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Vaccinations for Hajj & Umrah

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Vaccinations for Hajj  & Umrah
**Summary of a presentation by Prof. Datin Dr. Ilina Isahak, HUKM, at a seminar organized by PPIM

Apart from meningococcal vaccination which is mandatory there are 2 further protection which is advocated to those going for hajj or umrah …

PNEUMOCOCCAL VACCINATION FOR HAJJ & UMRAH

Streptococcus pneumoniae (pneumococcus) is the commonest cause of community acquired pneumonia. It is a major cause of morbidity and mortality. It causes 1.2 million deaths per annum world wide. Of these 50% are potentially preventable with immunization.

It causes pneumonia, acute otitis media, sinusitis and bacteraemia. It is the leading cause of meningitis in adults with a mortality rate of 30%.

The Hujjaj quite clearly represent an at risk population with the following combination of factors :

  1. elderly
  2. chronic disease
  3. overcrowding

The increase in the numbers of resistant strains of pneumococcus further complicates the treatment protocol. The most cost effective strategy would be  immunization with the pneumococcal vaccine. The 23 valent vaccine contains 23 serotypes that cause 85-90% of invasive pneumococcal infection.

The Advisory Committee on Immunisation Practices (ACIP USA) recommends pneumococal vaccination for the following high risk groups :

  1. elderly > 65 years
  2. asplenic
  3. patients with chronic diseases
  4. diabetes mellitus
  5. immunocompromised host
  6. specific environmental settings

Preliminary report on role of pneumococcal vaccination (PV) among M’sian hajj pilgrims. Significant difference (p<0.001) noted between PV group and control group in the following clinical features :

  1. fever
  2. cough
  3. change in sputum characteristic
  4. dyspnoea
  5. pulmonary consolidation

Follow up of pilgrims upon return to Malaysia showed a significant difference (p<0.001) in their health status :

  1. control group 54.1% fell ill
  2. PV group 19.9% fell ill

Only one dose is required. Elderly > 65 years, who received 1st does more than 5 years ago require a 2nd dose.

(the conjugate pneumococcal vaccine; prevnar,  is available in the USA and recommended by the ACIP for vaccination of children ages 2,4,6 months and a booster dose; protecton is life long; made a lot of money for Wyeth; where demand outsrips supply)

**Summary of a presentation by AP Dr. Nordiah Hj. Awang Jalil, Consultant Microbiologist, HUKM , at a seminar organized by PPIM

INFLUENZA VACCINATION FOR HAJJ AND UMRAH

The influenza viruses affect all age groups, Rates of infection are highest in children but rates of serious illness and death are highest in the elderly. The spread is rapid. There are frequent but unpredictable epidemics. Pandemics are periodic.

The typical influenza illness inclues 5-6 days of restricted activity, 3-4 days of disability in bed, 3 days of absenteeism from school or work. And 50% of influenza illness require medical attention.

The pilgrims often have multiple risk factors :

  1. overcrowding
  2. old age
  3. underlying chronic diseases
  4. “stressful” rituals – physically and emotionally

The WHO Influenza Vaccination Recommendations include among others “large groups of pilgrims gathering in the same area for several weeks”.

A case control study of influenza vaccine efficacy among M’sian pilgrims attending the hajj showed a protective efficacy of 77% (p<0.0001). Of the 820 persons with ILI (influenza like illness), 99% received over the counter medications and 84% received antibiotic.