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CDC urges travelers to Saudi Arabia to be current with meningococcal vaccines

The US Centers for Disease Control and Prevention (CDC) today issued a health alert and a level 1 travel alert about meningococcal disease in travelers to Saudi Arabia, especially those taking part in pilgrimage activities.

The alerts follow a recent notification from the European Centre for Disease Prevention and Control. Of 12 recent cases in the United States and Europe due to Saudi Arabia travel, 10 were in people who traveled to Saudi Arabia and 2 were close contacts, the CDC said in its Health Advisory Network notice.

Most cases were caused by serogroup W, but one US case was due to serogroup C and another involved an unknown serotype. Most patients were unvaccinated, and isolates from three patients suggest resistance to ciprofloxacin. 

Travel notice details vaccine recommendations, Saudi requirements

Also, the CDC today posted a level 1 travel notice , the lowest designation that urges travelers to practice usual precautions. It urged people traveling to the Hajj pilgrimage in Saudi Arabia, scheduled for June 14 to June 19, or the Umrah pilgrimage, to ensure that they are up to date with all routine and travel-related vaccines, including meningococcal disease. 

The agency added that Saudi Arabia requires all travelers 1 year and older arriving for pilgrimages to show proof that they have received quadrivalent (four-strain) vaccine at least 10 days prior to travel.

DR Congo mpox outbreak poses global threat of deadlier clade

An ongoing outbreak of the clade 1 mpox virus in the Democratic Republic of the Congo (DRC) poses a threat to the United States, authors write in Morbidity and Mortality Weekly Report. Clade 1 is more deadly and severe than the clade 2 virus that caused a global outbreak among men who have sex with men (MSM) in 2022.  

Both clades of the virus are endemic in the DRC, but the country noted an uptick in clade 1 cases in 2023 and 2024, with 19,919 suspected cases reported and 975 (4.9%) deaths. Cases are spreading both among traditional household transmission routes, and among sexual networks, including MSM and sex workers.  

Two thirds of cases in kids under 15

Of note, a large proportion of the current outbreak is among children ages 15 and under, representing 67% of suspected cases and 78% of suspected deaths. Children aged 12 to 59 months accounted for 28% of all suspected cases.

Beginning December 7, 2023, the US Centers for Disease Control and Prevention urged clinicians to consider clade 1 infections in persons with mpox signs and symptoms who had recently been in DRC, and conduct clade-specific testing for those patients.

To date, no cases of clade I mpox have been reported in the United States or in any countries where the virus is not endemic.

"To date, no cases of clade I mpox have been reported in the United States or in any countries where the virus is not endemic. However, given the documented sexual transmission of clade I MPXV in DRC, persons engaging in certain sexual behaviors (e.g., MSM with multiple sexual partners and sex workers) might be at increased risk if clade I mpox is introduced into the United States," said authors.  

The authors warned that 19 recent cases of clade 1 detected in DRC's neighboring Republic of the Congo suggests the cases in the DRC, "pose a new risk for global spread if the virus is not urgently contained.

"In addition to preparing for the possibility of spread beyond DRC, support to DRC from global partners is needed as the country works to increase testing and surveillance for clade I MPXV."

Stewardship programs tied to reduced initiation, shorter duration of antibiotics in newborns

A review and meta-analysis found that neonatal antimicrobial stewardship programs (ASPs) are associated with reduced initiation and duration of antibiotics use in newborns, with no increase in adverse events, researchers reported today in Pediatrics.

The review, conducted by researchers with the University of Toronto and the University of Alberta, analyzed data from 70 studies (44 cohort and 26 observational studies) involving 350,000 newborns that evaluated ASP impacts in neonatal intensive care units (NICUs) and postnatal ward settings. Antibiotics are the most frequently administered drugs in NICUs, and empiric use of broad-spectrum antibiotics in NICUs is a common practice to prevent infection or halt the progression of sepsis. But overuse of antibiotics in newborns has been associated with increased neonatal mortality and other adverse effects, as well as an increase in drug-resistant organisms.

Overall positive impact

Most studies included in the meta-analysis evaluated interventions aimed at reducing antimicrobial initiation and duration, and had significant heterogeneity in terms of ASP interventions, population settings, and outcome definitions.

Moderate-certainty evidence revealed a significant reduction in antimicrobial initiation in NICU (pooled risk difference [RD], 19%; 95% confidence interval [CI], 14% to 24%) and combined NICU and postnatal ward settings (pooled RD, 8%; 95% CI, 6% to 10%), days of therapy (pooled RD, 20%; 95% CI, 10% to 30%), length of therapy (pooled RD, 1.82 days; 95% CI, 1.09 to 2.56 days), and use of antimicrobial agents for more than 5 days (pooled RD, 9%; 95% CI, 3% to 15%). 

Low-certainty evidence revealed a reduction in drug resistance prevalence, costs, and favorable sustainability metrices, without an increase in sepsis-related mortality or the re-initiation of antimicrobial agents. 

"Our review highlights the overall positive impact of ASP interventions in restricting the initiation and duration of antimicrobial use in neonates, with quantifiable measures," the study authors wrote. "Future prospective studies are warranted to evaluate drug resistance and economic burden."

Beta-lactam allergies linked to higher risk of resistant infections, but not mortality

A longitudinal study of more than 20,000 patients in a regional healthcare system found that beta-lactam (BL) allergies were not associated with increased risk of death but were associated with increased risk of antibiotic-resistant infections, researchers reported late last week in JAMA Network Open.

Using electronic health record data on patients diagnosed as having sepsis, pneumonia, or urinary tract infection at the University of Pittsburgh Medical Center from 2007 through 2018, researchers assessed all-cause mortality among those patients with a documented BL allergy, which is the most common drug allergy worldwide but also the most reported in error. Secondary outcome included infection with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Clostridioides difficile , and the severity and occurrence of acute kidney injury (AKI).

Of the 20,092 patients (60.9% female; mean age, 62.9 years) included in the study, 4,211 (21%) had a documented BL allergy and 15,811 (79%) did not. Patients with a BL allergy were more likely to be female (69.1% vs 58.7%), older (64.2 years vs 62.6 years), and White (79.1% vs 75.7%) than those without. Baseline clinical characteristics did not differ significantly between the two groups.

44% increased risk of MRSA infection

While patients with documented BL allergy had higher rates of unadjusted all-cause mortality, multivariable analysis found no significant increase in the odds of mortality (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.96 to 1.09) compared with no documented BL allergy. But BL allergies were associated with increased odds of MRSA infection (OR, 1.44; 95% CI, 1.36 to 1.53), VRE infection (OR, 1.18; 95% CI, 1.05-1.32), and the pooled rate of the three evaluated antibiotic-resistant infections (OR, 1.33; 95% CI, 1.30 to 1.36).

No significant increase in risk of C difficile  infection alone (OR, 1.04; 95% CI, 0.94 to 1.16), stage 2 and 3 AKI (OR, 1.02; 95% CI, 0.96 to 1.10), or stage 3 AKI (OR, 1.06; 95% CI, 0.98 to 1.14) was observed.

The researchers say the association with increased risk of antibiotic-resistant infections suggests further research into the long-term impact of BL allergies is needed. They also call on health systems to emphasize accurate allergy documentation to reduce unnecessary BL avoidance.

Data show rising antibiotic resistance with repeat urinary tract infections

Over half (57%) of index urinary tract infections (UTIs) treated at a California healthcare system were caused by bacteria resistant to at least one antibiotic class, while 13% were resistant to three or more classes, with respective proportions rising to 65% and 20% with subsequent infections.

These  findings , published in the Journal of Infectious Diseases , show the importance of continually monitoring UTI recurrences and antibiotic susceptibility patterns to guide treatment decisions, the Kaiser Permanente Southern California–led research team said.

The researchers assessed the number of characteristics of subsequent UTIs in a patient cohort diagnosed as having an uncomplicated UTI (uUTI) from January 2016 to December 2020, with follow-up through 2021.

Need for continuous susceptibility monitoring

Of 148,994 patients diagnosed as having a uUTI, 19% had a subsequent culture-confirmed infection after a median of 300 days. Most index UTIs (79%) were caused by Escherichia coli , decreasing to 73% for the sixth UTI, while Klebsiella species rose from 7% of index UTIs to 11% for the sixth infection.

In total, 57% of index UTIs weren't susceptible to one or more antibiotic classes, and 13% of were resistant to at least three classes, climbing to 65% and 20%, respectively, by the sixth UTI. The most commonly resistant antibiotics were  penicillins alone (12%) and a combination of penicillin, trimethoprim-sulfamethoxazole, and at least one more antibiotic class (9%).

Continuously updated data on susceptibility patterns are critical to guide appropriate antibiotic prescribing as well as to inform interventions to prevent repeated UTI events.

In the year before the index UTI, the most common antibiotic class prescribed for any reason were penicillins (16%), followed by first-generation cephalosporins (13%) and fluoroquinolones (5%). In the year before each subsequent UTI, first-generation cephalosporins and fluroquinolones were most common, followed by penicillins and nitrofurantoin.

"Continuously updated data on susceptibility patterns are critical to guide appropriate antibiotic prescribing as well as to inform interventions to prevent repeated UTI events," the authors wrote. 

"As the degree of resistance to the most frequently prescribed antibiotics for UTI evolves over time and may vary by region, it is also important to continuously monitor the local prevalence of uropathogens and their susceptibility to guide appropriate antibiotic use," they concluded. 

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Minnesota, Iowa report infected dairy herds.

Study reveals persistent risk of death, symptoms in COVID survivors at 3 years

"A brief, seemingly innocuous or benign encounter with the virus can still lead to health problems years later," one study author says.

Report: More than 200 symptoms tied to long COVID

The report "offers a comprehensive review of the evidence base for how Long COVID may impact a patient's ability to engage in normal activities."

N95 respirator gets top billing in stopping SARS-CoV-2 viral leakage into the air

The "duckbill" N95 stopped 98% of the virus that causes COVID-19, the authors say.

Report describes emerging sexually transmitted fungal infection

The infection is caused by Trichophyton mentagrophytes type VII, a fungus that may spread via sexual contact.

