Uptake of Recommended Vaccines and Its Associated Factors Among Malaysian Pilgrims During Hajj and Umrah 2018

Hajj pilgrims from more than 180 countries across the globe visit Saudi Arabia for the 2 pilgrimages yearly. These mass gatherings are characterised by increased risk of infection and outbreaks of diseases like influenza. Despite the recommendations by health authorities, many studies have found varying figures in the uptake of the recommended vaccines, ranging from 0.7% up to 100% among Hajj and Umrah pilgrims. Common beliefs in Islam about alternative medicine during Hajj involving consumption of blessed foods and fruits result in vaccine hesitancy. This misconception, which is spread in Malaysia, affects the uptake of the recommended vaccines in that country. The purpose of this cross-sectional study, conducted among Malaysian Hajj pilgrims in the year 2018, is to determine the association between socio-demographic variables, comorbidities, previous Hajj/Umrah experience, and uptake of influenza and pneumococcal vaccines.

The uptake of the recommended vaccines was surveyed through an anonymous self-administered questionnaire to pilgrims attending a pre-departure Hajj/Umrah orientation course in Kelantan state, Malaysia. Descriptive statistics were used for elaborating the demographic characteristics and vaccines uptake of the respondents. Multiple logistic regression was used to predict the factors associated with the vaccines' uptake.

A total of 1,274 pilgrims participated in the study, 833 (65.4%) of whom were female. The uptake of influenza and pneumococcal vaccines was 28.6% (364/1,274) and 25.4% (324/1,274), respectively. Among the 527 pilgrims who were at increased risk of infections, 168 (31.9%) and 184 (34.9%) received influenza and pneumococcal vaccines, respectively. Uptake of these vaccines was significantly higher among pilgrims with higher education levels.

In conclusion, the study found that the vaccination uptake among Malaysian Hajj and Umrah pilgrims is low and declining from previous years. "Education of all pilgrims before departure is imperative to enlighten and create awareness toward vaccine uptake. Additional studies are required to explore the barriers as well as motivators to bridge the knowledge gap about the mandatory and recommended vaccine's uptake."