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

AIM To 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.METHODS An 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).RESULTS A 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. CONCLUSION Some 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.

Surveillance of Australian Hajj pilgrims for carriage of potentially pathogenic bacteria:Data from two pilot studies

AIM To estimate the pharyngeal carriage rate of Neisseria meningitidis(N. meningitidis), Streptococcus pneumoniae(S. pneumoniae) and Staphylococcus aureus(S. aureus) among Australian Hajj pilgrims.METHODS In 2014, surveillance was conducted in two phases among Australian Hajj pilgrims: The first phase during Hajj in Mina, and the second phase soon after returning home to Australia. Nasopharyngeal or oropharyngeal swabs were taken from participants then tested, firstly by nucleic acid testing, and also by standard culture.RESULTS Of 183 participants recruited in the first phase, 26(14.2%) tested positive for S. pneumoniae; 4 had received pneumococcal conjugate vaccine(PCV13). Only one tested positive for N. meningitidis(W). Of 93 2^(nd) phase samples cultured, 17(18.3%) grew S. aureus, all methicillin sensitive, 2(2.2%) grew N. meningitidis(on subculture; one serotype B, one negative), and 1(1%), from an unvaccinated pilgrim, grew S. pneumoniae.CONCLUSION Relatively high carriage of S. pneumoniae and little meningococcal carriage was found. This indicates the importance of a larger study for improved infection surveillance and possible vaccine evaluation.