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

HCWs evade such requirement leading to suboptimal vaccination rate as low as 64% among domestic pilgrims compared to 100% vaccination rate among UK pilgrims [37] . However, achieving optimum vaccination by the appropriate vaccine is still challenge even among the overseas pilgrims. For instance, a minority of Nigerian pilgrims were found to be vaccinated with the monovalent meningococcal serogroup A vaccine whereas the policy was to use the quadrivalent ACWY vaccine [38] . Occasional use of fake vaccination certificate was another challenge in some countries [39] . Influenza vaccination of HCWs during Hajj is highly recommended [19] , yet 29% participants in this study reported not receiving it before attending Hajj. Four previous studies evaluated the coverage of influenza vaccination among HCWs in Hajj with the uptake ranged from as low as 5.9% in 2003, to 61.6% in 2005, 50.9% in 2009 and 52.7% in 2013-15 [31] [32] [33] 40] . Even the uptake of the 2009 influenza A (H1N1) pandemic vaccine remained between 22% and 47% [33, 34] . The uptake rate in non-Hajj setting is almost similar, ranging from 21% to 51% in several surveys conducted between 2003 and 2014 [41] [42] [43] [44] [45] , and among Saudi medical students it reached 57.2% in 2017 [46] . Furthermore, a strong vaccine hesitancy was revealed in a recent study where 13% of HCWs reported not taking influenza vaccine in the past, and would not receive it in the future [47] .