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Aye AMM, Bai X, Borrow R, Bory S, Carlos J, Caugant DA, Chiou CS, Dai VTT, Dinleyici EC, Ghimire P, Handryastuti S, Heo JY, Jennison A, Kamiya H, Tonnii Sia L, Lucidarme J, Marshall H, Putri ND, Saha S, Shao Z, Sim JHC, Smith V, Taha MK, Van Thanh P, Thisyakorn U, Tshering K, Vázquez J, Veeraraghavan B, Yezli S, Zhu B. Meningococcal disease surveillance in the Asia-Pacific region (2020): The global meningococcal initiative. J Infect 2020; 81:698-711. [PMID: 32730999 DOI: 10.1016/j.jinf.2020.07.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022]
Abstract
The degree of surveillance data and control strategies for invasive meningococcal disease (IMD) varies across the Asia-Pacific region. IMD cases are often reported throughout the region, but the disease is not notifiable in some countries, including Myanmar, Bangladesh and Malaysia. Although there remains a paucity of data from many countries, specific nations have introduced additional surveillance measures. The incidence of IMD is low and similar across the represented countries (<0.2 cases per 100,000 persons per year), with the predominant serogroups of Neisseria meningitidis being B, W and Y, although serogroups A and X are present in some areas. Resistance to ciprofloxacin is also of concern, with the close monitoring of antibiotic-resistant clonal complexes (e.g., cc4821) being a priority. Meningococcal vaccination is only included in a few National Immunization Programs, but is recommended for high-risk groups, including travellers (such as pilgrims) and people with complement deficiencies or human immunodeficiency virus (HIV). Both polysaccharide and conjugate vaccines form part of recommendations. However, cost and misconceptions remain limiting factors in vaccine uptake, despite conjugate vaccines preventing the acquisition of carriage.
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Affiliation(s)
| | - Xilian Bai
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | | | - Josefina Carlos
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | | | | | - Vo Thi Trang Dai
- Department of Microbiology and Immunology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | | | | | | | - Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, South Korea.
| | | | - Hajime Kamiya
- National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | - Helen Marshall
- Robinson Research Institute and department of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
| | - Nina Dwi Putri
- Dr Cipto Mangunkusumo National Central Hospital, Jakarta, Indonesia
| | - Senjuti Saha
- Child Health Research Foundation, Mohammadpur, Dhaka1207, Bangladesh.
| | - Zhujun Shao
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | | | - Vinny Smith
- Meningitis Research Foundation, Bristol, UK.
| | | | - Phan Van Thanh
- Department of Microbiology and Immunology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Usa Thisyakorn
- Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand
| | - Kinley Tshering
- Jigme Dorji Wangchuck National Referral Hospital, Thimpu, Bhutan
| | - Julio Vázquez
- National Reference Laboratory for Meningococci, Institute of Health Carlos III, Spain.
| | | | - Saber Yezli
- Global Center for Mass Gatherings Medicine, Saudi Arabia
| | - Bingqing Zhu
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Meningococcal Vaccine for Hajj Pilgrims: Compliance, Predictors, and Barriers. Trop Med Infect Dis 2019; 4:tropicalmed4040127. [PMID: 31618945 PMCID: PMC6958484 DOI: 10.3390/tropicalmed4040127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/02/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023] Open
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.
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Kain D, Findlater A, Lightfoot D, Maxim T, Kraemer MUG, Brady OJ, Watts A, Khan K, Bogoch II. Factors Affecting Pre-Travel Health Seeking Behaviour and Adherence to Pre-Travel Health Advice: A Systematic Review. J Travel Med 2019; 26:5549355. [PMID: 31407776 DOI: 10.1093/jtm/taz059] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Recent years have seen unprecedented growth in international travel. Travellers are at high risk for acquiring infections while abroad and potentially bringing these infections back to their home country. There are many ways to mitigate this risk by seeking pre-travel advice (PTA), including receiving recommended vaccinations and chemoprophylaxis, however many travellers do not seek or adhere to PTA. We conducted a systematic review to further understand PTA-seeking behaviour with an ultimate aim to implement interventions that improve adherence to PTA and reduce morbidity and mortality in travellers. METHODS We conducted a systematic review of published medical literature selecting studies that examined reasons for not seeking PTA and non-adherence to PTA over the last ten years. 4484 articles were screened of which 56 studies met our search criteria after full text review. RESULTS The major reason for not seeking or non-adherence to PTA was perceived low risk of infection while travelling. Side effects played a significant role for lack of adherence specific to malaria prophylaxis. CONCLUSIONS These data may help clinicians and public health providers to better understand reasons for non-adherence to PTA and target interventions to improve travellers understanding of potential and modifiable risks. Additionally, we discuss specific recommendations to increase public health education that may enable travellers to seek PTA.
