Middle East (Bahrain, Cyprus, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syria, Turkey, United Arab Emirates, and Yemen) The area ranges from the mountains and steppes of the northwest to the large deserts and dry tropical scrub of the south.
Anthropod Borne Diseases
Arthropod-borne diseases, except for malaria in certain areas, are not a major hazard for the traveler. Malaria does not exist in Kuwait and no longer occurs in Bahrain, Cyprus, Israel, Jordan, Lebanon, or Qatar. Its incidence in Oman, Syria, Iran, and United Arab Emirates is low, but elsewhere it is endemic in certain rural areas. A rise in West Nile fever has been seen recently in Israel. A meningococcal vaccination certificate is required from all visitors arriving in Saudi Arabia for the purpose of Umra or Hajj for seasonal work. In 2000, Saudi Arabian health officials identified an outbreak of meningococcal disease; a substantial proportion of the isolates were the bacterial strain Neisseria meningitidis serogroup W-135. Health authorities in Saudi Arabia now require vaccination of all adult pilgrims with the quadrivalent (A/C/Y/W-135) meningococcal polysaccharide vaccine.
Cutaneous leishmaniasis is reported throughout the area; visceral leishmaniasis, although rare throughout most of the area, is common in central Iraq, in the southwest of Saudi Arabia, in the northwest of Syria, in Turkey (southeast Anatolia only), and in the west of Yemen. Murine and tickborne typhus can occur in certain countries. Tickborne relapsing fever can occur. Crimean-Congo hemorrhagic fever has been reported from Iraq, Iran, Saudi Arabia, United Arab Emirates, and Oman. Limited foci of onchocerciasis area reported in Yemen.
Foodborne and Waterborne Diseases
Foodborne and waterborne diseases are, however, a major hazard in most countries in the area. The typhoid fevers and hepatitis A exist in all countries. Schistosomiasis occurs in Iraq, Saudi Arabia, Syria, and Yemen. A limited focus of urinary schistosomiasis persists in southwest Iran. Dracunculiasis (Guinea worm) occurs in isolated foci in Yemen. Taeniasis (tapeworm) is reported from many of the countries. Brucellosis is reported from most countries, and there are foci of echinococcosis (hydatid disease). The risk of poliovirus infection is low in most countries of the area, with the exception of Yemen. Trachoma and animal rabies are found in many countries in the area.
Hepatitis B is endemic.
The greatest hazards to pilgrims to Mecca and Medina are heat and dehydration if the period of the Hajj coincides with the hot season.