title: Influenza vaccination among Australian Hajj pilgrims: uptake, attitudes, and barriers.
abstract: BACKGROUND
  Hajj is the largest annual mass gathering where the risk of respiratory infection is high. Although the Saudi Arabian authority recommends influenza vaccination for Hajj pilgrims, the uptake is variable. Influenza vaccine uptake data among Australian Hajj pilgrims is not readily available. Therefore, we aimed to estimate the influenza vaccination uptake rate and identify both attitudes and barriers to vaccine uptake from two consecutives surveys at Hajj in 2011 and 2012.
  
  
  METHODS
  Using an anonymous self-administered questionnaire, surveys were conducted in Mecca, Saudi Arabia, among Hajj pilgrims from Australia in 2011 and 2012. Pilgrims staying in "Australian" tents were recruited serially.
  
  
  RESULTS
  In 2011, 431 Australian pilgrims completed the survey-median age was 42 (range 7-86) years, 55% were male; 65% reported receiving influenza vaccine. In 2012, 535 pilgrims of median age 43 (range 12-83) years completed the survey, 62% were male; 89% reported receiving the vaccine. Both in 2011 and 2012, common reasons for not receiving the vaccine were the pilgrims' reliance on their "natural immunity" (33 and 26%, respectively, p = 0.4) and believing that they would rarely catch influenza or come in contact with influenza patients (18 and 29%, respectively, p = 0.1). In 2012, when asked why they had received the vaccine, 65% pilgrims responded that it was because of the tour group leaders' recommendation.
  
  
  CONCLUSIONS
  Influenza vaccine uptake among Australian Hajj pilgrims seems satisfactory and increasing but could be better because many pilgrims have misconceptions about vaccines. Tour operators may play a greater role in promoting vaccination.
authors.affiliation: National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, Australia.
authors.forename: Osamah
authors.initials: O
authors.lastname: Barasheed
authors.forename: Harunor
authors.initials: H
authors.lastname: Rashid
authors.forename: Leon
authors.initials: L
authors.lastname: Heron
authors.forename: Iman
authors.initials: I
authors.lastname: Ridda
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Haworth
authors.forename: Jonathan
authors.initials: J
authors.lastname: Nguyen-Van-Tam
authors.forename: Dominic E
authors.initials: DE
authors.lastname: Dwyer
authors.forename: Robert
authors.initials: R
authors.lastname: Booy
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001315:Australia; D002648:Child; D003441:Crowding; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012529:Saudi Arabia; D014195:Travel; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines