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

Al-Mamoon Badahdah; Fatimah Alghabban; Wajd Falemban; Abdullah Albishri; Gouri Rani Banik; Tariq Alhawassi; Hatem Abuelizz; Marwan A Bakarman; Ameneh Khatami; Robert Booy; Harunor Rashid

doi:10.3390/tropicalmed4040127

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

Trop Med Infect Dis. 2019 Oct 15;4(4):127. doi: 10.3390/tropicalmed4040127.

Authors

Al-Mamoon Badahdah^{1

2

3}, Fatimah Alghabban⁴, Wajd Falemban⁵, Abdullah Albishri⁶, Gouri Rani Banik⁷, Tariq Alhawassi⁸, Hatem Abuelizz⁹, Marwan A Bakarman¹⁰, Ameneh Khatami^{11

12}, Robert Booy^{13

14

15}, Harunor Rashid^{16

17

18}

Affiliations

¹ National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, NSW 2145, Australia. almamoon.badahdah@health.nsw.gov.au.
² The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia. almamoon.badahdah@health.nsw.gov.au.
³ Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia. almamoon.badahdah@health.nsw.gov.au.
⁴ Faculty of medicine, Umm Al-Qura University, Makkah 24381, Saudi Arabia. ghabban.1993@gmail.com.
⁵ Faculty of medicine, Umm Al-Qura University, Makkah 24381, Saudi Arabia. W.f-94@hotmail.com.
⁶ Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia. dr.amb4@gmail.com.
⁷ National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, NSW 2145, Australia.
⁸ Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 12372, Saudi Arabia. tarriq@ksu.edu.sa.
⁹ Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 12372, Saudi Arabia. habuelizz@ksu.edu.sa.
¹⁰ Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia. bakarmanm@gmail.com.
¹¹ The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia. ameneh.khatami@gmail.com.
¹² Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia. ameneh.khatami@gmail.com.
¹³ National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, NSW 2145, Australia. robert.booy@health.nsw.gov.au.
¹⁴ The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia. robert.booy@health.nsw.gov.au.
¹⁵ Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Westmead, NSW 2145, Australia. robert.booy@health.nsw.gov.au.
¹⁶ National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, NSW 2145, Australia. harunor.rashid@health.nsw.gov.au.
¹⁷ The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia. harunor.rashid@health.nsw.gov.au.
¹⁸ Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Westmead, NSW 2145, Australia. harunor.rashid@health.nsw.gov.au.

Abstract

Background: Major intercontinental outbreaks of invasive meningococcal disease associated with the Hajj occurred in 1987, 2000, and 2001. Mandatory meningococcal vaccination for all pilgrims against serogroups A and C and, subsequently, A, C, W, and Y controlled the epidemics. Overseas pilgrims show excellent adherence to the policy; however, vaccine uptake among domestic pilgrims is suboptimal. This survey aimed to evaluate meningococcal vaccine uptake among Hajj pilgrims and to identify key factors affecting this.

Methods: An anonymous cross-sectional survey was conducted among pilgrims in Greater Makkah during the Hajj in 2017-2018. Data on socio-demographic characteristics, vaccination status, cost of vaccination, and reasons behind non-receipt of the vaccine were collected.

Results: A total of 509 respondents aged 13 to 82 (median 33.8) years participated in the survey: 86% male, 85% domestic pilgrims. Only 389/476 (81.7%) confirmed their meningococcal vaccination status; 64 individuals (13.4%), all domestic pilgrims, did not receive the vaccine, and 23 (4.8%) were unsure. Among overseas pilgrims, 93.5% certainly received the vaccine (6.5% were unsure) compared to 80.9% of domestic pilgrims (p < 0.01). Being employed and having a tertiary qualification were significant predictors of vaccination adherence (odds ratio (OR) = 2.2, 95% confidence interval (CI) = 1.3-3.8, p < 0.01; and OR = 1.7, CI = 1-2.5, p < 0.05, respectively). Those who obtained pre-Hajj health advice were more than three times as likely to be vaccinated than those who did not (OR = 3.3, CI = 1.9-5.9, p < 0.001). Lack of awareness (63.2%, 36/57) and lack of time (15.8%, 9/57) were the most common reasons reported for non-receipt of vaccine.

Conclusion: Many domestic pilgrims missed the compulsory meningococcal vaccine; in this regard, lack of awareness is a key barrier. Being an overseas pilgrim (or living at a distance from Makkah), receipt of pre-Hajj health advice, and employment were predictors of greater compliance with the vaccination policy. Opportunities remain to reduce the policy-practice gap among domestic pilgrims.

Keywords: Hajj; meningococcal disease; pre-travel health advice; vaccine uptake.