Influenza vaccination among Saudi Hajj pilgrims: Revealing the uptake and vaccination barriers

Mohammad Alfelali; Osamah Barasheed; Al-Mamoon Badahdah; Hamid Bokhary; Mohammed I Azeem; Turki Habeebullah; Marwan Bakarman; Atif Asghar; Robert Booy; Harunor Rashid; Hajj Research Team

doi:10.1016/j.vaccine.2018.03.007

Influenza vaccination among Saudi Hajj pilgrims: Revealing the uptake and vaccination barriers

Vaccine. 2018 Apr 12;36(16):2112-2118. doi: 10.1016/j.vaccine.2018.03.007. Epub 2018 Mar 16.

Authors

Affiliations

¹ National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, and The University of Sydney, NSW, Australia; Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia. Electronic address: malfelali@kau.edu.sa.
² National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, and The University of Sydney, NSW, Australia; The Executive Administration of Research and Innovation at King Abdullah Medical City in Holy Capital (KAMC-HC), Makkah, Saudi Arabia.
³ National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, and The University of Sydney, NSW, Australia; Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.
⁴ Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia; Umm Al-Qura University, Makkah, Saudi Arabia.
⁵ National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, and The University of Sydney, NSW, Australia.
⁶ The Custodian of the Two Holy Mosques Institute for Hajj and Umrah Research, Umm Al-Qura University, Makkah, Saudi Arabia.
⁷ Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.
⁸ National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, and The University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia.

Abstract

Background: Hajj is the world's largest annual mass gathering that attracts two to three million Muslims from around the globe to a religious assemblage in Makkah, Saudi Arabia. The risk of acquisition and transmission of influenza among Hajj pilgrims is high. Therefore, influenza vaccination is recommended, and was monitored frequently among pilgrims from different countries. However, the vaccination uptake among Saudi pilgrims has not been assessed in recent years.

Objective: This analysis aims to evaluate influenza vaccine uptake among Saudi Hajj pilgrims, and identify the key barriers to vaccination.

Method: Data on influenza vaccination were obtained from Saudi pilgrims who took part in a large trial during the Hajj of 2013, 2014 and 2015. Pilgrims were met and recruited in Mina, Makkah during the peak period of Hajj and were asked to complete a baseline questionnaire that recorded their influenza vaccination history, including reason(s) for non-receipt of vaccine.

Results: A total of 6974 Saudi pilgrims aged between 18 and 95 (median 34) years were recruited; male to female ratio was 1:1.2. Of the total, 90.8% declared their influenza vaccination history, 51.3% of them reported receiving influenza vaccine before travel to Hajj. The vaccination rates for the years 2013, 2014 and 2015 were 21.4%, 48.2% and 58.1%, respectively (P < 0.001). Of 1,269 pilgrims who were at higher risk of severe disease, 54.5% received the vaccine. Lack of awareness (47.5%), reliance on natural immunity (15.8%) and being busy (15.5%) were the main reasons for non-receipt.

Conclusion: These data from a convenience sample indicate that influenza vaccine uptake among Saudi Hajj pilgrims is increasing over years but still needs further improvement. Lack of awareness and misperceptions are the main barriers. Education of Saudi pilgrims and health professionals is required to raise awareness about influenza vaccination. Further studies are needed to understand pilgrims' misperceptions.

Keywords: Hajj; Influenza; Influenza vaccine; Saudi Arabia; Vaccine; Vaccine uptake.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Female
Humans
Influenza Vaccines / immunology*
Influenza, Human / epidemiology*
Influenza, Human / prevention & control*
Male
Middle Aged
Patient Acceptance of Health Care
Pregnancy
Public Health Surveillance
Saudi Arabia / epidemiology
Vaccination*
Young Adult

Substances

Influenza Vaccines