Hajj and the risk of influenzaBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39052.628958.BE (Published 07 December 2006) Cite this as: BMJ 2006;333:1182
All rapid responses
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
Dr Sharmin Zahan
Currently, Public Health MSc Student, Queen Mary University
Ex Clinical Fellow (SHO Level) O&G Barts and the London NHS Trust
Competing interests: No competing interests
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.
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.
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
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.
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: No competing interests