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

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. Author Contributions: Conceptualization, G.R.B., T.A., H.A., and H.R.; data curation, A.-M.B.; formal analysis, A.-M.B. and H.R.; project administration, H.R.; supervision, A.K., R.B., and H.R.; validation, A.-M.B., F.A., W.F., Trop. Med. Infect. Dis. 2019, 4, 127 11 of 13 and A.A.; visualization, A.-M.B.; writing-original draft, A.-M.B., F.A., W.F., A.A., and A.K.; writing-review and editing

A Longitudinal Study Regarding the Health Profile of the 2017 South African Hajj Pilgrims

“…While pilgrims also receive health promotion messages and information on preventive measures and health services while in KSA, health authorities in the countries of origin are encouraged to provide health education for pilgrims prior to arrival to KSA for Hajj. This is because pre-Hajj health advice is an essential factor contributing to increased compliance with pilgrims’ recommended health measures [ 47 , 48 ].…”

Meningococcal disease surveillance in the Asia–Pacific region (2020): The global meningococcal initiative

“…One of the most common reasons is a lack of knowledge about vaccines, 114 with some pilgrims being unaware that there is a vaccine available. 115 Equally, availability is an ongoing issue as vaccine shortages are a possibility. 13 Cost is also cited as a reason for not receiving a vaccine, 114 but pilgrims will receive a vaccination if the cost is low or free.…”

Special Issue: Travel and Tropical Medicine

“…A follow up study conducted during the 2020 Hajj amidst the COVID-19 pandemic showed no improvement and pilgrims' mean hand hygiene knowledge score remained essentially unchanged (mean score 6.7 (±1.9) vs 6.4 (±1.35) of total 12) [11,13]. Another cross-sectional study conducted in 2017 and 2018 showed that 13.4% of Hajj pilgrims certainly missed meningococcal vaccination and another 4.8% were unsure about their vaccination status, which is a great concern [12].…”

“…One original study focussed on Hajj pilgrims’ understanding and practice of hand hygiene [ 11 ] and another of meningococcal vaccination [ 12 ]. A cross-sectional study conducted during the 2019 Hajj identified that most pilgrims knew hand hygiene could prevent respiratory and gastrointestinal infections, but many pilgrims did not know about precise hand washing methods.…”

“…Since 2000, when the quadrivalent meningococcal vaccination was made a Hajj visa-requirement, the uptake among overseas pilgrims ranged from 93% to 100% [ 12 , 14 , 15 ], but the vaccination rate among domestic pilgrims was lower (≤82%) [ 11 , 12 , 16 , 17 ]. A recent study with detailed breakdown on vaccination history has shown that, even among overseas pilgrims, the actual vaccine uptake is only 77%.…”