Mandatory meningococcal vaccine, and other recommended immunisations: Uptake, barriers, and facilitators among health care workers and trainees at Hajj

Badahdah, Al-Mamoon; Alfelali, Mohammad; Alqahtani, Amani S; Alsharif, Saeed; Barasheed, Osamah; Rashid, Harunor

The lower uptake rate of meningococcal and influenza vaccines among males could be due to their lower preventative sense, notably towards preemptive and pre-travel advices, or could be a chance finding seeing that most of the survey participants were male [48] . A Dutch study involving Hajj pilgrims showed that being a female was an independent predictor for accepting dTP vaccine [49] . Although no official recommendation for routine pneumococcal vaccination for HCWs exists, experts have recommended it for Hajj attendees considered to be "at increased risk" [28, 29] . Our findings showed suboptimal vaccination rate (13.8%) even among "at increased risk" group (27.3%). Previously, a much lower vaccination rate (1.5%) was reported among "at increased risk" international pilgrims, however, much higher uptake (29%-48%) among "at increased risk" pilgrims from developed countries is reported [50] . Promisingly, the main reason for receipt of vaccines was to follow the health authority's recommendation but there were several key misperceptions. A false belief among HCWs that they were up-to-date with their vaccinations and that they did not need any more vaccines for Hajj attendance was a key barrier. This belief may have stemmed from their lack of awareness about the requirement and the availability of Hajj vaccines, and their presumption that just for joining the congregation they may not need the vaccinations since they were local residents. HCWs' reliance on other preventive measures and their claimed ability to know how to ward off an infection without vaccination were other important barriers. Some of these barriers were previously reported among HCWs serving at Hajj [34, 35] . Workplace vaccination campaigns could make a difference and was found to be successful in Saudi Arabia. For instance, assigning a dedicated nurse in each department to conduct vaccinations during an annual in-hospital campaign increased staff influenza vaccination up to three folds at a tertiary hospital in Saudi Arabia (from 29% to 77%, 81% and 67%) [45] . The strength of this survey is that it gives a very quick snapshot about Hajj HCWs' uptake of three vaccines: a mandatory vaccine (meningococcal), a highly desirable vaccine (influenza), and an optional vaccine (pneumococcal), and for the first time provides insight on motivators of vaccination. However, this study is fraught with limitations. Small sample size is a key limitation of this survey, HCWs are too busy to complete a survey form, hence like most other surveys involving HCWs at Hajj it has a small sample size. Also, the data are self-reported, and we had no way to validate their vaccination histories but since HCWs are expected to have sufficient health literacy the information are considered to be reliable. The survey did not distinguish between polysaccharide and conjugate meningococcal vaccines, and both vaccines were used in Saudi Arabia during the survey period. Furthermore, the questionnaire did not distinguish those who received the meningococcal vaccine in the previous years versus the current year. Finally, since the survey was online and because we wanted to make it simple for the busy HCWs, we did not ask about reasons for receipt or nonreceipt of individual vaccines, so the responses received could be meant for any one or all the three vaccines.