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Meningococcal Vaccine for Hajj Pilgrims: Compliance, Predictors, and Barriers
Al-Mamoon Badahdah1,2,3, Fatimah Alghabban4, Wajd Falemban5
1National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, NSW 2145, Australia. almamoon.badahdah@health.nsw.gov.au.
Insights
Many domestic Hajj pilgrims lack meningococcal vaccine awareness, leading to suboptimal uptake. Pre-Hajj health advice and employment are key factors for vaccine adherence.
Area of Science:
- Public Health
- Epidemiology
- Vaccinology
Background:
- Major intercontinental outbreaks of invasive meningococcal disease (IMD) linked to the Hajj have occurred historically.
- Mandatory vaccination policies against specific serogroups have controlled past epidemics.
- Suboptimal vaccine uptake among domestic pilgrims presents a public health challenge.
Purpose of the Study:
- To evaluate meningococcal vaccine uptake among Hajj pilgrims.
- To identify factors influencing vaccine adherence, particularly among domestic pilgrims.
Main Methods:
- An anonymous cross-sectional survey was conducted among Hajj pilgrims in Greater Makkah (2017-2018).
- Data collected included socio-demographics, vaccination status, cost, and reasons for non-vaccination.
- Statistical analysis identified predictors of vaccination adherence.
Main Results:
- Overall meningococcal vaccine uptake was lower among domestic pilgrims (80.9%) compared to overseas pilgrims (93.5%).
- Key predictors for adherence included being employed, having tertiary education, and receiving pre-Hajj health advice.
- Lack of awareness (63.2%) and time (15.8%) were primary reasons for non-vaccination among domestic pilgrims.
Conclusions:
- Lack of awareness is a significant barrier to meningococcal vaccination compliance for domestic Hajj pilgrims.
- Targeted interventions, especially pre-Hajj health advice, can improve vaccine uptake.
- Addressing the policy-practice gap requires focused strategies for domestic pilgrim populations.
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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