Influenza vaccine effectiveness among Hajj pilgrims: a test-negative case-control analysis of data from different Hajj years.

Alfelali, Mohammad; Barasheed, Osamah; Koul, Parvaiz; Badahdah, Al-Mamoon; Bokhary, Hamid; Tashani, Mohamed; Bakarman, Marwan; Khandaker, Gulam; Booy, Robert; Rashid, Harunor

Background: Influenza is a common respiratory infection at Hajj. Thus, influenza vaccine is recommended for Hajj pilgrims but data on its effectiveness from a large sample is unavailable. This analysis aims to assess the effectiveness of trivalent seasonal influenza vaccine (TIV) among Hajj pilgrims. Patients and methods: A 'test-negative' case-control analysis using data from individual studies was conducted. Included studies involved participants from Saudi Arabia, India, Australia and the United Kingdom who attended Hajj in Makkah, Saudi Arabia in different years between 2005 and 2015. Pilgrims who developed symptoms of respiratory infection during Hajj were included in these studies. Participants' vaccination histories were recorded and respiratory samples were collected to test for influenza by PCR. Vaccine effectiveness (VE) was calculated after adjusting for potential confounders. Results: A total of 1,569 pilgrims were included in this analysis. Influenza vaccine uptake was 52.2% and the prevalence of influenza was 8.2%. The estimated overall VE was 43.4% (95% CI 11.4% to 63.9%, P= 0.01). VE against a specific subtype of influenza was not significant. Conclusion: The current analysis has shown that TIV is moderately effective among Hajj pilgrims, but the vaccine uptake has been suboptimal. Power was much reduced when testing for influenza subtypes.