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Affiliation(s)
- Dylan Kain
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Aidan Findlater
- Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Timea Maxim
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | | | - Oliver J Brady
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Alexander Watts
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Kamran Khan
- Department of Medicine, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, Canada.,Divisions of General Internal Medicine and Infectious Diseases, University Health Network, Toronto, Canada
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Badahdah AM, Alfelali M, Alqahtani AS, Alsharif S, Barasheed O, Rashid H, the Hajj Research Team. Mandatory meningococcal vaccine, and other recommended immunisations: Uptake, barriers, and facilitators among health care workers and trainees at Hajj. World J Clin Cases 2018; 6:1128-1135. [PMID: 30613671 PMCID: PMC6306626 DOI: 10.12998/wjcc.v6.i16.1128] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/21/2018] [Accepted: 11/24/2018] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Al-Mamoon Badahdah
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Harunor Rashid, National Centre for Immunisation Research and Surveillance, the Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Harunor Rashid, the Discipline of Child and Adolescent Health, the Faculty of Medicine and Health, the University of Sydney, Westmead, NSW 2145, Australia
| | - Mohammad Alfelali
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia
- Harunor Rashid, National Centre for Immunisation Research and Surveillance, the Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Harunor Rashid, the Discipline of Child and Adolescent Health, the Faculty of Medicine and Health, the University of Sydney, Westmead, NSW 2145, Australia
| | | | - Saeed Alsharif
- Command and Control Centre of Infectious Diseases of Public Health Department of Ministry of Health, Taif 26521, Saudi Arabia
| | - Osamah Barasheed
- Harunor Rashid, National Centre for Immunisation Research and Surveillance, the Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Harunor Rashid, the Discipline of Child and Adolescent Health, the Faculty of Medicine and Health, the University of Sydney, Westmead, NSW 2145, Australia
- the Executive Administration of Research and Innovation at King Abdullah Medical City in Holy Capital, Makkah 24246, Saudi Arabia
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Focusing on the implementation of 21st century vaccines for adults. Vaccine 2017; 36:5358-5365. [PMID: 28807604 DOI: 10.1016/j.vaccine.2017.07.100] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/21/2017] [Accepted: 07/26/2017] [Indexed: 12/17/2022]
Abstract
Adult immunization is a priority for public health, particularly in countries where an aging population has become increasingly more numerous. Protection against diseases which typically affect adults (like flu, pneumococcal diseases and Herpes zoster), the shift of age of infections which originally affected children (like measles), the decreasing protection with time for infections which need periodical booster doses of vaccines (Tdap), the availability of vaccines which can also impact on adult health (HPV) are only some examples of the importance of implementing targeted vaccination strategies. The possibility to reach high coverage with immunizations that can guarantee a fundamental improvement of health for adults and the elderly can only be achieved through a coordinated effort where all stakeholders, under the coordination of public health, contribute to issue recommendations; create a functioning database for vaccine coverage registration; promote formative courses for healthcare workers and continuous information for the public; increase vaccines uptake among healthcare workers, who need to give the first testimony on the relevance of immunization.
