The Saudi Thoracic Society pneumococcal vaccination guidelines-2016

Abstract

Streptococcus pneumoniae (pneumococcus) is the leading cause of morbidity and mortality worldwide. Saudi Arabia is a host to millions of pilgrims who travel annually from all over the world for Umrah and the Hajj pilgrimages and are at risk of developing pneumococcal pneumonia or invasive pneumococcal disease (IPD). There is also the risk of transmission of S. pneumoniae including antibiotic resistant strains between pilgrims and their potential global spread upon their return. The country also has unique challenges posed by susceptible population to IPD due to people with hemoglobinopathies, younger age groups with chronic conditions, and growing problem of antibiotic resistance. Since the epidemiology of pneumococcal disease is constantly changing, with an increase in nonvaccine pneumococcal serotypes, vaccination policies on the effectiveness and usefulness of vaccines require regular revision. As part of the Saudi Thoracic Society (STS) commitment to promote the best practices in the field of respiratory diseases, we conducted a review of S. pneumoniae infections and the best evidence base available in the literature. The aim of the present study is to develop the STS pneumococcal vaccination guidelines for healthcare workers in Saudi Arabia. We recommend vaccination against pneumococcal infections for all children <5 years old, adults ≥50 years old, and people ≥6 years old with certain risk factors. These recommendations are based on the presence of a large number of comorbidities in Saudi Arabia population <50 years of age, many of whom have risk factors for contracting pneumococcal infections. A section for pneumococcal vaccination before the Umrah and Hajj pilgrimages is included as well.

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

“…A Dutch study involving Hajj pilgrims showed that being a female was an independent predictor for accepting dTP vaccine [49] . Although no official recommendation for routine pneumococcal vaccination for HCWs exists, experts have recommended it for Hajj attendees considered to be "at increased risk" [28,29] . Our findings showed suboptimal vaccination rate (13.8%) even among "at increased risk" group (27.3%).…”

“…Studies revealed an increase of the pneumococcal nasal carriage up to 2.7-fold before and after Hajj [26,27] . The Saudi Thoracic Society and independent experts also recommend pneumococcal vaccines especially for those at higher risk of complications [28,29] . An estimated 70000 emergency room visits and 12000 hospitalisations occur during a typical Hajj season, and a physician needs to see over 600 patients and a nurse looks after about 400 patients per day during Hajj [30] .…”

Phenotypic and molecular study of pneumococci causing respiratory tract infections

“…In Lebanon, a 6-year study including 78 hospitals showed 51%, 74% and 80% of PCV7, PCV10 and PCV13 coverage respectively for children of 2-5 years of age 27. A recent review done in Saudi Arabia stated that different IPD causing pneumococcal serotypes vary between the different geographic areas and the vaccination periods of the studies 7. Despite the diverse demographic studies listed above and the different vaccines coverage obtained, the majority concluded on the urgent need of current monitoring of prevalent pneumococcal serotypes in order to evaluate current vaccines impact on IPD epidemiology.…”

Vaccination in Hajj: An overview of the recent findings

“…[3839] Dabiran et al . suggested that the high-risk groups in Hajj including patients with chronic obstructive pulmonary disease, asthma, chronic bronchitis, emphysema, cardiac diseases, cancers, and those who have been splenectomy should receive pneumovax-23 vaccine.…”

“…[29] The Saudi Thoracic Society recommended that all children smaller than 5 years old, people elder than 50 years old, and adults who have specific risk factors and are elder than 6 years old should be vaccinated against pneumococcal infections. [39]…”