Influenza vaccine uptake among British Muslims attending Hajj, 2005 and 2006

doi:10.1136/bmj.39051.734329.3A

BMJ 2006;333:1220 (9 December), doi:10.1136/bmj.39051.734329.3A

Letters

Influenza vaccine uptake among British Muslims attending Hajj, 2005 and 2006

Every year 1% of British Muslims travel to SaudiArabia on the Hajj pilgrimage. High rates of influenza havebeen reported among pilgrims,¹ ² and theSaudi Arabian Ministry of Health recommends that all pilgrimsshould receive influenza vaccination before travelling. We determinedthe uptake of influenza vaccination among British Hajj pilgrimswho attended the British Hajj Delegation Clinic in Mecca andmobile clinics set up by us in Mina in 2005 and 2006.

In 2005, 196 pilgrims were recruited and in2006, 146 (age range 2 to 83; 313 men); 104 were from London.Ninety two pilgrims (27%) were categorised as being at riskof influenza, one fifth (19) of them solely because of being65 or over and the rest because of having chronic diseases regardlessof age.

A total of 108 pilgrims (32%) were vaccinated,all but two by their general practitioner. Vaccine coverageamong pilgrims at risk was 55% (51/92) and among those not atrisk 23% (57/250) (P<0.001). Coverage among over-65s was63% (19/30) and among under-65s regardless of underlying chronicdisease 52% (32/62).

Immunisation uptake by all pilgrims in 2005was 27% (53/196) and 38% (55/146) in 2006 (P=0.036), and thecoverage among those at risk was 51% (29/57) and 63% (22/35)respectively (P=0.26). Uptake by all pilgrims who lived in Londonin these two years was 20% (21/104) compared with 37% (87/238)in other centres (P=0.003). Uptake by "at risk" residents ofLondon was 38% (10/26) compared with 62% (41/66) elsewhere (P=0.04).

The rate of vaccination among Muslims at riskis worryingly lower (55%) than the nationwide uptake rate amongthe target population (70%),³ and even lower among the residentsof London. Uptake could be improved by advertising, phone calls,patient and staff education, standing orders, targeting peoplewith high risk behaviours at their meeting venues, and offeringhome visits by nurses.⁴ Clinics set up, in partnership withcommunity leaders, travel agents, and imams for pilgrims planningto go on Hajj might further improve uptake.

Shuja Shafi, Harunor Rashid, Kamal Ali, Haitham El Bashir, Elizabeth Haworth, Ziad A Memish, Robert Booy

¹ Department of Microbiology and HPA Collaborating Laboratory, Northwick Park Hospital, Harrow, Middlesex HA1 3UJ

shuja.shafi{at}nwlh.nhs.uk

Funding: This work was supported from a Departmentof Health grant. We thank British Hajj Delegation team, EuropeanHajj Mission and the GPs for help with the data collection andstaff at HPA laboratory, London & Respiratory Virus Unit,Health Protection Agency, Centre for Infections, London, forperforming the PCR tests. Ethical Approval Multicentre ResearchEthics Committee, UK (MREC 02/2/12).

Competing interests Roche supplied free coursesof Tamiflu for treatment of pilgrims with influenza infectionon near-patient testing. SS served as Chair, Health and MedicalCommittee of the Muslim Council of Britain (until August 2006)

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