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Tashani M, Alfelali M, Azeem MI, Fatema FN, Barasheed O, Alqahtani AS, Tekin H, Rashid H, Booy R. Barriers of vaccinations against serious bacterial infections among Australian Hajj pilgrims. Postgrad Med 2016; 128:541-7. [PMID: 27233684 DOI: 10.1080/00325481.2016.1191956] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Vaccination against serious bacterial infections is recommended for Hajj pilgrims. Although the uptake of mandatory vaccines among Hajj pilgrims is acceptable, the uptake of other recommended vaccines remains suboptimal. In this study, we have explored the barriers to vaccination against serious bacterial infections among Australian Hajj pilgrims. METHODS Travellers aged 18 years and older planning to attend Hajj in the years 2014 and 2015 were surveyed at the immunization clinic of the Children's Hospital at Westmead, Sydney, Australia. A questionnaire-based survey was conducted to explore pilgrims' vaccination histories for their previous visits to Mecca, the reasons for non-receipt of vaccination, and to assess knowledge about the transmission of infections. RESULTS A total of 300 participants aged 18-76 (median 41) years completed the survey. Most (233 [77.7%]) were born outside Australia. Overall, 113 (37.7%) had performed pilgrimage in the past; 19 (16.8%) of them reported receiving pneumococcal vaccine and 16 (14.1%) diphtheria, tetanus and pertussis (DTP) vaccine. Lack of awareness about the availability of the vaccines was the main reason for non-receipt of pneumococcal and DTP vaccines (respectively 41.1% and 44.7%). Most pilgrims (266 [88.7%]) believed that travel vaccines are necessary before embarking on a journey; however, some expressed concerns about adverse reactions (156 [52.0%]), cost (114 [38.0%]), and permissibility of the vaccine according to their religion (6 [2.0%]). Respectively, 187 (62.3%), 145 (48.3%) and 86 (28.7%) respondents did not correctly know how meningococcal and pneumococcal diseases and pertussis transmit. Nevertheless, most (256 [85.3%]) indicated that they trust their family doctor for medical information and most (203 [67.7%]) preferred to receive the medical information in English. CONCLUSION The uptake of recommended vaccines against serious bacterial infections among Australian Hajj pilgrims is low. Lack of awareness about the availability of vaccines, misperceptions surrounding the safety of vaccines and high cost are key barriers of uptake.
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Affiliation(s)
- Mohamed Tashani
- a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.,b Discipline of Paediatrics and Child Health, Sydney Medical School , University of Sydney , Sydney , Australia
| | - Mohammad Alfelali
- a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.,b Discipline of Paediatrics and Child Health, Sydney Medical School , University of Sydney , Sydney , Australia.,c Department of Family and Community Medicine, Faculty of Medicine in Rabigh , King Abdulaziz University , Jeddah , Saudi Arabia
| | - Mohammad Irfan Azeem
- a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.,b Discipline of Paediatrics and Child Health, Sydney Medical School , University of Sydney , Sydney , Australia
| | - Fayeza Nusrat Fatema
- a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia
| | - Osamah Barasheed
- a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.,b Discipline of Paediatrics and Child Health, Sydney Medical School , University of Sydney , Sydney , Australia.,d The Executive Administration of Research , King Abdullah Medical City (KAMC) , Makkah , Saudi Arabia
| | - Amani Salem Alqahtani
- a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.,e School of Public Health , The University of Sydney , Sydney , Australia
| | - Hatice Tekin
- a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia
| | - Harunor Rashid
- a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.,b Discipline of Paediatrics and Child Health, Sydney Medical School , University of Sydney , Sydney , Australia.,f Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School , University of Sydney , Sydney , Australia
| | - Robert Booy
- a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.,b Discipline of Paediatrics and Child Health, Sydney Medical School , University of Sydney , Sydney , Australia.,f Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School , University of Sydney , Sydney , Australia.,g WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events , Flinders University , Adelaide , Australia
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Alqahtani AS, Wiley KE, Tashani M, Willaby HW, Heywood AE, BinDhim NF, Booy R, Rashid H. Exploring barriers to and facilitators of preventive measures against infectious diseases among Australian Hajj pilgrims: cross-sectional studies before and after Hajj. Int J Infect Dis 2016; 47:53-9. [PMID: 26875699 PMCID: PMC7110465 DOI: 10.1016/j.ijid.2016.02.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 01/29/2016] [Accepted: 02/05/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE For reasons that have yet to be elucidated, the uptake of preventive measures against infectious diseases by Hajj pilgrims is variable. The aim of this study was to identify the preventive advice and interventions received by Australian pilgrims before Hajj, and the barriers to and facilitators of their use during Hajj. METHODS Two cross-sectional surveys of Australians pilgrims aged ≥18 years were undertaken, one before and one after the Hajj 2014. RESULTS Of 356 pilgrims who completed the survey (response rate 94%), 80% had the influenza vaccine, 30% the pneumococcal vaccine, and 30% the pertussis vaccine. Concern about contracting disease at Hajj was the most cited reason for vaccination (73.4%), and not being aware of vaccine availability was the main reason for non-receipt (56%). Those who obtained pre-travel advice were twice as likely to be vaccinated as those who did not seek advice. Of 150 pilgrims surveyed upon return, 94% reported practicing hand hygiene during Hajj, citing ease of use (67%) and belief in its effectiveness (62.4%) as the main reasons for compliance; university education was a significant predictor of hand hygiene adherence. Fifty-three percent used facemasks, with breathing discomfort (76%) and a feeling of suffocation (40%) being the main obstacles to compliance. CONCLUSION This study indicates that there are significant opportunities to improve awareness among Australian Hajj pilgrims about the importance of using preventive health measures.