FDA panel supports switch to JN.1 for fall COVID vaccines

Though the vote was unanimous, discussions were complicated by the diversity of JN.1 viruses.

Study: Truthful yet misleading Facebook posts drove COVID vaccine reluctance much more than outright lies did

Unflagged vaccine-skeptical content cut vaccination intent by 2.28 percentage points per user, versus −0.05 percentage points for flagged content.

Second dairy farm worker infected with H5 avian flu in Michigan

Unlike similar earlier cases in the United States, the newly reported patient had respiratory symptoms.

CDC: Cucumber-linked Salmonella outbreak sickens 162 in 25 states, Washington DC

Fifty-four people have been hospitalized, with no deaths reported.

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Saudi Arabia

Travel Advisory January 24, 2024

Saudi arabia - level 3: reconsider travel.

Updated after periodic review to provide information on the risk of arrest due to social media use and the importation of prohibited items.

Reconsider travel to Saudi Arabia due to  the threat of missile and drone attacks.   Exercise increased caution in Saudi Arabia due to  terrorism, the risk of arrest based on social media activity, and importation of prohibited items.  Some areas have increased risk.  Read the entire Travel Advisory.

Do not travel to the following locations due to the threat of  missile and drone attacks  and  terrorism :

• Within 50 miles of the Saudi-Yemen border, as well as the cities of Abha, Jizan, Najran, and Khamis Mushayt;
• Abha airport;
• Qatif in the Eastern Province and its suburbs, including Awamiyah.

Country Summary : U.S. government personnel under Chief of Mission responsibility must adhere to the above travel restrictions.  As such, the U.S. government has limited ability to provide emergency services to U.S. citizens in these locations.

Missile and drone attacks perpetrated by Iran and Iran-supported militant groups have occurred as recently as September 2023.  The Islamic Republic of Iran has in the past supplied Yemen-based Houthis and regional proxy groups with weapons to conduct destructive and sometimes lethal attacks using drones, missiles, and rockets against a variety of Saudi sites, including critical infrastructure, civilian airports, military bases, and energy facilities throughout the country, as well as vessels in Red Sea shipping lanes.  Past attacks were aimed at targets throughout Saudi Arabia including Riyadh, Jeddah, Dhahran, Jizan, Khamis Mushayt, the civilian airport in Abha, Al Kharj, military installations in the south, as well as oil and gas facilities.

Debris from intercepted drones and missiles has also represented a significant risk to civilian areas and populations in the recent past.  Militant groups have threatened to conduct attacks against locations in Saudi Arabia.  U.S. citizens living and working near military bases and critical civilian infrastructure, particularly near the border with Yemen, are at heightened risk if missile, drone, or rocket attacks reoccur.

Terrorism continues to be a concern in Saudi Arabia.  Attacks can occur with little or no warning.  Past attacks have targeted tourist locations, large gatherings, transportation hubs, markets/shopping malls, and local government facilities.  Terrorists are also known to time attacks around major holidays and/or in response to military operations.  Terrorists have targeted both Saudi and international interests, mosques and other religious sites (both Sunni and Shia), and places frequented by U.S. citizens.

Be advised that social media commentary – including past comments – which Saudi authorities may deem critical, offensive, or disruptive to public order, could lead to arrest .  This may include posting, re-posting, or liking comments about Saudi institutions, policies, and public life.  U.S. citizens have been convicted for social media activity under Saudi laws concerning cybercrime, terrorism, and disrupting public order.  Punishment for social media activity has included prison sentences of up to 45 years in some cases.  Saudi courts do not necessarily consider the timeframe of the posts or the location from which they were made to be material to these cases.

The importation of drugs (including marijuana), drug paraphernalia, alcohol, weapons, pork, or any materials that could be considered pornographic or suggestive, is prohibited.   Penalties for drug possession, consumption, and trafficking are severe by U.S. standards.  An extensive list of banned items is available on our Saudi Arabia country information page .

Due to risks to civil aviation operating within the Persian Gulf and the Gulf of Oman region, including Saudi Arabia, the Federal Aviation Administration (FAA) has issued an advisory Notice to Air Missions (NOTAM).  For more information U.S. citizens should consult the  Federal Aviation Administration’s Prohibitions, Restrictions and Notices .

Read the  country information page  for additional information on travel to Saudi Arabia.

If you decide to travel to Saudi Arabia:

• Visit our website for information on  travel to high-risk areas .
• Stay alert in large crowds and/or locations frequented by foreign nationals.
• Obtain comprehensive medical insurance that includes medical evacuation.
• Review local laws and conditions before traveling, including our Saudi Arabia country information on arrest notification and the Department of State’s general information on arrests of U.S. citizens abroad .
• Enroll in the  Smart Traveler Enrollment Program  ( STEP ) to receive Alerts and make it easier to locate you in an emergency.
• Follow the Department of State on  Facebook  and  Twitter .
• Follow the U.S. Embassy in Saudi Arabia on  Facebook  and  Twitter .
• Review the  Country Security Report   for Saudi Arabia.
• Visit the CDC page for the latest  Travel Health Information  related to your travel.
• Prepare a contingency plan for emergency situations. Review the  Traveler’s Checklist .

Yemen Border, Abha airport, and Qatif in the Eastern Province and its suburbs, including Awamiyah – Level 4: Do Not Travel

Militants in Yemen have attacked Saudi border towns and other sites in Saudi Arabia with armed drones, missiles, and rockets .  Civilians that are near the border with Yemen are especially at risk.   Terrorist groups continue plotting possible attacks in Saudi Arabia, including in Qatif.

The U.S. government has limited ability to provide emergency services to U.S. citizens within 50 miles of the Saudi-Yemen border as U.S. government personnel and their families are restricted from travel to this area.

Visit our website for information on  travel to high-risk areas

Embassy Messages

View Alerts and Messages Archive

Quick Facts

A valid passport is required for U.S. citizens to enter or exit the Kingdom of Saudi Arabia. A minimum of six months’ validity beyond the date of travel is recommended.

One page required for entry stamp.

Required for certain visa classes

More than 16,000 USD must be declared. Customs details are here .

Embassies and Consulates

The normal work week in Saudi Arabia is Sunday through Thursday.

U.S. Embassy Riyadh Abdullah Ibn Hudhafah As Sahmi Street Roundbaout no. 9, Diplomatic Quarter Riyadh, Saudi Arabia Telephone: (966) (11) 488-3800 Emergency Telephone: (966) (11) 488-3800 Fax: (966) (11) 488-7670 [email protected]

U.S. Consulate General Jeddah Al Safa Street, Al Muhammadiyah District, near the new American School building. Jeddah, Saudi Arabia Telephone: (966) (12) 220-5000 Fax: (966) (12) 220-5093 [email protected]

U.S. Consulate General Dhahran Off King Saud bin Abdulaziz Road, at the corner of Salaheddin al Ayoubi Street and Prince Fahd bin Sultan bin Abdulaziz Street, Dhahran, Saudi Arabia Telephone:   (966) (13) 839-5700 Emergency Telephone:   (966) (13) 839-5700 Fax:   (966) (13) 330-6816 [email protected]

Destination Description

Learn about the U.S. relationship to countries around the world.

Entry, Exit and Visa Requirements

See the  Embassy of Saudi Arabia’s website  for visa information.

COVID-19 Requirements: There are no COVID-related entry requirements for U.S. citizens.

For residency permit-holders (iqama), an exit/reentry permit is required to leave Saudi Arabia as well as six month’s validity on your passport to request an exit/reentry permit.

• Saudi law requires that residency permit-holders carry their residency card (iqama) at all times while in the Kingdom. Failure to do so could result in a fine of 3,000 Saudi riyals and a jail sentence of six weeks.
• Females and minors may require a male guardian’s permission to leave the country, including U.S. citizens or dual-nationals.
• You must exit Saudi Arabia using the passport for the nationality corresponding to the one on which you entered Saudi Arabia.

Saudi law requires all Saudi citizens to enter and depart the country with a Saudi travel document. If you enter the country on a Saudi laissez-passer (temporary travel document), you may encounter difficulty leaving the Kingdom.

Saudi embassies do not have the authority to adjudicate citizenship claims or issue passports, but they may issue a laissez-passer for presumed Saudi citizens for whom citizenship has not been adjudicated, such as children of a Saudi parent or parents who were married outside of Saudi Arabia. Once admitted to Saudi Arabia on a laissez-passer, the traveler must obtain a Saudi passport before leaving the country. Saudi nationality is not conferred quickly or easily, and the processing time for a Saudi passport in these cases has often been six months or years in some cases. Obtaining a U.S. passport will not help, as you will not be able to leave Saudi Arabia without an exit visa which will not be granted if you entered as a Saudi citizen.

The Department strongly recommends that U.S. citizens enter Saudi Arabia on a U.S. passport and Saudi visa, and not a laissez-passer.

Length of Stay:  Bearers of tourist visas are generally admitted for a 90-day stay and may not remain in the Kingdom more than 180 days in a twelve month period. Carefully check your visa validity and length of stay granted, and clarify any questions on permitted length of stay with Saudi immigration officials on arrival. Dates are calculated in accordance with the Hijri calendar, which differs from the Gregorian calendar.

If you overstay your visa, you could face significant fines, detention, and/or deportation, and a ban from returning to Saudi Arabia.

The U.S. Embassy is unable to intercede, reduce fines, or prevent incarceration if you violate Saudi law.

Travel Bans:  When placed under a travel ban, you cannot exit the country, even if you are a U.S. citizen or a dual U.S.-Saudi citizen. Travel bans are rigidly enforced and can take months or even years to resolve. Only Saudi Arabian authorities and sponsors can remove travel bans.

The government may issue travel bans on people who are/have:

• charged with criminal offenses;
• under investigation;
• involved in financial or labor disputes;
• failed to report to work according to the terms of the contract (absconded);
• unpaid debts or who have passed bad checks.

The list above is not exhaustive. Private Saudi citizens may also initiate travel bans against foreign citizens for various reasons.

