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LETTERS: Shuja Shafi, Harunor Rashid, Kamal Ali, Haitham El Bashir, Elizabeth Haworth, Ziad A Memish, and Robert Booy Influenza vaccine uptake among British Muslims attending Hajj, 2005 and 2006 BMJ 2006; 333: 1220 [Full text]

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Pilgrimage and flu

Mohammad S. Jamal, Muhammad A. Islam   (11 December 2006)

Pilgrimage and flu 11 December 2006
Mohammad S. Jamal, graduate student Greenwich University, Medway, Kent, ME4 5TB, Muhammad A. Islam Send response to journal: Re: Pilgrimage and flu	Muslim pilgrims attending the Hajj from countries plagued by avian influenza notably Indonesia, Turkey, Iraq and Egypt may introduce the deadly virus to the congregation leading to its global outburst. Additionally, reports of the three latest bird flu clusters in Indonesia,1 a country that sends the maximum number of pilgrims to the Hajj, warn us that we are probably at the brink of the long-waited pandemic influenza and it is very likely that Hajj will play a pivotal role in accelerating its global spread. Simultaneous out break of Meningococcus W135 in several countries following Hajj in recent years is a good lesson we must not forget too quickly.2 Furthermore, the risk of emergence of a variant strain due to amalgamation of different flu viruses at the Hajj should not be underrated. British pilgrims will not spare if an outbreak results; 38% returning UK Hajjis had influenza,3 yet in the last two years the overall influenza vaccine uptake among high risk pilgrims was lower than the national average particularly among the Londoners.4 Legal implementation, e.g. obtaining mandatory influenza vaccination certificate before applying for Hajj visa, may be required in order to increase uptakes. Targeting only ‘at risk’ group will make the scheme tricky; a compulsory universal rather than an optional selective vaccination policy will be needed to improve influenza vaccine coverage and consequently the risk of pandemic flu among British pilgrims. Universal requirement for quadrivalent meningitis (ACWY) vaccination before going on Hajj has already revealed successful results.5 Offering vaccination and health education in makeshift travel clinics at the meeting places of Muslims, e.g. in mosques and community centres, in large cities including London would be a novel step to improve vaccination as well as health awareness. Mohammad S. Jamal graduate student Department of Pharmaceutical Sciences, Greenwich University, Medway, Kent, ME4 5TB jm406@gre.ac.uk Muhammad A. Islam specialist registrar Infection and Immunity , Bart’s and The London NHS Trust, London E 1 1BB 1 Kandun IN, Wibisono H, Sedyaningsih ER, Yusharmen, Hadisoedarsuno W, Purba W, et al. Three Indonesian clusters of H5N1 virus infection in 2005.N Engl J Med 2006;355:2186-94. 2 Hahne SJM, Gray SJ, Aguilera J, Crowcroft NS, Nichols T, Kaczmarski EB, et al. W135 meningococcal disease in England and Wales associated with Hajj 2000 and 2001. Lancet 2002;359:582-83. 3 Bashir H, Haworth E, Zambon M, Shafi S, Zuckerman J, Booy R. Influenza among UK pilgrims to Hajj, 2003. Emerg Infect Dis 2004;10:882-3. 4 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 5 Shafi S, Memish ZA, Gatrad AR, Sheikh A. Hajj 2006: communicable disease and other health risks and current official guidance for pilgrims. Euro Surveill 2005;10:E051215.2. Competing interests: None declared