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Affiliation(s)
- Amani S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Kerrie E Wiley
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mohamed Tashani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia
| | - Harold W Willaby
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Nasser F BinDhim
- Health Informatics Department, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide, Australia
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Al-Tawfiq JA, Memish ZA. Prevention of pneumococcal infections during mass gathering. Hum Vaccin Immunother 2015; 12:326-30. [PMID: 26176306 DOI: 10.1080/21645515.2015.1058456] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The interest in mass gathering and its implications has been increasing due to globalization and international travel. The potential occurrence of infectious disease outbreaks during mass gathering is most feared. In this context, respiratory tract infections are of great concern due to crowding in a limited space which facilitates and magnifies the potential of disease spread among attendees. Pneumococcal disease is best described among pilgrims to Makkah and vaccination is one of the methods for the prevention of this disease. Pneumonia was described in a mass gathering with a prevalence of 4.8/100,000 pilgrims and contributes to 15-39% of hospitalizations. Various studies showed that 7-37% of pilgrims are 65 y of age or older. The uptake of pneumococcal vaccine among pilgrims is low at 5%. There is no available data to make strong recommendations for S. pneumoniae vaccination of all pilgrims, it is important that a high risk population receive the indicated vaccination. We reviewed the available literature on the burden of pneumococcal infections during mass gathering and evaluate the available literature on pneumococcal vaccinations for attendees of mass gathering.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- a Johns Hopkins Aramco Healthcare ; Dhahran , Kingdom of Saudi Arabia.,b Indiana University School of Medicine ; Indianapolis , IN USA
| | - Ziad A Memish
- c Ministry of Health and College of Medicine; Alfaisal University ; Riyadh , Saudi Arabia
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Alqahtani AS, Sheikh M, Wiley K, Heywood AE. Australian Hajj pilgrims' infection control beliefs and practices: Insight with implications for public health approaches. Travel Med Infect Dis 2015; 13:329-34. [PMID: 26028307 DOI: 10.1016/j.tmaid.2015.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/09/2015] [Accepted: 05/11/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hajj is one of the largest annual mass gatherings around the world. Although the Saudi Arabian health authority recommends vaccination and other infection control measures, studies identified variable uptake of these measures among pilgrims, and the reasons behind this variability remain unclear. This qualitative study aimed to addresses this knowledge gap. METHODS In-depth interviews were conducted with pilgrims over 18 years of age. RESULTS A total of 10 participants took part in the study. There was low perception of the potential severity of respiratory conditions and the need for influenza vaccination during Hajj. Different attitudes were found by age group with elderly participants believing that they were under Allah's protection, and were fatalistic about the risk of illness. While younger participants described the impact infections would have on their worship. Facemask use was infrequent with discomfort; difficulty in breathing and a feeling of isolation were commonly cited barriers to use of facemasks. Participants accepted and trusted preventative health advice from travel agents and friends who had previously undertaken the Hajj more so than primary care practitioners. CONCLUSIONS This study extended our understanding of how health beliefs influence uptake of preventive measures during the Hajj, and the gaps in the provision of Hajj-specific health information to pilgrims.