Residency Permits:  If you are seeking residency in Saudi Arabia, make sure you have all required legal documents authenticated before arriving. Neither the U.S. Embassy in Riyadh nor the U.S. Consulates General in Jeddah or Dhahran can provide this service.

You should have all U.S. issued documents authenticated by the  Department of State Office of Authentications  (202-485-8000) and attested by the  Embassy of Saudi Arabia  in Washington D.C.

Work Visas: If you plan on working in Saudi Arabia, you must obtain a work visa before you arrive. Foreigners working in Saudi Arabia are subject to the country’s sponsorship system, which concedes substantial legal authority over the worker to the employer. This can include the ability to prevent the employee from leaving the country. American citizens considering working in Saudi Arabia should carefully review the information about employment in the “Local Laws and Special Circumstances” section below.

If the visitor or business visa has been annotated “not permitted to work,” you are not allowed to legally work in Saudi Arabia. You risk substantial financial penalties, detention, deportation, and a ban from returning to Saudi Arabia if you work without legal permission. Additionally, without a work visa, there would be no legal grounds to pursue a case against an employer should a dispute arise.

HIV/AIDS:  To obtain work and residence permits, you are required to obtain a medical report or physical examination confirming that you are free from contagious diseases, including HIV/AIDS and hepatitis. If you test positive for HIV/AIDS or hepatitis, you will not be allowed to work in the Kingdom. Saudi Arabia has not imposed HIV/AIDS or hepatitis travel restrictions on other categories of travelers. Please inquire directly with the  Embassy of Saudi Arabia  before you travel.

Vaccinations:  Visitors to Saudi Arabia should check vaccination requirements on the  Saudi Ministry of Health website.

Yemen Travel:  The Department strongly advises U.S. citizens against travel to Yemen due to the ongoing conflict in that country. See our  Yemen Travel Advisory  for further information. A visa is required to enter Saudi Arabia, and Saudi authorities generally do not permit foreign citizens to enter Saudi Arabia using land border crossings from Yemen. The Embassy and Consulates General cannot provide assistance to U.S. citizens seeking to cross the Yemeni-Saudi border.

Safety and Security

The Department of State advises you to exercise increased caution when traveling to Saudi Arabia due to terrorism and the threat of missile and drone attacks on civilian targets. See the Travel Advisory for Saudi Arabia here .

Do not travel:

• Within 50 miles of the border with Yemen due to terrorism and armed conflict.

Terrorist groups continue plotting possible attacks in Saudi Arabia. Terrorists may attack with little or no warning, targeting tourist locations, transportation hubs, markets/shopping malls, and local government facilities. Terrorists have targeted both Saudi and Western government interests, mosques and other religious sites (both Sunni and Shia), and places frequented by U.S. citizens and other Westerners.

Houthis operating in Yemen have fired long-range missiles into Saudi Arabia, specifically targeting populated areas and civilian infrastructure; they have publicly stated their intent to continue doing so. Missile attacks have targeted major cities such as Riyadh and Jeddah, Riyadh’s international airport, Saudi Aramco facilities, and vessels in Red Sea shipping lanes. Rebel groups are also in possession of unmanned aerial systems (UASs or drones) which they have used to target civilian infrastructure and military facilities in Saudi Arabia. U.S. citizens living and working on or near such installations, particularly in areas near the border with Yemen, are at heightened risk of missile and drone attack.

On October 11, 2018 the Saudi General Authority for Civil Aviation issued a Notice to Airmen about threats to civil aviation and airports in Saudi Arabia posed by missiles and UASs launched from Yemen. For more information, U.S. citizens should consult the U.S. Government’s Defense Internet NOTAM Service (Type “OEJD” in the search field, then click “View NOTAMs,” then scroll down to W0438/18 and click to view).

The U.S. government has limited ability to provide emergency services to U.S. citizens in the following locations as U.S. government personnel and their families are restricted from travel to:

• Within 50 miles of the Saudi-Yemen border, including the cities of Jizan and Najran;
• Qatif in the Eastern province and its suburbs, including Awamiyah.

You can find additional details relating to safety and security in our Travel Advisory and Alerts and the website of the U.S. Mission in Saudi Arabia .

Crime: Crime in Saudi Arabia has increased over recent years but remains at levels far below most major metropolitan areas in the United States.

• You should be aware of your surroundings, keep valuables out of sight and secure, and travel with a companion, if possible.
• Some Saudi citizens who perceive that a foreigner is not observing conservative standards of conduct or dress have been known to harass, pursue, or assault that person.
• Even when released from detention, witnesses to criminal incidents may be prohibited from leaving the country until investigation of the incident is complete.

See the websites of the Department of State  and the  FBI for information on scams.

Victims of Crime: If you or someone you know becomes the victim of a crime, you should contact the local police at “999” and contact the Embassy in Riyadh or one of the Consulates in Jeddah or Dhahran.Remember that local authorities are responsible for investigating and prosecuting the crime.

See the Department of State’s webpage on help for U.S. victims of crime overseas .

The Department can:

• help you identify appropriate medical care;
• assist you in reporting a crime to the police;
• contact relatives or friends with your written consent;
• explain the local criminal justice process in general terms;
• provide a list of local attorneys;
• provide information on victim’s compensation programs in the U.S. ;
• provide an emergency loan for repatriation to the United States and/or limited medical support in cases of destitution;
• help you find accommodation and arrange flights home;
• replace a stolen or lost passport.

Domestic Violence: If you are the victim of any form of physical violence, including domestic violence, you should contact the Saudi police by calling “999”.  In addition, victims of domestic violence can contact the Saudi National Domestic Violence Hotline by dialing “1919.” The Saudi Ministry of Labor and Social Development runs a network of shelters for women and children. Contacting the domestic violence hotline (“1919”) is the only way to access these shelters. The Saudi National Family Safety Program also runs a Child Help Line “116111” and can assist children in accessing Saudi social services.

When reporting domestic violence, it is imperative to get a case reference number as all Saudi social and legal assistance is tied to this case number. It is also a good idea to document any injuries and obtain a copy of any medical reports. U.S. citizens should be advised that filing a police report or utilizing any Saudi victims’ assistance services may result in the Saudi authorities informing your sponsor or guardian.

U.S. citizen victims of domestic violence may contact the Embassy or Consulates for assistance.

Tourism:  The tourism industry is unevenly regulated, and safety inspections for equipment and facilities do not commonly occur. Hazardous areas/activities are not always identified with appropriate signage, and staff may not be trained or certified either by the host government or by recognized authorities in the field. In the event of an injury, appropriate medical treatment is typically available only in/near major cities. First responders are generally unable to access areas outside of major cities and to provide urgent medical treatment. U.S. citizens are encouraged to purchase medical evacuation insurance. See our webpage for more information on insurance providers for overseas coverage .

Local Laws & Special Circumstances

Dual Citizenship: Saudi Arabia generally does not recognize dual nationality. Saudi law requires Saudi citizens to obtain official permission from the government before obtaining a second nationality. At times, Saudi authorities have confiscated the passports of U.S. citizens applying for Saudi citizenship. This does not constitute loss of U.S. citizenship. If this happens to you or someone you know, report the incident to the U.S. Embassy.

Arrest Notification: If you are arrested or detained, ask police or prison officials to notify the U.S. Embassy or consulate immediately. Be aware that Saudi Arabia generally restricts consular notification of the arrest of foreigners to the Embassy of the country that issued the travel document used to enter the Kingdom. If you enter Saudi Arabia with a Saudi travel document, or with the passport of a country other than the United States, it will be extremely difficult for the U.S. Embassy to provide consular services if you are subsequently detained. Persons detained in Saudi Arabia may be held without charges for lengthy periods and denied access to counsel; dual citizens may not have consular assistance. See the Embassy’s webpage for further information.

Drones: The importation of drones for commercial or personal use is prohibited without prior approval from the General Authority for Civil Aviation (GACA). A customs clearance certificate authorizing importation can be obtained as part of the GACA approval process. Visit GACA’s website for further information.

Criminal Penalties: While in Saudi Arabia, you are subject to local laws. If you violate Saudi laws, even unknowingly, you may be expelled; arrested; imprisoned; held without trial for lengthy periods of time; interrogated without counsel; subject to corporal punishments, including lashings; or executed.

Penalties for the import, manufacture, possession, and consumption of alcohol or illegal drugs in Saudi Arabia are severe. Convicted offenders can expect long jail sentences, heavy fines, public floggings, and deportation. The penalty for drug trafficking is death. Furthermore, some laws are prosecutable in the United States regardless of local law. For examples, see our webpage on crimes against minors abroad and the Department of Justice website .

There are substantial limitations on freedom of speech and political expression in Saudi Arabia. For additional information see the Department of State’s Human Rights Report for Saudi Arabia .

Faith-Related Travel Issues: Islam is the official religion of the country and is present in all aspects of life in Saudi Arabia. See our Hajj and Umrah Fact Sheet .

• Saudi authorities do not permit criticism of Islam or Muslim religious figures, including on social media.
• The government prohibits the public practice of religions other than Islam. Non-Muslims suspected of violating these restrictions have been jailed and/or deported. Church services in private homes have been raided, and participants have been jailed and/or deported.
• Muslims who do not adhere to the strict interpretation of Islam prevalent in much of Saudi Arabia may encounter societal discrimination and constraints on public worship.
• Public display of non-Islamic religious articles, such as crosses and Bibles, is not permitted.
• Non-Muslims are forbidden to travel to Mecca and parts of Medina, the cities where two of Islam’s holiest mosques are located.
• See the Department of State’s International Religious Freedom Report .

LGBTI Travelers: Same-sex sexual relations, even when consensual, are criminalized in Saudi Arabia. Violations of Saudi laws governing perceived expressions of, or support for, same-sex sexual relations, including on social media, may be subject to severe punishment. Potential penalties include fines, jail time, or death. See our LGBTI Travel Information page and section 6 of the Department of State's Human Rights report for further details.

