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.
Highlights
Hajj is a large annual mass gathering that attracts more than two million Muslims from around the world to congregate within confined areas in Makkah, Saudi Arabia
A highly crowded and congested environment during Hajj amplifies risks associated with mass gatherings, including transmission of respiratory organisms, notably Neisseria meningitidis [1,2]
Neisseria meningitidis is associated with a substantially high rate of carriage in crowded and closed populations, which resulted in large intercontinental outbreaks of invasive meningococcal disease during Hajj [3]
Summary
Hajj is a large annual mass gathering that attracts more than two million Muslims from around the world to congregate within confined areas in Makkah, Saudi Arabia. Following the Hajj in 1987, an intercontinental Hajj-related outbreak of meningococcal serogroup A (MenA) disease led to approximately 2000 cases [4], and its subsequent introduction into the African meningitis belt affected around 70,000 people [5]. Switching the vaccination policy to the quadrivalent (serogroups A, C, W, and Y) meningococcal (MenACWY) polysaccharide vaccine in 2002, coupled with chemoprophylaxis at the port of entry for pilgrims arriving from the African meningitis belt, again brought the subsequent epidemics under control [8]. The enforcement of the Hajj permit requirement by rigorous procedures at points of entry into Makkah reduced the number and proportion of domestic pilgrims (from 1.4 million (45%) in 2012 to 600,000 (26%) in 2018) [21]. A survey was undertaken to evaluate the coverage of MenACWY vaccines among Hajj pilgrims and to identify the key predictors and barriers affecting their uptake, among domestic pilgrims, which was not assessed in previous studies
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
