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Letters to the EditorReply Muhammad Yousuf, MBBS, MRCS, MRCP Dib Abdulaziz Al-Saudi, MBBS, MSC Riaz Ahmad Sheikh, and MBBS, MD Mohammad Shafi LoneMBBS, MD Muhammad Yousuf Department of Medicine, King Abdul Aziz Hospital, Madinah Al-Munawarah, Saudi Arabia Search for more papers by this author , Dib Abdulaziz Al-Saudi Department of Medicine, King Abdul Aziz Hospital, Madinah Al-Munawarah, Saudi Arabia Search for more papers by this author , Riaz Ahmad Sheikh Department of Medicine, King Abdul Aziz Hospital, Madinah Al-Munawarah, Saudi Arabia Search for more papers by this author , and Mohammad Shafi Lone Department of Medicine, King Abdul Aziz Hospital, Madinah Al-Munawarah, Saudi Arabia Search for more papers by this author Published Online:1 Jul 1996https://doi.org/10.5144/0256-4947.1996.480bSectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: We thank Dr. F. Jamal for her interest in our paper. We were not able to carry out microbiological studies to determine the etiology of pneumonias among Haj pilgrims and in our paper have already suggested the need for further study to find out the factors and microorganisms responsible for pneumonias in both Makkah and Madinah. We foresee that pneumonias may become an interesting problem in the coming Haj seasons, which will fall in the relatively cooler months of the year, and such a study would help improve the management of pilgrims with this infection.Study based on sputum culture will, however, be technically quite difficult among pilgrims because of the problems of obtaining a good sample due to the language barrier, particularly in Turkish, Nigerian and Indonesian pilgrims who cannot speak English or Arabic. Evaluation of these cases by transtracheal aspiration (TTA), blood culture and serology may yield better information.1We agree with her that the availability and success of 23-polyvalent pneumococcal vaccine makes it particularly worthwhile to determine the proportion of cases caused by Streptococcus pneumoniae and characterize the strains implicated by serotyping and antibiotic sensitivity testing. We concur with her observations that Streptococcus pneumoniae can be the major cause of community-acquired pneumonias in old patients and an important cause of death,2–4 and the recommendations to vaccinate this high-risk group with polyvalent pneumococcal vaccine are worth consideration. However, Haj pilgrims constitute a special group of patients. Most of them are from Asia or Africa. They usually develop pneumonia after their stay in Haj camps of Mina and Arafat and not while living in the community. They have diabetes mellitus as the third common co-morbid illness. For these reasons, causative microorganisms responsible for their pneumonias may well be different from European or American studies of community-acquired pneumonias. Pneumococcal vaccine is not yet recommended for the general public by the Public Health Service Advisory Committee on Immunization Practice of the Centers for Disease Control.5 Furthermore, the efficacy of the vaccine is more in females as compared to males,6 whereas males constitute most of the pilgrims. Also, efficacy of the vaccine depends on the serotype, which varies with the age of the patient, hospital type and source of isolate7 and this information may be vital in pilgrims who may benefit from such vaccination.Keeping the above factors in mind, we recommend that pending the results of microbiological study in pilgrims with pneumonia, polyvalent pneumococcal vaccination can be recommended in high-risk cases, i.e., those with COPD, bronchial asthma and age above 60 years. Those who cannot afford the vaccine may take prophylactic antibiotics before they move to Mina or Arafat, as has been recommended earlier.8ARTICLE REFERENCES:1. Ostergaard L, Andersen PL. "Etiology of community-acquired pneumonia. Evaluation by transtracheal aspiration, blood culture or serology" . Chest. 1993; 104: 1400–7. Google Scholar2. Ortqvist A, Hedlund J, Grillner L, et al. "Etiology, outcome and prognostic factors in community-acquired pneumonia requiring hospitalization" . Eur Respir J. 1990; 3: 1105–13. Google Scholar3. Pachon J, Prados MD, Capote F, et al. "Severe community-acquired pneumonia. Etiology, prognosis and treatment" . Am Rev Respir Dis. 1990; 142: 369–73. Google Scholar4. Moine P, Vercken JB, Chevret S, Chastang C, Gajdos P. "Severe community-acquired pneumonia. Etiology, epidemiology and prognostic factors. French study group for community-acquired pneumonia in the intensive care unit" . Chest. 1994; 105: 1487–95. Google Scholar5. Requejo HI. "Polyvalent pneumococcal polysaccharide vaccine: a review of the literature" . Rev Hosp Clin Fac Med. 1993; 48: 130–8. Google Scholar6. Gable CB, Holzer SS, Englehart L, et al. "Pneumococcal vaccine. Efficacy and associated cost savings" . JAMA. 1990; 264: 2910–5. Google Scholar7. Hager HL, Wooley W, Berk SL. "Review of recent pneumococcal infections with attention to vaccine and nonvaccine serotypes" . Rev-Infect Dis. 1990; 12: 267–72. Google Scholar8. Yousuf M, Zafar M, Maqbool M. "Medical problems of Pakistani pilgrims in Saudi Arabia" . Pak J Med Res. 1993; 32: 172–5. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 16, Issue 4July 1996 Metrics History Published online1 July 1996 InformationCopyright © 1996, Annals of Saudi MedicinePDF download