Travelers Who Require Accessibility Assistance: Individuals with disabilities may find accessibility and accommodation very different from what is generally found in the United States. Saudi law does not prohibit discrimination against people with disabilities, and there is no legislation requiring public accessibility. Newer commercial and government buildings, however, often include such access. According to the Ministry of Labor and Social Development, there are numerous government-sponsored centers for people with disabilities. Note that Saudi Arabia has limited infrastructure to care for those with mental disabilities.

Students: See the Department’s Students Abroad page and FBI travel tips .

Women Residents and Travelers: Married women, including non-Saudis, require their husband's permission to depart the country, while unmarried women and children require the permission of their father or male guardian.

Minor children must have their father’s permission in order to leave the Kingdom. Children visiting their fathers in Saudi Arabia, even when there is a custody agreement, can be prevented from leaving unless the father consents. This is true even if the child is an American citizen. The U.S. Embassy and Consulates cannot obtain exit visas for the departure of minor children without their father/guardian's permission.

If a foreigner and a Saudi living in Saudi Arabia divorce, Saudi courts rarely grant permission for the foreign parent to leave the country with the children born during the marriage, even if he or she has been granted physical custody.

Foreign mothers of Saudi children, who are divorced or widowed, may apply for a permanent residency permit(iqama) without the need for a sponsor. To do so, they must prove maternity and that they were legally married to the Saudi father.

Also see the Department’s travel tips for Women Travelers .

Employment: The Arabic text of a contract governs employment and business arrangements under Saudi law. Verbal assurances or side letters are not binding under Saudi law. In the event of any contract dispute, Saudi authorities refer to the written contract.

• Sponsors have wide latitude and responsibilities for employees and family members under their sponsorship, including obtaining residence permits for the employee and for any family members.
• All residents should be issued a Saudi residence permit (iqama) and are legally required to carry it at all times.
• The U.S. Embassy and Consulates General in Saudi Arabia cannot sponsor private U.S. citizens for Saudi visas.
• Sponsors have been known to demand that residents working in Saudi Arabia surrender their passports while in the Kingdom. Such practices are illegal and should be reported to the Ministry of Labor and Social Development .
• Since the Saudi sponsor controls the issuance of exit permits, U.S. citizens may be prevented by the sponsor from leaving Saudi Arabia in the event of a labor or business dispute, which could take months or years to resolve.
• To change employers within the Kingdom, Saudi Arabia requires the written permission of the original sponsoring employer.
• The U.S. Embassy and U.S. Consulates General cannot assist in labor or business disputes, nor can they provide translation or legal services.
• U.S. consular officers can provide lists of local attorneys to help U.S. citizens settle business disputes, but ultimate responsibility for the resolution of disputes through the Saudi legal system, and payment for those services, lies with the parties involved. For additional information on Saudi labor law, please refer to the Ministry of Labor and Social Development’s webpage .
• Saudi customs authorities enforce strict regulations concerning the importation of such banned items as alcohol, weapons, and any item that is held to be contrary to the tenets of Islam (such as pork, anything considered pornographic under strict Islamic principles, and religious materials).
• Imported and domestic audiovisual media and reading matter are censored.
• Christmas and other holiday decorations, fashion magazines, and "suggestive" videos may be confiscated and the owner subject to penalties and fines.
• Electronic devices may be subject to inspection upon entry or exit. Please see the Department’s Customs Information page as well as the Saudi Customs webpage.

Importing Animals: The Saudi Ministry of Agriculture must approve all pets imported into Saudi Arabia.

• Cats and dogs entering Saudi Arabia require a Veterinary Health Certificate and a dated letter from the veterinary practitioner addressed to his/her sponsor to obtain the necessary approval from the Ministry of Agriculture.
• Both documents must be authenticated by the Department of Agriculture Veterinary Service Office and the State Department's Authentications Office and attested by the Embassy of Saudi Arabia .
• The certificate must indicate that the animal was examined and is free from disease and confirm that rabies and other vaccines are current. Information on the name, breed, sex, color, and age of the animal must also be stated.
• Please see additional information on taking a pet overseas .

Teaching English in Saudi Arabia: In recent years, increasing numbers of American language teachers have experienced contractual and other problems. Some teachers have complained about arbitrary dismissals, difficult living conditions, salary arrears, unwanted reassignments, restrictions on their movement, and inability to leave the country. Prospective teachers in Saudi Arabia should vet their potential employer and carefully review their employment offer as well as the detailed information found in the Embassy’s Guide to Teaching English in Saudi Arabia . Additionally, prospective teachers should also take care to make sure that they obtain the appropriate work visa prior to coming to Saudi Arabia. The Embassy cannot help you if you violate Saudi labor law.

Standards of Conduct and Religious Police: Norms for public behavior in Saudi Arabia are extremely conservative. Both the uniformed police and the religious police, referred to colloquially as the mutawwa or al-hay’a, are charged with enforcing these standards.

• Mutawwa are required to carry special identification and usually are accompanied by uniformed police.
• While a 2016 government decree withdrew the authority of the mutawwa to make arrests independently of regular police forces, visitors should be prudent in their interactions with mutawwa.
• An individual must, if requested, present his/her residence permit (iqama) or other identification to the mutawwa or the police.
• U.S. citizens who are involved in an incident with the mutawwa should report the incident to the U.S. Embassy in Riyadh or the U.S. Consulates General in Jeddah or Dhahran.

In most areas of Saudi Arabia, and particularly in Riyadh and the central part of the Kingdom, women wear a full-length covering known as an abaya. Most women in conservative areas also cover their hair with a hijab for modesty, and many also cover their faces with a niqab.

Tourists are expected to dress modestly in public, avoiding tight fitting clothing or clothes with profane language or images; women are not required to wear abayas or cover their hair but are expected to cover their shoulders and knees, and men should not go without a shirt. Women who choose not to conform to Saudi Arabia’s dress code face a risk of confrontation by mutawwa, negative or hostile comments by Saudi citizens, and possible detention Guidelines on public decorum for tourists are available at the Saudi government’s official tourism website, www.visitsaudi.com. Many areas of life in Saudi Arabia are segregated by sex to ensure that unrelated men and women have no possibility of mingling (a punishable crime) by unmarried men and women. Less frequently, members of the mutawwa try to enforce this by asking for proof that a couple is married or related. Men and women detained for socializing with individuals who are not relatives may be charged with moral crimes such as khulwa (mixing with unrelated members of the opposite sex). Less frequently, some restaurants may refuse to serve women who are not accompanied by a close male relative In addition, a few restaurants or cafes do not have a "family section" in which women are permitted to eat. Men not accompanied by a close female family member are not allowed to enter family sections and cannot use services (such as registers at supermarkets) designated as “family.” These restrictions are not always clearly posted.

While there are now movie theaters, musical concerts, and artistic performances in Saudi Arabia, the country remains socially conservative. Social media postings which contravene cultural standards can have legal and/or criminal consequences.

Photography: The Saudi government does not permit photography of governmental facilities, such as military bases and government buildings, nor military, security, or police personnel. The Saudi government is also sensitive to photographs that may be perceived as portraying the country in an unfavorable light. This policy can include photos of mosques, impoverished areas, the local population, and traditional souks (markets). You should not take anyone’s picture without clear consent, and never take a picture of a woman or a place where women congregate. Be aware of local sensitivities whenever you are taking pictures in public. U.S. citizens have been routinely detained for violating these policies. The U.S. Embassy and Consulates General are unable to intervene if you violate Saudi law.

The Hajj and Umrah: Please review the Department of State’s Hajj and Umrah Fact Sheet for useful information on traveling to perform the Hajj or Umrah.

COVID-19 Testing:  COVID-19 testing is available to U.S. citizens throughout Saudi Arabia at public and private facilities. Private hospitals and clinics charge a fee for COVID-19 testing.  Cost, delivery method, and timing of results varies. Some facilities can electronically deliver results within 24 hours or less.  

COVID-19 Vaccines:  The COVID-19 vaccine is available for U.S. citizens to receive in Saudi Arabia. For more information, please see the Ministry of Health’s website.

Visit the FDA's website to learn more about FDA-approved vaccines in the United States.

Medical care varies greatly in quality, and high-profile cases of medical malpractice and errors have occurred. Consult your regular physician if you are considering serious medical treatment in Saudi Arabia.

The U.S. Embassy and U.S. Consulates General do not pay medical bills.  Be aware that U.S. Medicare does not apply overseas.

Medical Insurance: Make sure your health insurance plan provides coverage overseas. Most care providers in Saudi Arabia accept cash or credit card payments.  See the Department’s webpage for more  information on insurance providers for overseas coverage . Supplemental insurance to cover medical evacuation is strongly recommended. If you are covered by Saudi insurance, be sure to read the fine print: local insurance can have exclusions that are unusual in the United States. For example, some local policies may not supply coverage for accidents that occur while engaging in adventure sports, such as riding quad vehicles in the desert, that are a common past-time for expatriates.

If traveling with prescription medication, check with the  government of Saudi Arabia  to ensure the medication is legal in Saudi Arabia. Always carry your prescription medication in original packaging, along with your doctor’s prescription. 

Please note:

• Saudi Arabia has a dry climate with extreme heat several months of the year – travelers should stay hydrated.
• Air pollution is a significant concern in many parts of Saudi Arabia including Riyadh, Al Jubail, Jeddah, and Dammam.
• Many infectious diseases, such as measles, typhoid, dengue, and Middle East Respiratory Syndrome (MERS), are present in Saudi Arabia.

Be up-to-date on all  vaccinations  recommended by the U.S. Centers for Disease Control and Prevention.

For further health information, go to:

• World Health Organization (WHO)
• U.S. Centers for Disease Control and Prevention   (CDC)
• Saudi Ministry of Health

Medical care varies greatly in quality, and high profile cases of medical malpractice and errors have occurred. Consult your regular physician if you are considering serious medical treatment in Saudi Arabia.

We do not pay medical bills.  Be aware that U.S. Medicare does not apply overseas.

