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Barriers of vaccinations against serious bacterial infections among Australian Hajj pilgrims
Authors:Mohamed Tashani  Mohammad Alfelali  Mohammad Irfan Azeem  Fayeza Nusrat Fatema  Osamah Barasheed  Amani Salem Alqahtani
Affiliation:1. National Centre for Immunisation Research and Surveillance (NCIRS), The Children’s Hospital at Westmead, Sydney, Australia;2. Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, Australia;3. Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia;4. The Executive Administration of Research, King Abdullah Medical City (KAMC), Makkah, Saudi Arabia;5. School of Public Health, The University of Sydney, Sydney, Australia
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.

Keywords:Australia  Hajj  knowledge  attitude and practice  serious bacterial infection  vaccine uptake
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