Burden of influenza-related severe acute respiratory infections during Hajj season 1438 (2017). Lessons and future directions

Assiri, Abdullah M.; Asiri, Sari I.; Banassir, Talib; Baljoon, Mustafa J.; Jokhdar, Hani

Abdullah M. Assiri, MD, FACP, Sari I. Asiri, MD, SBFM, Talib Banassir, PhD, Mustafa J. Baljoon, MsD, PhD, Hani Jokhdar, MD, PhD I nfluenza poses a public health challenge during Hajj. Published data indicate that influenza virus infection was a common cause of severe respiratory illness in pilgrims returning from Hajj. 1 Hajj pilgrimage follows the lunar calendar; thus, it may or may not coincide with wintertime in Saudi Arabia. As pilgrims performing Hajj come from both, the northern and southern hemispheres, some come from areas with active transmission of seasonal influenza. The seasonal availability of the influenza vaccine presents a challenge for the preventive efforts related to Hajj. 2 The Ministry of Health (MOH) in Saudi Arabia issues Hajj health requirements every year. It has recommended that all pilgrims, and in particular those at high risk of severe influenza (pregnant women, children aged <5 years, the elderly, and individuals with pre-existing health conditions such as asthma, chronic heart or lung diseases, and HIV/AIDS) are vaccinated against seasonal influenza with the most recently available vaccine. 3 In 2015, the National Technical Immunization Committee (NTIG), affiliated with the MOH, recommended the inclusion of the influenza vaccine in the Hajj health requirements. This requirement was implemented for domestic Hajjis in 1437 (2016). Health centers and selected hospitals all over the kingdom provided the southern hemisphere in 2016 vaccine free of charge. The vaccine uptake was modest (29%) in 2016. In 2017, adequate quantities of the southern hemisphere vaccine were purchased and made available in ample time before the Hajj. Media and official channels published strong calls to increase vaccination compliance. More than 262,000 doses of the vaccine were provided to domestic Hajjis (coverage, 44%). In 2016, similar quantities of the vaccine had been requested, but only a fraction was available for use at the right time due to procurement challenges.