Medical Insurance: Make sure your health insurance plan provides coverage overseas. Most care providers overseas only accept cash payments.  See our webpage for more  information on insurance providers for overseas coverage . We strongly recommend supplemental insurance to cover medical evacuation. If you are covered by Saudi insurance, be sure to read the fine print: local insurance can have exclusions that are unusual in the United States. For example, some local policies may not supply coverage for accidents that occur while engaging in adventure sports, such as riding quad vehicles in the desert, that are a common past-time for expats.

Always carry your prescription medication in original packaging, along with your doctor’s prescription.

If traveling with prescription medication, check with the  government of Saudi Arabia  to ensure the medication is legal in Saudi Arabia. Always carry your prescription medication in original packaging, along with your doctor’s prescription.

For health-related information on the Middle East respiratory syndrome coronavirus (MERS-CoV), formerly called “novel coronavirus,” visit the  CDC’s MERS-CoV webpage .

Be up-to-date on all  vaccinations   recommended by the U.S. Centers for Disease Control and Prevention.

• World Health Organization
• U.S. Centers for Disease Control and Prevention  (CDC)

Travel and Transportation

Road Conditions and Safety: Driving in Saudi Arabia can be hazardous due to speeding and aggressive driving, lax enforcement of traffic regulations, and a high volume of traffic.

Beginning on June 24, 2018, women have been able to obtain a driver’s license and can legally drive in Saudi Arabia. With a valid visitor visa and U.S. or international driver’s license, visitors may drive a rental car. However, outside the major cities of Riyadh, Dhahran and Jeddah, visitors—especially women—may experience difficulty renting a car. Female residents with independent sponsorships and U.S. or international driver’s licenses also may obtain a Saudi driver’s license, necessary to drive vehicles other than rental cars. Foreign women residing in Saudi Arabia who are listed as dependents on their Saudi residency permit (“iqama”) may experience difficulties in obtaining Saudi driver’s licenses. To drive vehicles other than rental cars, a Saudi driver’s license, appropriate car registration, and auto insurance are required. Police may detain you if you cannot produce these documents.

See the Saudi Arabian Ministry of Interior website for further information.

Traffic Laws :

• Temporary visitors may drive using their valid U.S. or international driver's license for up to 90 days.
• Foreigners resident in Saudi Arabia who wish to drive must obtain a local driver's license from the Department of Traffic Police.
• In the event of a traffic accident, U.S. citizens should dial “993” to report the accident. You must remain on the scene until the traffic police arrive. Failure to do so can result in a criminal offense.
• Additionally, U.S. citizens should contact Najm, a private company contracted by the traffic police to complete the accident report (+966 9200 00560).
• In the event of a traffic accident resulting in personal injury, everyone involved (if not seriously injured) is likely be taken to the local police station.
• All drivers, regardless of fault, can be held in custody for several days until responsibility is determined and any reparations paid.
• Use of front seat belts (driver and passenger) is required by law.
• U.S. citizens involved in a serious accident resulting in injury or death should immediately contact their sponsors and the U.S. Embassy or nearest U.S. Consulate.
• Residents should update their personal details through one of the methods available here to receive SMS notifications once a traffic ticket is issued.
• Delay in payment of any ticket might result in doubling of the ticket amount.
• Travelers will need to pay any fines issued through this system before leaving the country.

Public Transportation:

• U.S. Government employees are prohibited from using taxis in Saudi Arabia with the exception of Uber Black in Riyadh, Kareem First in Jeddah, and Majestic taxi service in Dhahran. If you must use a taxi, only use established companies, such as those offering cabs with meters. Taxis and lift services are available throughout major cities, and you should arrange a pickup by telephone or via smartphone app when possible.
• Avoid sitting in the front seat of a taxi, do not travel to unfamiliar areas, and do not enter taxis with unknown passengers.

Please refer to the Department’s Road Safety page for more information. Also, it is recommended that you visit the website of the Saudi Arabian Ministry of Interior .

Aviation Safety Oversight: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Saudi Arabia's Civil Aviation Authority as being in compliance with International Civil Aviation Organization aviation safety standards for oversight of Saudi Arabia's air carrier operations. Further information may be found on the FAA safety assessment page .

Information for Mariners:

Mariners should also review U.S. maritime alerts and advisories on the Maritime Security Communications with Industry Web Portal .

For additional travel information

• Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive security messages and make it easier to locate you in an emergency.
• Call us in Washington, D.C. at 1-888-407-4747 (toll-free in the United States and Canada) or 1-202-501-4444 (from all other countries) from 8:00 a.m. to 8:00 p.m., Eastern Standard Time, Monday through Friday (except U.S. federal holidays).
• See the  State Department’s travel website  for the  Worldwide Caution  and  Travel Advisories .
• Follow us on  Twitter  and  Facebook .
• See  traveling safely abroad  for useful travel tips.

Review information about International Parental Child Abduction in Saudi Arabia . For additional IPCA-related information, please see the International Child Abduction Prevention and Return Act ( ICAPRA ) report.

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Destinations

Measles cases are increasing globally, including in the United States. The majority of measles cases imported into the United States occur in unvaccinated U.S. residents who become infected during international travel. A list of countries with confirmed measles outbreaks can be found on the Global Measles Travel Health Notice (THN) . Measles spreads rapidly in communities that are not fully vaccinated and may pose a risk to international travelers in places not included in the THN. CDC recommends all travelers get fully vaccinated against measles before traveling to any international destination.

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Complete List of Destinations

• Afghanistan
• American Samoa
• Anegada (see Virgin Islands, British )
• Anguilla (U.K.)
• Antigua and Barbuda
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• Bahamas, The
• Barbuda (see Antigua and Barbuda )
• Bermuda (U.K.)
• Bora-Bora (see French Polynesia (France) )
• Bosnia and Herzegovina
• British Indian Ocean Territory (U.K.)
• Burkina Faso
• Burma (Myanmar)
• Caicos Islands (see Turks and Caicos Islands (U.K.) )
• Canary Islands (Spain)
• Cayman Islands (U.K.)
• Central African Republic
• Christmas Island (Australia)
• Cocos (Keeling) Islands (Australia)
• Congo, Republic of the
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• Côte d'Ivoire
• Curaçao
• Democratic Republic of the Congo
• Dominican Republic
• Dubai (see United Arab Emirates )
• Easter Island (Chile)
• El Salvador
• England (see United Kingdom )
• Equatorial Guinea
• Eswatini (Swaziland)
• Falkland Islands (Islas Malvinas)
• Faroe Islands (Denmark)
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• French Polynesia (France)
• Galápagos Islands (see Ecuador )
• Gambia, The
• Gibraltar (U.K.)
• Greenland (Denmark)
• Grenadines (see Saint Vincent and the Grenadines )
• Guam (U.S.)
• Guernsey (see United Kingdom )
• Guinea-Bissau
• Holy See (see Italy )
• Hong Kong SAR (China)
• Isle of Man (see United Kingdom )
• Israel, including the West Bank and Gaza
• Ivory Coast (see Côte d'Ivoire )
• Jersey (see United Kingdom )
• Jost Van Dyke (see Virgin Islands, British )
• Liechtenstein
• Macau SAR (China)
• Madeira Islands (Portugal)
• Marquesas Islands (see French Polynesia (France) )
• Marshall Islands
• Martinique (France)
• Mayotte (France)
• Micronesia, Federated States of
• Montserrat (U.K.)
• Moorea (see French Polynesia (France) )
• Myanmar (Burma) (see Burma (Myanmar) )
• Netherlands, The
• New Caledonia (France)
• New Zealand
• Niue (New Zealand)
• Norfolk Island (Australia)
• North Korea
• North Macedonia
• Northern Ireland (see United Kingdom )
• Northern Mariana Islands (U.S.)
• Papua New Guinea
• Philippines
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• Puerto Rico (U.S.)
• Réunion (France)
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• Rurutu (see French Polynesia (France) )
• Saint Barthelemy
• Saint Croix (see Virgin Islands, U.S. )
• Saint Helena (U.K.)
• Saint John (see Virgin Islands, U.S. )
• Saint Kitts and Nevis
• Saint Lucia
• Saint Martin
• Saint Pierre and Miquelon (France)
• Saint Thomas (see Virgin Islands, U.S. )
• Saint Vincent and the Grenadines
• Saipan (see Northern Mariana Islands (U.S.) )
• São Tomé and Príncipe
• Saudi Arabia
• Scotland (see United Kingdom )
• Sierra Leone
• Sint Eustatius
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• Society Islands (see French Polynesia (France) )
• Solomon Islands
• South Africa
• South Georgia and the South Sandwich Islands (U.K.)
• South Korea
• South Sandwich Islands (see South Georgia and the South Sandwich Islands (U.K.) )
• South Sudan
• Swaziland (Eswatini) (see Eswatini (Swaziland) )
• Switzerland
• Tahiti (see French Polynesia (France) )
• Timor-Leste (East Timor)
• Tinian (see Northern Mariana Islands (U.S.) )
• Tobago (see Trinidad and Tobago )
• Tokelau (New Zealand)
• Tortola (see Virgin Islands, British )
• Trinidad and Tobago
• Tubuai (see French Polynesia (France) )
• Turkmenistan
• Turks and Caicos Islands (U.K.)
• United Arab Emirates
• United Kingdom
• United States
• Vatican City (see Italy )
• Virgin Gorda (see Virgin Islands, British )
• Virgin Islands, British
• Virgin Islands, U.S.
• Wake Island
• Wales (see United Kingdom )
• Zanzibar (see Tanzania )

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Morning Briefing

Summaries of health policy coverage from major news organizations, visiting saudi arabia be sure to get meningococcal vaccine first, cdc says.

Twelve cases stemming from people who either traveled to the nation or were close contacts prompted the travel and health alerts. In other news, a more severe mpox outbreak in the Democratic Republic of the Congo could have global implications.

