{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T22:55:21Z","timestamp":1793660121446,"version":"4.5.1"},"reference-count":35,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2019,10,15]],"date-time":"2019-10-15T00:00:00Z","timestamp":1571097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Background: Major intercontinental outbreaks of invasive meningococcal disease associated with the Hajj occurred in 1987, 2000, and 2001. Mandatory meningococcal vaccination for all pilgrims against serogroups A and C and, subsequently, A, C, W, and Y controlled the epidemics. Overseas pilgrims show excellent adherence to the policy; however, vaccine uptake among domestic pilgrims is suboptimal. This survey aimed to evaluate meningococcal vaccine uptake among Hajj pilgrims and to identify key factors affecting this. Methods: An anonymous cross-sectional survey was conducted among pilgrims in Greater Makkah during the Hajj in 2017\u20132018. Data on socio-demographic characteristics, vaccination status, cost of vaccination, and reasons behind non-receipt of the vaccine were collected. Results: A total of 509 respondents aged 13 to 82 (median 33.8) years participated in the survey: 86% male, 85% domestic pilgrims. Only 389\/476 (81.7%) confirmed their meningococcal vaccination status; 64 individuals (13.4%), all domestic pilgrims, did not receive the vaccine, and 23 (4.8%) were unsure. Among overseas pilgrims, 93.5% certainly received the vaccine (6.5% were unsure) compared to 80.9% of domestic pilgrims (p &lt; 0.01). Being employed and having a tertiary qualification were significant predictors of vaccination adherence (odds ratio (OR) = 2.2, 95% confidence interval (CI) = 1.3\u20133.8, p &lt; 0.01; and OR = 1.7, CI = 1\u20132.5, p &lt; 0.05, respectively). Those who obtained pre-Hajj health advice were more than three times as likely to be vaccinated than those who did not (OR = 3.3, CI = 1.9\u20135.9, p &lt; 0.001). Lack of awareness (63.2%, 36\/57) and lack of time (15.8%, 9\/57) were the most common reasons reported for non-receipt of vaccine. Conclusion: Many domestic pilgrims missed the compulsory meningococcal vaccine; in this regard, lack of awareness is a key barrier. Being an overseas pilgrim (or living at a distance from Makkah), receipt of pre-Hajj health advice, and employment were predictors of greater compliance with the vaccination policy. Opportunities remain to reduce the policy\u2013practice gap among domestic pilgrims.<\/jats:p>","DOI":"10.3390\/tropicalmed4040127","type":"journal-article","created":{"date-parts":[[2019,10,16]],"date-time":"2019-10-16T03:32:54Z","timestamp":1571196774000},"page":"127","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Meningococcal Vaccine for Hajj Pilgrims: Compliance, Predictors, and Barriers"],"prefix":"10.3390","volume":"4","author":[{"given":"Al-Mamoon","family":"Badahdah","sequence":"first","affiliation":[{"name":"National Centre for Immunisation Research and Surveillance (NCIRS), The Children\u2019s Hospital at Westmead, Westmead, NSW 2145, Australia"},{"name":"The Discipline of Child and Adolescent Health, The Children\u2019s Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia"},{"name":"Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1268-154X","authenticated-orcid":false,"given":"Fatimah","family":"Alghabban","sequence":"additional","affiliation":[{"name":"Faculty of medicine, Umm Al-Qura University, Makkah 24381, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wajd","family":"Falemban","sequence":"additional","affiliation":[{"name":"Faculty of medicine, Umm Al-Qura University, Makkah 24381, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Albishri","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gouri","family":"Rani Banik","sequence":"additional","affiliation":[{"name":"National Centre for Immunisation Research and Surveillance (NCIRS), The Children\u2019s Hospital at Westmead, Westmead, NSW 2145, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5675-9516","authenticated-orcid":false,"given":"Tariq","family":"Alhawassi","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7092-7544","authenticated-orcid":false,"given":"Hatem","family":"Abuelizz","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3515-9850","authenticated-orcid":false,"given":"Marwan A.","family":"Bakarman","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameneh","family":"Khatami","sequence":"additional","affiliation":[{"name":"The Discipline of Child and Adolescent Health, The Children\u2019s Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia"},{"name":"Department of Infectious Diseases and Microbiology, The Children\u2019s Hospital at Westmead, Westmead, NSW 2145, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Booy","sequence":"additional","affiliation":[{"name":"National Centre for Immunisation Research and Surveillance (NCIRS), The Children\u2019s Hospital at Westmead, Westmead, NSW 2145, Australia"},{"name":"The Discipline of Child and Adolescent Health, The Children\u2019s Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia"},{"name":"Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Westmead, NSW 2145, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2286-5139","authenticated-orcid":false,"given":"Harunor","family":"Rashid","sequence":"additional","affiliation":[{"name":"National Centre for Immunisation Research and Surveillance (NCIRS), The Children\u2019s Hospital at Westmead, Westmead, NSW 2145, Australia"},{"name":"The Discipline of Child and Adolescent Health, The Children\u2019s Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia"},{"name":"Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Westmead, NSW 2145, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,10,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.tmaid.2017.10.005","article-title":"Expected immunizations and health protection for Hajj and Umrah 2018\u2014An overview","volume":"19","author":"Gautret","year":"2017","journal-title":"Travel Med. 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