have been the gold standard of protection under circumstances in which it is crucial to be protected against insect bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
NOTE: Picardin repellents (20% formulation, such as Sawyer GoReady or Natrapel 8-hour) are now recommended by the CDC and the World Health Organization as acceptable non-DEET alternatives to protect against malaria-transmitting mosquito bites. Picaridin is also effective and ticks and biting flies.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.
• 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.

Meningitis: Serious outbreaks of meningitis have occurred, particularly in association with the Hajj pilgrimage. Pilgrims for Hajj or Umrah are required by the Government of Saudi Arabia to have a valid certificate of vaccination against meningitis before they are issued a visa. Over 50% of recent cases of meningococcal meningitis have been caused by serogroupp W-135. The CDC recommends that all travelers to Saudi Arabia be vaccinated with a quadravalent meningitis vaccine, no matter what their destination or time of year.

Middle East respiratory syndrome coronavirus (MERS-CoV)  Update Sept., 2014:

  • The rate of secondary transmission among household contacts of patients with Middle East respiratory syndrome coronavirus (MERS-CoV) pneumonia is approximately 4%.
  • All 12 secondary cases had mild or subclinical infections.
  • Travelers to countries of the Arabian Peninsula are unlikely to be at risk unless they are health care workers or visit households with cases of MERS-CoV pneumonia.

Other Diseases/Hazards: AIDS (very low prevalence; officially attributed to blood transfusions)
• Brucellosis (outbreak reported from Jizan in July 2004)
• Crimean-Congo hemorrhagic fever
• Echinococcosis (carried by stray dogs, especially in rural and agricultural areas)
• Onchocerciasis (black-fly-borne; confined to the southwestern Arabian peninsula in focally endemic area)
• Plague (flea-borne; no cases reported recently, but enzootic foci exist in the Asir region of the southwestern Arabian peninsula and along the Tigris-Euphrates river extending to Kuwait)
• Q fever
• Rift Valley fever (cases reported in south-west Saudi Arabia, mainly in the Jizan area)
• Sandfly fever (transmission primarily April through October)
• Flea-borne typhus (sporadic cases occur in eastern areas)
• Soil-transmitted helminthic infections (roundworm, hookworm, and whipworm)

Poliomyelitis (Polio): This disease has been reported active in this country. All travelers should be fully immunized. Proof of immunization may be required for travelers <15 years of age.

Rabies: Human cases are very sporadic, usually occurring in northern and eastern rural areas. Most animal rabies is in foxes with spillover into the stray dog population.
Rabies pre-exposure vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection. Children are considered at higher risk because they tend to play with animals and may not report bites.
• Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Prompt medical evaluation and treatment of any animal bite, especially a dog or fox. is essential, regardless of vaccination status.

Sandfly Fever: This viral disease is endemic. Foci may occur throughout the country, with elevated risk (April through October) in village and periurban areas. All travelers should take precautions against sandfly bites, which occur between dusk and dawn.

Schistosomiasis: Schistosoma mansoni (intestinal) and Schistosoma haematobium (urinary) are present in this country. Risk is present in the western (in wadis and cisterns) and central (in oases) emirates. Intestinal schistosomiasis foci occur in the central (Hail, Riyadh), northern (Al Jawf ), northwestern (Tabuk, Medina), midwestern (Makkah, Al Bahah), and the highlands of the southwestern (Jiazan) and midwestern (Makkah) emirates.
• Schistosomiasis is transmitted through exposure to contaminated water while wading, swimming, and bathing. Schistosoma larvae, released from infected freshwater snails, penetrate intact skin to establish infection. All travelers should avoid swimming, wading, or bathing in freshwater lakes, ponds, streams, cisterns, aqueducts, or irrigated areas. There is no risk in chlorinated swimming pools or in seawater.

Travelers' Diarrhea: Water is supplied via potable water distribution systems in all major urban areas of Saudi Arabia and is safe for drinking. Outside of hotels and resorts, we recommend that you boil, filter or purify all drinking water or drink only bottled water or other bottled beverages and do not use ice cubes. Avoid unpasteurized milk and dairy products. Do not eat raw or undercooked food (especially meat, fish, raw vegetables—these may transmit intestinal parasites, as well as bacteria). Peel all fruits.
• Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%.
• A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.

Tuberculosis (TB): A high incidence of tuberculosis occurs in Saudi Arabia. Tuberculosis (TB) is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact with an infected individual. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.

Typhoid Fever: Typhoid fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC for all people (with the exception of short-term visitors who restrict their meals to hotels or resorts) traveling to or working in the Middle East, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi, the cause of paratyphoid fever. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should continue to practice strict food, water and personal hygiene precautions, even if vaccinated.