Mandatory meningococcal vaccine, and other recommended immunisations: Uptake, barriers, and facilitators among health care workers and trainees at Hajj

Abstract

AIMTo evaluate the uptake of a mandatory meningococcal, a highly recommended influenza, and an optional pneumococcal vaccine, and to explore the key factors affecting vaccination rate among health care workers (HCWs) during the Hajj.METHODSAn anonymous cross-sectional online survey was distributed among HCWs and trainees who worked or volunteered at the Hajj 2015-2017 through their line managers, or by visiting their hospitals and healthcare centres in Makkah and Mina. Overseas HCWs who accompanied the pilgrims or those who work in foreign Hajj medical missions were excluded. Pearson’s χ2 test was used to compare categorical variables and odds ratio (OR) was calculated by “risk estimate” statistics along with 95% confidence interval (95%CI).RESULTSA total of 138 respondents aged 20 to 59 (median 25.6) years with a male to female ratio of 2.5:1 participated in the survey. Only 11.6% (16/138) participants reported receiving all three vaccines, 15.2% (21/138) did not receive any vaccine, 76.1% (105/138) received meningococcal, 68.1% (94/138) influenza and 13.8% (19/138) pneumococcal vaccine. Females were more likely to receive a vaccine than males (OR 3.6, 95%CI: 1.0-12.7, P < 0.05). Willingness to follow health authority’s recommendation was the main reason for receipt of vaccine (78.8%) while believing that they were up-to-date with vaccination (39.8%) was the prime reason for non-receipt.CONCLUSIONSome HCWs at Hajj miss out the compulsory and highly recommended vaccines; lack of awareness is a key barrier and authority’s advice is an important motivator. Health education followed by stringent measures may be required to improve their vaccination rate.

Acquisition of respiratory and gastrointestinal pathogens among health care workers during the 2015 Hajj season

“…For HCWs deployed in Hajj, the rates of immunization in our study were similar to those reported in a study conducted in the 2015-2017 Hajj seasons. 32 However, our data indicates that the rate of immunization of influenza vaccination among the Hajj cohort was higher than that reported pre-2015. 19,20 In general, since the introduction of the compulsory BICSL license that includes the compulsory influenza and meningococcal immunization section, data from the MOH indicate that in 2017, all HCWs deployed to Hajj were vaccinated with both vaccines.…”

Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events

“…84,85 Since the inclusion of the quadrivalent meningococcal vaccine in 2001, 85 no major meningo coccal meningitis outbreaks related to hajj have been identified. [85][86][87] However, concern that new serogroups of N meningitidis (eg, B and X), which are not covered in the current quadrivalent vaccine targeting serogroups A, C, W135, and Y, could be a cause of future epidemics is increasing. 88,89 Owing to the high incidence of pertussis seen among Hajj pilgrims in 2003, 90 Bordetella pertussis is considered a risk in pilgrims, especially those who have not completed their immuni sation schedule.…”

“…103 For the Hajj and other mass gatherings appropriate travel advice on hygiene measures, [104][105][106][107] wearing of face masks, and recom mendations for mandatory and optional vaccines for prevention of infections are issued by local public health authorities and WHO. Occasionally authorities in countries of origin face hurdles in the implementation of these measures 87,108 or issues regarding reduced immunogenicity of vaccines owing to interactions between vaccines. 109 Although no global outbreaks of meningococcal disease have occurred after the Hajj for decades, a high level of awareness of the possibility of outbreaks at all mass gatherings remains.…”

“…109 Although no global outbreaks of meningococcal disease have occurred after the Hajj for decades, a high level of awareness of the possibility of outbreaks at all mass gatherings remains. 87,[110][111][112] Increasingly, attention is being focused on vaccinepreventable diseases, such as cholera, polio, measles, and pertussis, which are increasing in the eastern Mediterranean owing to conflict and large refugee populations with poor access to preventive public health services. 113 The highly lethal MERSCoV causes increasing concern, as it continues to circulate in Saudi Arabia 78,79 and remains in the top ten of the WHO Research and Development Blueprint list of infectious diseases likely to cause major epidemics (appendix).…”

Meningococcal Vaccine for Hajj Pilgrims: Compliance, Predictors, and Barriers

“…Additionally, despite being enforced and freely offered, the vaccine coverage was found to be very low (64%) in 2006 in the only published work reporting vaccine uptake among domestic pilgrims [12]. The rate was also unsatisfactory among domestic HCWs (ranging from 51.7% to 84.7%) in several studies conducted between 2009 and 2018 [17][18][19][20]. In recent years, the enforcement of the Hajj permit requirement by rigorous procedures at points of entry into Makkah reduced the number and proportion of domestic pilgrims (from 1.4 million (45%) in 2012 to 600,000 (26%) in 2018) [21].…”