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infuenza surveillance for hajj
- Nasser A. Al-Hamdan (17 December 2006)
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What is the Saudi guidance on flu jab for pilgrims, WHO knows?
- Sharmin A Zahan (22 December 2006)
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Nasser A. Al-Hamdan, General Supervisor, Field Epidemiolog Training Program Ministry of Health, Saudi Arabia
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Dear Editor: In reference to the editorial entitled “Hajj and the risk of influenza: The threat can no longer be ignored” published in your distinguished journal BMJ volume 333, 9 December 2006, page 1182, by A Rashid Gatrad, Shuja Shafi, Ziad A. Memish, and Aziz Sheikh. I would like to clarify that, in fact, we do have an Influenza surveillance system in Saudi Arabia, established in cooperation with the World Health Organization (WHO) Eastern Mediterranean Region and US Naval Medical Research Unit No.3 (NAMRU-3) as part of the Regional Influenza Surveillance Program, since 2004.1 This Influenza surveillance system operates throughout the year and is further enhanced during the hajj season. Influenza surveillance is done year-round at both Al Madinah AlMonawara city, and Makkah (Mecca), Ajyad hospital. During hajj, surveillance points at the two airports, where the hajj pilgrims arrive to Saudi Arabia, are added: King AbdulAziz Airport in Jeddah, and Prince Mohammed Bin Abdul;Aziz Airport in Al Madinah AlMonawara. Following the WHO case definition and sample handling procedures, a deep throat swab sample is obtained from symptomatic Hajji (pilgrim) arriving to the country. Samples are then preserved and transported in Nitrogen tanks to our collaborating Virology laboratory at King AbdulAziz University in Jeddah, where virus isolation and HAI are carried out. Representative samples are then submitted to the reference center. Each typeable isolate and aggregate ILI information is reported with the date of sampling, age and location of the patient to the surveillance coordinator. To help in development of the Influenza Surveillance System in Saudi Arabia, a cross-sectional study was conducted to identify the circulating serotypes of influenza virus and other baseline epidemiological information at both Makkah and Mina health care facilities during Hajj season of 2004. Results of this study were published in the Saudi Epidemiology Bulletin in 2005.2 Influenza viruses isolated during the hajj were sent to the WHO influenza reference laboratories at the Centers for Disease Control and Prevention (CDC), United States to be considered for inclusion in the constituents of the new influenza vaccine.1 Thank you. Dr. Nasser A. Al-Hamdan Consultant Family and Community Medicine General Supervisor, Field Epidemiology Training Program, Department of Preventive Medicine, Ministry of Health P.O. Box 6344 Riyadh 11442, Saudi Arabia. References: 1. World Health Organization Regional Office for the Eastern Mediterranean. Influenza Surveillance in the Region. Division of Communicable Disease Control Newsletter. 2005 June; 5: 5. 2. AlSaleh E, Al Mazroua M, Choudhry A, Turkistani A, Al Hamdan N, Azhar E, Olyan D. Serotypes of influenza during Hajj season, 1424 H (2004). Saudi Epidemiology Bulletin 2005; 12(1): 1. Competing interests: None declared |
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Sharmin A Zahan, Student MSc Public Health Queen Mary University, London
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EDITOR-Gatrad and colleagues mentioned in their editorial published in the BMJ on 9th December that the Saudi authorities recommend influenza vaccination for “high risk” pilgrims,1 while in the same issue Shafi (who also co-authored the editorial) and his friends narrated, “the Saudi Arabian Ministry of Health recommends that all pilgrims should receive influenza vaccination before travelling”.2 We, as physicians caring for Muslim patients in the UK, are puzzled with two conflicting statements in the same issue of the BMJ regarding the Saudi guidelines on flu jab for Hajj pilgrims. In the UK, individuals over 65, and/or with co-existing diseases such as heart, lung, kidney and liver diseases, and on immunosuppressant drugs are considered ‘at risk’ of influenza and receive the vaccine every winter annually. If the Saudi advice on flu jab were only for these ‘high risk’ pilgrims, there would be no need for any fresh recommendation, as the Hajj goers would automatically receive the vaccine under the present UK guidelines. According to WHO, Saudi recommendation on the vaccine is for pilgrims in general and for the elderly and patients with chronic medical conditions in particular,3 however, unlike meningococcal ‘ACWY’ vaccine, flu jab is not a mandatory requirement for Hajj visa and hence a large number of pilgrims are missing the vaccine including many ‘at risk’ individuals.2 Department of Health, UK, should make it clear, to keep in line with the Saudi guidance whether healthy pilgrims travelling on Hajj should receive influenza vaccination or not. 1 Gatrad AR, Shafi S, Memish ZA, Sheikh A. Hajj and the risk of influenza. BMJ 2006;333;1182-1183. 2 Shafi S, Rashid H, Ali K El-Bashir H, Haworth E, Memish ZA, et al. Influenza vaccine uptake among British Muslims attending Hajj, 2005 and 2006. BMJ 2006;333:1220 3 World Health Organization. Wkly Epidemiol Rec 2006;81:422–423. Conflict of interests None declared Dr Sharmin Zahan
Competing interests: None declared |
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