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Affiliation(s)
- Amani S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Mohamud Sheikh
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kerrie Wiley
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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Alqahtani AS, Rashid H, Heywood AE. Vaccinations against respiratory tract infections at Hajj. Clin Microbiol Infect 2014; 21:115-27. [PMID: 25682277 DOI: 10.1016/j.cmi.2014.11.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/27/2014] [Accepted: 11/27/2014] [Indexed: 02/08/2023]
Abstract
The transmission of respiratory tract infections (RTIs) is very high among the Hajj congregation in Mecca, Saudi Arabia. Despite recommendations for vaccinations, pilgrims remain at increased risk of RTIs. In this paper we systematically reviewed available studies assessing the uptake and effectiveness of vaccinations against RTIs among Hajj pilgrims and enumerated important demographic factors, if described, associated with vaccine uptake. Of the 42 included studies, 29 reported on the uptake and effectiveness of influenza vaccine among pilgrims, eight studies reported the uptake of other vaccines, notably pneumococcal, diphtheria and bacillus Calmette-Guérin vaccines, and the remaining five studies described both influenza and non-influenza vaccines. The uptake of seasonal influenza vaccine ranged from 0.7% to 100% across the study populations, with coverage highest in the elderly and those with pre-existing co-morbidities. The effectiveness of influenza vaccine was variable across studies but was significantly effective against laboratory-confirmed influenza (risk ratio 0.56; 95% CI 0.41-0.75; p <0.001) in pooled metadata from six studies. Uptake of diphtheria and pneumococcal vaccines was low, and the only study reporting pertussis among Hajj pilgrims found the presence of pre-Hajj immunity to be significantly protective against disease. Despite favourable evidence of effectiveness, our review shows variable uptake of vaccines across a number of studies with few data available on the uptake of non-influenza vaccines. Mixed-method studies are needed to gauge knowledge, attitudes and practices of Hajj pilgrims regarding vaccination, and randomized controlled trials are required to confirm the efficacy of vaccines and improve uptake in this vulnerable travelling population.
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Affiliation(s)
- A S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospitals at Westmead, NSW, Australia; School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - H Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospitals at Westmead, NSW, Australia.
| | - A E Heywood
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia
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Barasheed O, Rashid H, Heron L, Ridda I, Haworth E, Nguyen-Van-Tam J, Dwyer DE, Booy R. Influenza vaccination among Australian Hajj pilgrims: uptake, attitudes, and barriers. J Travel Med 2014; 21:384-90. [PMID: 25145836 DOI: 10.1111/jtm.12146] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/18/2014] [Accepted: 04/22/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hajj is the largest annual mass gathering where the risk of respiratory infection is high. Although the Saudi Arabian authority recommends influenza vaccination for Hajj pilgrims, the uptake is variable. Influenza vaccine uptake data among Australian Hajj pilgrims is not readily available. Therefore, we aimed to estimate the influenza vaccination uptake rate and identify both attitudes and barriers to vaccine uptake from two consecutives surveys at Hajj in 2011 and 2012. METHODS Using an anonymous self-administered questionnaire, surveys were conducted in Mecca, Saudi Arabia, among Hajj pilgrims from Australia in 2011 and 2012. Pilgrims staying in "Australian" tents were recruited serially. RESULTS In 2011, 431 Australian pilgrims completed the survey-median age was 42 (range 7-86) years, 55% were male; 65% reported receiving influenza vaccine. In 2012, 535 pilgrims of median age 43 (range 12-83) years completed the survey, 62% were male; 89% reported receiving the vaccine. Both in 2011 and 2012, common reasons for not receiving the vaccine were the pilgrims' reliance on their "natural immunity" (33 and 26%, respectively, p = 0.4) and believing that they would rarely catch influenza or come in contact with influenza patients (18 and 29%, respectively, p = 0.1). In 2012, when asked why they had received the vaccine, 65% pilgrims responded that it was because of the tour group leaders' recommendation. CONCLUSION Influenza vaccine uptake among Australian Hajj pilgrims seems satisfactory and increasing but could be better because many pilgrims have misconceptions about vaccines. Tour operators may play a greater role in promoting vaccination.
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Affiliation(s)
- Osamah Barasheed
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, Australia
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Implementation of a Q fever vaccination program for high-risk patients in the Netherlands. Vaccine 2013; 31:2617-22. [DOI: 10.1016/j.vaccine.2013.03.062] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/27/2013] [Accepted: 03/28/2013] [Indexed: 11/20/2022]
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