CIDRAP: CDC Urges Travelers To Saudi Arabia To Be Current With Meningococcal Vaccines  The US Centers for Disease Control and Prevention (CDC) today issued a health alert and a level 1 travel alert about meningococcal disease in travelers to Saudi Arabia, especially those taking part in pilgrimage activities. The alerts follow a recent notification from the European Centre for Disease Prevention and Control. Of 12 recent cases in the United States and Europe due to Saudi Arabia travel, 10 were in people who traveled to Saudi Arabia and 2 were close contacts, the CDC said in its Health Advisory Network notice. (Schnirring, 5/20)

CIDRAP: DR Congo Mpox Outbreak Poses Global Threat Of Deadlier Clade An ongoing outbreak of the clade 1 mpox virus in the Democratic Republic of the Congo (DRC) poses a threat to the United States, authors write in Morbidity and Mortality Weekly Report. Clade 1 is more deadly and severe than the clade 2 virus that caused a global outbreak among men who have sex with men (MSM) in 2022. (Soucheray, 5/20)

In covid news —

CIDRAP: Long-COVID Codes In Health Record May Dramatically Underestimate Its Prevalence  Long COVID is likely much more prevalent than indicated in electronic health record (EHR) diagnostic or referral codes, London School of Hygiene and Tropical Medicine researchers report in eClinicalMedicine. (Van Beusekom, 5/20)

WUSF: New CDC Guidance For Schools Encourages Vaccination And Masks New guidance from the Centers for Disease Control and Prevention aims to help schools reduce the spread of infections, but recommendations include some that Florida officials have spoken out against. Florida Gov. Ron DeSantis and Florida Surgeon General Joseph Ladapo have previously discouraged vaccination and mask wearing — particularly when it comes to COVID-19. (Miller, 5/21)

Science Alert: Here's Yet Another Reason To Stay On Top Of Your COVID Vaccine Boosters If the effects don't fade too rapidly, new data suggests regular COVID-19 vaccinations could strengthen our immune systems against future variants and even related viruses. This is on top of the proven protection they already provide against current infections. (Koumoundouros, 5/21)

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Health Alert Network (HAN)

CDC’s Health Alert Network (HAN) is CDC’s primary method of sharing cleared information about urgent public health incidents with public information officers; federal, state, territorial, tribal, and local public health practitioners; clinicians; and public health laboratories.

CDC’s HAN collaborates with federal, state, territorial, tribal, and city/county partners to develop protocols and stakeholder relationships that will ensure a robust interoperable platform for the rapid distribution of public health information.

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Health Alert Network (HAN) No. 508 – Meningococcal Disease Cases Linked to Travel to the Kingdom of Saudi Arabia (KSA): Ensure Pilgrims are Current on Meningococcal Vaccination 05/20/2024 10:30 AM

Health Alert Network (HAN) No. 507 – Adverse Effects Linked to Counterfeit or Mishandled Botulinum Toxin Injections 04/23/2024 11:00 AM

Health Alert Network (HAN) No. 506 – Highly Pathogenic Avian Influenza A(H5N1) Virus: Identification of Human Infection and Recommendations for Investigations and Response 04/05/2024 1:30 PM

Health Alert Network (HAN) No. 505 – Increase in Invasive Serogroup Y Meningococcal Disease in the United States 03/28/2024 1:30 PM

Health Alert Network (HAN) No. 504 – Increase in Global and Domestic Measles Cases and Outbreaks: Ensure Children in the United States and Those Traveling Internationally 6 Months and Older are Current on MMR Vaccination 03/18/2024 12:30 PM

Health Alert Network (HAN) No. 503 – Urgent Need to Increase Immunization Coverage for Influenza, COVID-19, and RSV and Use of Authorized/Approved Therapeutics in the Setting of Increased Respiratory Disease Activity During the 2023 – 2024 Winter Season 12/14/2023 12:15 PM

Health Alert Network (HAN) No. 502 – Severe and Fatal Confirmed Rocky Mountain Spotted Fever among People with Recent Travel to Tecate, Mexico 12/08/2023 4:15 PM

Health Alert Network (HAN) No. 501 – Mpox Caused by Human-to-Human Transmission of Monkeypox Virus with Geographic Spread in the Democratic Republic of the Congo 12/07/2023 10:45 AM

Health Alert Network (HAN) No. 500 – High Blood Lead Levels in Children Consuming Recalled Cinnamon Applesauce Pouches 11/13/2023 2:00 PM

Health Alert Network (HAN) No. 499 – Limited Availability of Nirsevimab in the United States—Interim CDC Recommendations to Protect Infants from Respiratory Syncytial Virus (RSV) during the 2023–2024 Respiratory Virus Season 10/23/2023 3:30 PM

Health Alert Network (HAN) No. 481 – Update on Managing Monkeypox in Patients Receiving Therapeutics 11/17/2022 7:00 PM

Health Alert Network (HAN) No. 427 – Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV) 02/01/2020 9:00 AM

Health Alert Network (HAN) No. 426 – Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV) in Wuhan, China 01/17/2020 8:30 PM

Health Alert Network (HAN) No. 425 – Elevated Influenza Activity: Influenza B/Victoria and A(H1N1)pdm09 Viruses are the Predominant Viruses 01/10/2020 11:40 AM

Health Alert Network (HAN) No. 424 – Outbreak of Pneumonia of Unknown Etiology (PUE) in Wuhan, China 01/08/2020 4:15 PM

Health Alert Network (HAN) No. 423 – Guidance for Using Rapid Diagnostic Tests for Ebola in the United States 12/16/2019 2:00 PM

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CDC Warns Muslim Pilgrims to Saudi Arabia of Meningitis Outbreak

Key takeaways.

Health officials are warning Muslim travelers about an outbreak of meningitis in Saudi Arabia

The annual Hajj is coming up in a matter of weeks

Twelve cases of meningitis have been linked to recent pilgrimages to Mecca

WEDNESDAY, May 22, 2024 (HealthDay News) -- Muslim pilgrims attending the annual Hajj could be at risk for meningitis due to outbreaks occurring in Saudi Arabia, U.S. health officials warned this week.

Twelve cases of meningitis linked to Umrah travel to Saudi Arabia have been reported to national health agencies in three countries, the CDC said in a travel health notice .

Umrah is an Islamic pilgrimage to Mecca in Saudi Arabia that can be performed any time of the year, the CDC said.

The Hajj is an annual pilgrimage, scheduled to occur June 14 to 19 this year, in which between 2 to 3 million Muslims travel to Mecca.

Saudi Arabia requires all Hajj and Umrah pilgrims older than 1 year to be vaccinated for meningitis, the CDC noted.

Nevertheless, nine of the meningitis cases were unvaccinated, the CDC said.

Meningitis is a rare but severe disease that kills 10% to 15% of patients, even if they're receiving antibiotics, the CDC said.

The infection causes inflammation of the lining of the brain and spinal cord. Symptoms can include fever, headache, stiff neck, nausea, vomiting, light sensitivity and altered mental status, the CDC said.

The infection also can spread into the bloodstream, with additional symptoms including chills, fatigue, cold hands and feet, severe aches and pains, rapid breathing, diarrhea and a dark purple rash.

Symptoms worsen rapidly and can become life-threatening within hours, the CDC noted. Survivors might wind up deaf or require amputation.

There have been five cases reported in the United States, four cases in France and three cases in the United Kingdom, the CDC said.

Ten cases involve patients who traveled to Saudi Arabia, and two were in people who had close contact with recent travelers.

Two cases were in children younger than 18, four in young adults ages 18 to 44, four in middle-aged folks ages 45-64, and two in adults aged 65 or older, the CDC said.

In the United States, meningitis vaccination is routinely recommended for teenagers and for travelers to countries where meningitis outbreaks are occurring. This could include a booster dose for folks who had their last vaccination three to five years before.

The CDC is urging doctors to make sure that Muslim patients considering a pilgrimage are fully vaccinated against meningitis.

Doctors also should be on the lookout for symptoms of meningitis among any patients returning to the United States following a pilgrimage to Mecca, the CDC said.

The most recent global outbreak of meningitis associated with travel to Saudi Arabia for Hajj was in 2000-2001, the CDC said.

That outbreak was primarily caused by Neisseria meningitidis serogroup W (NmW), the same bacteria responsible for 10 of the cases in this latest outbreak.

Since 2002, Saudi Arabia has required that international travelers provide documentation of meningitis vaccination, the CDC said.

"Nevertheless, meningococcal vaccination coverage among Umrah travelers is known to be incomplete," the CDC said.

More information

The U.S. Centers for Disease Control and Prevention has more about meningitis .

SOURCE: U.S. Centers for Disease Control and Prevention, travel health notice , May 20, 2024

What This Means For You

People planning a trip to Mecca should make sure they are fully vaccinated for meningitis.

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Stephen Hiltner/The New York Times

The sculpted facade of a 2,000-year-old tomb glows in the late-afternoon sun at Hegra, a UNESCO World Heritage site.

Crowds of Muslim pilgrims gather outside the Prophet’s Mosque in Medina.

Camels march through the desert on the outskirts of the Empty Quarter, the world’s largest sand sea.

For many years these Saudi Arabian scenes, including the lively open-air markets in Jeddah, were off limits to most travelers.

But not anymore. As it undergoes a profound transformation, Saudi Arabia is spending lavishly to lure tourists with its luxe new resorts ...

... its rich cultural heritage ...

... and its sublime natural beauty.

Can the Saudi government persuade would-be visitors to look past — or reconsider — its longstanding associations with religious extremism, ultraconservatism and human rights abuses?

Will the kingdom’s $800 billion bet on tourism pay off?

Supported by

Surprising, Unsettling, Surreal: Roaming Through Saudi Arabia

To witness the kingdom’s profound transformation and assess its ambitious tourism projects, a Times journalist spent a month on the road there. Here’s what he saw.

By Stephen Hiltner

An editor and photojournalist for the Travel section, Stephen Hiltner drove 5,200 miles and visited all 13 of Saudi Arabia’s provinces while reporting and shooting this story.

Wandering alone along the southern fringes of Saudi Arabia’s mountainous Asir Province, some eight miles from the Yemeni border, in a nondescript town with a prominent sculpture of a rifle balanced on an ornately painted plinth, I met a man, Nawab Khan, who was building a palace out of mud.

Actually, he was rebuilding the structure, restoring it. And when I came across him, he hadn’t yet begun his work for the day; he was seated on the side of the road beneath its red-and-white windows — cross-legged, on a rug, leaning over a pot of tea and a bowl of dates.

Two weeks earlier, on the far side of the country, a fellow traveler had pointed at a map and described the crumbling buildings here, in Dhahran al-Janub, arranged in a colorful open-air museum. Finding myself nearby, I’d detoured to have a look — and there was Mr. Khan, at first looking at me curiously and then waving me over to join him. Sensing my interest in the cluster of irregular towers, he stood up, produced a large key ring and began opening a series of padlocks. When he vanished through a doorway, I followed him into a shadowy stairwell.

This, of course, was my mother’s worst nightmare: Traveling solo, I’d been coaxed by a stranger into an unlit building in a remote Saudi village, within a volatile border area that the U.S. Department of State advises Americans to stay away from .

By now, though, more than halfway through a 5,200-mile road trip, I trusted Mr. Khan’s enthusiasm as a genuine expression of pride, not a ploy. All across Saudi Arabia, I’d seen countless projects being built, from simple museums to high-end resorts. These were the early fruits of an $800 billion investment in the travel sector, itself part of a much larger effort, Vision 2030 , to remake the kingdom and reduce its economic dependence on oil.

But I’d begun to see the building projects as something else, too: the striving of a country — long shrouded to most Westerners — to be seen, reconsidered, accepted. And with its doors suddenly flung open and the pandemic behind us, visitors like me were finally beginning to witness this new Saudi Arabia, much to Mr. Khan’s and all the other builders’ delight.

Few countries present as complicated a prospect for travelers as Saudi Arabia.

Long associated with Islamic extremism, human rights abuses and the oppression of women, the kingdom has made strides in recent years to refashion its society and its reputation abroad.

The infamous religious police, which upheld codes of conduct based on an ultraconservative interpretation of Islam, were stripped of their power. Public concerts, once banned, are now ubiquitous. Women have been granted new rights — including the freedom to drive and to travel without permission from a male guardian — and are no longer required to wear floor-length robes in public or to cover their hair.

These changes are part of a broad set of strategies to diversify the kingdom’s economy, elevate its status in the world and soften its image — the last of which is a tall order for a government that has killed a newspaper columnist , kidnapped and tortured dissidents , precipitated a humanitarian crisis in Yemen and imprisoned people for supporting gay rights , among a number of other recent abuses .

Central to the transformations led by 38-year-old Crown Prince Mohammed bin Salman, the kingdom’s de facto ruler, is a major push for international visitors. It represents a sea change in a country that, until 2019, issued no nonreligious tourist visas and instead catered almost exclusively to Muslim pilgrims visiting Mecca and Medina, Islam’s two holiest cities. In February, by contrast, my tourist e-visa was approved online in minutes.

Saudi Arabia has already transformed one of its premier destinations — Al-Ula, with its UNESCO-listed Nabatean tombs — from a neglected collection of archaeological sites into a lavish retreat with a bevy of activities on offer, including guided tours, wellness festivals, design exhibitions and hot air balloon rides.

Another project will create a vast array of luxury resorts on or near the Red Sea.

Still more projects include the development of Diriyah , the birthplace of the first Saudi state; the preservation and development of the coastal city of Jeddah ; an offshore theme park called the Rig ; and Neom , the futuristic city that has garnered the lion’s share of attention.

All told, the country is hoping to draw 70 million international tourists per year by 2030, with tourism contributing 10 percent of its gross domestic product. (In 2023, the country logged 27 million international tourists, according to government figures , with tourism contributing about 4 percent of G.D.P.)

At-Turaif, a UNESCO World Heritage site, was the birthplace of the kingdom of Saudi Arabia. It is now the centerpiece of the $63 billion Diriyah project, a new center of culture just outside Riyadh.

Nujuma, a Ritz-Carlton Reserve on a remote island in the Red Sea, opened in late May. (A one-bedroom villa costs about $2,500 per night, excluding taxes and fees.) It is one of 50 properties scheduled to open in the area by 2030.

The preservation and development of Jeddah, a coastal city famous for its historic district built largely from blocks of coral, comes with a price tag of some $20 billion.

Al-Ula is a cornerstone of Saudi Arabia’s tourism ambitions. Part of the city’s Old Town, long crumbling in neglect, has now been painstakingly restored.

To get a sense of these projects and the changes unfolding in Saudi society, I spent a month exploring the kingdom by car. I traveled alone, without a fixer, driver or translator. Per New York Times ethics guidelines, I declined the government’s many offers of discounts and complimentary services.

Much of the time I felt I’d been tossed the keys to the kingdom. But there were moments, too, when I faced a more complicated reality, one epitomized by a road sign that forced me to abruptly exit the highway some 15 miles from the center of Mecca. “Obligatory for Non Muslims,” it read, pointing to the offramp.

To me, the sign broadcast the lines being drawn to compartmentalize the country, which is now marketing itself to two sets of travelers with increasingly divergent — and sometimes contradictory — expectations: luxury tourists at ease with bikinis and cocktails, and pilgrims prepared for modesty and strict religious adherence. It’s hard to know whether the kingdom can satisfy both without antagonizing either.

My trip began in Jeddah, where, after spending two days exploring its historic district, I rented a car and drove eight hours north to Al-Ula, a benchmark for the new Saudi tourism initiatives.

Saudi Arabia

Reporter’s route

Dhahran al-Janub

Wadi al-Disah

Red Sea Resort

The name Al-Ula refers to both a small city and a broader region packed with attractions: Hegra , the kingdom’s first UNESCO World Heritage site and its biggest archaeological draw, is a 30-minute drive north of Old Town, a maze of crumbling mud-brick buildings now partly restored. Between the two, and fanning out to the east and west, are several other archaeological sites, as well as a smattering of resorts, event spaces and adventure outfitters. Farther northeast, beyond Hegra, is the Sharaan Nature Reserve , a vast protected zone used for conservation efforts.

My first priority during my five-day stay in Al-Ula was a visit to Hegra.

Like Petra , its better-known counterpart in Jordan, Hegra was built by the Nabateans, an ancient people who flourished 2,000 years ago. The site contains more than 100 tombs that were carved from solid rock, their entrances adorned with embellishments. Most impressive among them, set apart and standing some 70 feet tall, is a tomb colloquially called the Lonely Castle.

Not long ago, visitors could hire private guides and wander the area on foot, climbing in and out of — and no doubt damaging — the many tombs. Not anymore: I boarded an air-conditioned tour bus and zipped past most of them, stopping at just four locations.

At the penultimate stop, we exited the bus and trudged several hundred feet along a sandy path to the front of the Lonely Castle. Even in the late afternoon, the heat was stifling. I craned my neck to take in the details of the sculpted facade, which emerged like a mirage from one side of a massive boulder: its four pilasters, the rough chisel marks near the bottom, its characteristic five-stepped crown. Ten minutes evaporated, and I turned to find my group being shepherded back onto the bus. I jogged through the sand to catch up.

A few miles north of Hegra, I hopped in the back of a Toyota Land Cruiser — accompanied by an Italian graduate student and his mother — for a drive through the sandy expanse of the Sharaan Nature Reserve.

The scenery was sublime: Slipping through a narrow slot canyon, we emerged into a vast, open desert plain, then settled into a wide valley enclosed by an amphitheater of cliffs. Occasionally our guide stopped and led us on short hikes to petroglyphs, some pockmarked by bullet holes, or to lush fields of wildflowers, where he plucked edible greens and invited us to sample their lemony tang.

Gabriele Morelli, the graduate student, had first come to Al-Ula a few years ago — a different era, he said, given how quickly the place had transformed. He described a version that no longer exists, rife with cheap accommodation, lax rules and a free-for-all sensibility.

Some of the changes, of course, have been necessary to protect delicate ecosystems and archaeological sites from ever-growing crowds. But several people I met in Al-Ula — Saudis and foreigners alike — quietly lamented the extent of the high-end development and the steady erosion of affordability. Many of the new offerings, like the Banyan Tree resort, they pointed out, are luxury destinations that cater to wealthy travelers.

These hushed criticisms were among my early lessons on how difficult it can be to gauge the way Saudis feel about the pace and the pervasiveness of the transformations reshaping their society.

I got a taste of Al-Ula’s exclusivity — and of the uncanniness that occasionally surfaced throughout my trip — at a Lauryn Hill concert in an event space called Maraya . To reach the hall, I passed through a security gate, where an attendant scanned my e-ticket and directed me two miles up a winding road into the heart of the Ashar Valley, home to several high-end restaurants and resorts.

Rounding the final bend, I felt as if I’d stumbled into a computer-generated image: Ant-size humans were dwarfed by a reflective structure that both asserted itself and blended into the landscape. Inside, waiters served hors d’oeuvres and brightly colored mocktails to a chic young crowd.

The surreality peaked when, midway through the show, I left my plush seat to join some concertgoers near the stage — only to turn and see John Bolton, former President Donald J. Trump’s national security adviser, seated in the front row.

Where else, I wondered, could I attend a rap concert in the middle of the desert with a longtime fixture of the Republican Party — amid a crowd that cheered when Ms. Hill mentioned Palestine — but this strange new corner of Saudi Arabia?

The mirrored facade at Maraya, a vast event space in Al-Ula, warps and reflects the surrounding desert landscape.

The building is in some ways a precursor to the kingdom’s most ambitious architectural design: the project at Neom called the Line, a 106-mile linear city that will also feature a mirrored surface.

Lauryn Hill performing in front of a large crowd at Maraya.

After Al-Ula, I drove to another of the kingdom’s extravagant schemes: the Red Sea project, billed as the “world’s most ambitious regenerative tourism destination.” After weaving through a morass of construction-related traffic, I boarded a yacht — alongside a merry band of Saudi influencers — and was piloted some 15 miles to a remote island, where I disembarked in a world of unqualified opulence at the St. Regis Red Sea Resort .

I was chauffeured around in an electric golf cart — past 43 beachside “dune” villas and onto two long boardwalks that connect the rest of the resort to 47 “coral” villas, built on stilts over shallow turquoise water. Along the way, I listened to Lucas Julien-Vauzelle, an executive assistant manager, wax poetic about sustainability. “We take it to the next level,” he said, before rattling off a list of facts and figures: 100 percent renewable energy, a solar-powered 5G network , plans to enhance biologically diverse habitats.

By 2030, he said, the Red Sea project will offer 50 hotels across its island and inland sites. Citing the Maldives, he mentioned the kingdom’s plans to claim a share of the same high-end market.

Another prediction came by way of Keith Thornton, the director of restaurants, who said he expects the resort to legally serve alcohol by the end of the year. (While a liquor store for non-Muslim diplomats recently opened in Riyadh, the Saudi government has made no indication that it plans to reconsider its broader prohibition of alcohol.)

The hotel was undeniably impressive. But there’s an inescapable irony to a lavish resort built at unfathomable expense in the middle of the sea — with guests ferried out by chartered boat and seaplane — that flaunts its aspirations for sustainability.

Toward the end of my several-hour visit, I learned that every piece of vegetation, including 646 palm trees, had been transplanted from an off-site nursery. Later, reviewing historical satellite images, I found visual evidence that the island — described to me as pristine — had been dramatically fortified and, in the process, largely remade. Its footprint had also been significantly altered. It was, in a sense, an artificial island built where a smaller natural island once stood.

Something else struck me, too: The place was nearly empty, save for the staff and the Saudi influencers. Granted, the resort had just opened the month before — but the same was true at the nearby Six Senses Southern Dunes , an inland Red Sea resort that opened in November. Fredrik Blomqvist, the general manager there, told me that its isolated location in a serene expanse of desert — part of its appeal — also presented a challenge in drawing customers. “The biggest thing,” he said, “is to get the message out that the country is open.”

Since the country began issuing tourist visas, influencers have been documenting their experiences in places like Jeddah and Al-Ula, their trips often paid for by the Saudi government. Their breezy content contributes to the impression that the kingdom is awaiting discovery by foreign visitors with out-of-date prejudices. To an extent, for a certain segment of tourists, that’s true.

For many travelers, though, the depiction of the kingdom as an uncomplicated getaway could be dangerously misleading.

Speech in Saudi Arabia is strictly limited; dissent is not tolerated — nor is the open practice of any religion other than the government’s interpretation of Islam. In its travel advisory , the U.S. Department of State warns that “social media commentary — including past comments — which Saudi authorities may deem critical, offensive, or disruptive to public order, could lead to arrest.” Punishment for Saudi nationals has been far worse: In 2023, a retired teacher was sentenced to death after he criticized the ruling family via anonymous accounts. As of late 2023, he remained in prison.

Other restrictions are harder to parse. L.G.B.T.Q. travelers are officially welcome in the kingdom but face a conundrum: They might face arrest or other criminal penalties for openly expressing their sexual orientation or gender identity. As recently as 2021, an independent U.S. federal agency included Saudi Arabia on a list of countries where same-sex relationships are punishable by death , noting that “the government has not sought this penalty in recent years.”

When asked how he would convince a same-sex couple that it was safe to visit, Jerry Inzerillo, a native New Yorker and the group chief executive of Diriyah, said: “We don’t ask you any questions when you come into the country or when you leave.”

“Maybe that’s not conclusive enough,” he added, “but a lot of people have come.”

Female travelers might also face difficulties, since advancements in women’s rights are not equally distributed throughout the kingdom.

The changes were more visible in big cities and tourist centers. Ghydda Tariq, an assistant marketing manager in Al-Ula, described how new professional opportunities had emerged for her in recent years. Maysoon, a young woman I met in Jeddah, made extra money by occasionally driving for Uber. Haneen Alqadi, an employee at the St. Regis Red Sea, described how women there are free to wear bikinis without fear of repercussions.

Outside such places, though, I sometimes went for days without seeing more than a handful of women, invariably wearing niqabs, let alone seeing them engaged in public life or tourism. My photographs reflect that imbalance.

As an easily identifiable Western man, I moved through the country with an array of advantages: the kindness and cheery curiosity of strangers, the ease of passage at military checkpoints, and the freedom to interact with a male-dominated society at markets, museums, parks, restaurants, cafes. Not all travelers could expect the same treatment.

Roaming in the far north and south, I often found the earlier version of the kingdom — with lax rules and less development — that had been described to me in Al-Ula.

I trekked to the northern city of Sakaka to see an archaeological site promoted as the Stonehenge of Saudi Arabia: a set of monoliths called the Rajajil Columns thought to have been erected some 6,000 years ago but about which little is definitively known.

My heart sank when I pulled into the parking lot after a five-hour drive and found the columns blocked by a tall fence. Approaching on foot, though, I noticed that a section of the fence had been peeled back and that visitors were wandering freely among the stones, which protruded from the earth like isolated clusters of crooked teeth. I joined the small crowd, if hesitatingly, and was surprised to find no footpaths, nor anything to keep us a safe distance from the columns. In the end I wondered if our access had been officially approved or informally arranged.

My travel experiences were sometimes awkward in other ways, too.

Standing just outside the grounds of the central mosque in Medina, where the Prophet Muhammad is buried, I was detained by a stern member of the Special Forces. (Even after 2019, non-Muslim tourists remained barred from Mecca and Medina, Islam’s two holiest cities. The ban was relaxed in parts of Medina in 2021.)

The guard interrogated me and, after calling a colleague to confer, demanded that I leave the area. “Go,” he said threateningly. Another traveler who witnessed the encounter scurried away to avoid a similar fate.

The unsettling exchange cast a pall over my time in the city, which few non-Muslims have seen. As far as I knew, I’d abided by the rules by staying outside the grounds of the Prophet’s Mosque — a boundary line that I’d confirmed with tourism officials beforehand.

Peering through the perimeter fence — the boundary line for non-Muslims — at the Prophet’s Mosque in Medina.

The Mosque of Al-Ghamamah, one of the oldest in the holy city.

A sprawling maze of ramshackle residential buildings sits less than a mile from the Prophet’s Mosque.

A guide speaking to a group of visitors near the Hejaz Railway Museum, visible in the distance. (The museum was closed for renovations at the time.)

A group of young men, most of whose families emigrated from Sudan, playing soccer in a field just outside the center of Medina.

More than anything, family and friends wanted to know if I felt safe on my trip — and I did, almost without exception. Petty crime in Saudi Arabia is exceedingly rare. And while parts of the country are under a Level 4 “Do Not Travel” advisory , even my rambling itinerary was approved by a security expert.

Instead of fearing for my safety, I was often preoccupied with how I’d fairly portray a place that elicited such a range of conflicting emotions: joy and distress, excitement and apprehension, sincerity and doubt. So much lay hidden from public view — like the collective anguish over the war raging in Gaza . And so little was easy to categorize, in part because the warmth of everyday Saudis was strikingly at odds with the ruthlessness of their authoritarian government.

In Riyadh, a young man warned me not to speak openly with strangers. “People get arrested here for a tweet ,” he said. “Can you imagine?”

I could, actually. The Saudi columnist Jamal Khashoggi had chronicled his government’s increasingly draconian responses to criticism. “Repression and intimidation are not — and never should be — the acceptable companions of reform,” he wrote in The Washington Post in 2018, just months before he was killed and dismembered at his country’s consulate in Istanbul.

Were we to travel only where we feel comfortable and unchallenged, we’d all be poorer for it. But the question of whether to travel to Saudi Arabia is thornier than that.

It’s easy to see one response, “No,” as yielding to closed-mindedness at the expense of ordinary people — like the kindly vendor Abdullah, who served me local honey at his shop in the southern mountains.

But it’s easy, too, to see “Yes” as an affirmation that might makes right, that amusement outweighs morality, that princely wealth can wipe a stained slate clean.

Sunrise over the mountainous village of Fayfa, some six miles from the Yemeni border.

Abdullah Ghaleb Zaid, a honey vendor, at his shop atop a mountain pass near the southern city of Abha.

Sunset near Jabal Soudah, the kingdom’s highest peak.

Ten days into my trip, I ventured to Wadi al-Disah, a steep-walled valley where I’d booked a tent at a campsite I found on Airbnb. For an additional 300 riyals ($80), my host, Faisal, led me on a four-wheel-drive tour, departing the paved road and weaving through a path along the bed of an ephemeral river. Continually jolted by the uneven terrain, we eased past thick reeds, lofty palms and small bands of visitors who’d nestled into clearings.

As we left, I met a group of young men gathered for a picnic, their sandals scattered around a carpet on which they were preparing their dinner. Delighted to meet an American with a camera, they asked if I’d take a group portrait, then exchanged information with me so I could send them a copy — a scenario by then so familiar that I hardly thought anything of it.

A full day later, some 200 miles away, I was cruising along a lonely highway near the Jordanian border when a Land Cruiser blew past me at an astonishing speed. I felt my compact car rock from its turbulence — and then I watched with a twinge of dread as the car abruptly braked, slowing hard in the left lane until our front ends were aligned. It held steady there.

For a moment I stared straight ahead, hoping to avoid a confrontation. When I finally turned to look, I saw a group of boys grinning wildly and waving through an open window. Then I realized: Improbably, it was three of the young men I’d met the day before. Somehow we’d all followed the same route. And somehow, in the split second it took them to fly past, they’d recognized me. I lifted my camera from the passenger seat and snapped a photograph.

The picture shows three young Saudis on a precipice: endearing, erratic, captivating. I have a sense of where they came from but no certainty about where they’re going. Two are flashing peace signs, and none appears to be wearing a seatbelt. No one is watching the road as their car drifts out of its lane, careening a little recklessly into a hopeful and uncertain future.

Stephen Hiltner’s recent work includes a photo essay about his childhood in Budapest , an examination of A.I.-generated guidebooks and an investigation into the deaths of Russian soldiers in Ukraine . You can follow his travels on Instagram .

Got a question about this story? Drop a note in the comments section. Got a tip? Send him an email .

Stephen Hiltner is an editor, writer and photographer for the Travel section of The Times. More about Stephen Hiltner

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