title: Barriers of vaccinations against serious bacterial infections among Australian Hajj pilgrims.
abstract: OBJECTIVE
  Vaccination against serious bacterial infections is recommended for Hajj pilgrims. Although the uptake of mandatory vaccines among Hajj pilgrims is acceptable, the uptake of other recommended vaccines remains suboptimal. In this study, we have explored the barriers to vaccination against serious bacterial infections among Australian Hajj pilgrims.
  
  
  METHODS
  Travellers aged 18 years and older planning to attend Hajj in the years 2014 and 2015 were surveyed at the immunization clinic of the Children's Hospital at Westmead, Sydney, Australia. A questionnaire-based survey was conducted to explore pilgrims' vaccination histories for their previous visits to Mecca, the reasons for non-receipt of vaccination, and to assess knowledge about the transmission of infections.
  
  
  RESULTS
  A total of 300 participants aged 18-76 (median 41) years completed the survey. Most (233 [77.7%]) were born outside Australia. Overall, 113 (37.7%) had performed pilgrimage in the past; 19 (16.8%) of them reported receiving pneumococcal vaccine and 16 (14.1%) diphtheria, tetanus and pertussis (DTP) vaccine. Lack of awareness about the availability of the vaccines was the main reason for non-receipt of pneumococcal and DTP vaccines (respectively 41.1% and 44.7%). Most pilgrims (266 [88.7%]) believed that travel vaccines are necessary before embarking on a journey; however, some expressed concerns about adverse reactions (156 [52.0%]), cost (114 [38.0%]), and permissibility of the vaccine according to their religion (6 [2.0%]). Respectively, 187 (62.3%), 145 (48.3%) and 86 (28.7%) respondents did not correctly know how meningococcal and pneumococcal diseases and pertussis transmit. Nevertheless, most (256 [85.3%]) indicated that they trust their family doctor for medical information and most (203 [67.7%]) preferred to receive the medical information in English.
  
  
  CONCLUSIONS
  The uptake of recommended vaccines against serious bacterial infections among Australian Hajj pilgrims is low. Lack of awareness about the availability of vaccines, misperceptions surrounding the safety of vaccines and high cost are key barriers of uptake.
authors.affiliation: a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.|b Discipline of Paediatrics and Child Health, Sydney Medical School , University of Sydney , Sydney , Australia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Tashani
authors.affiliation: a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.|b Discipline of Paediatrics and Child Health, Sydney Medical School , University of Sydney , Sydney , Australia.|c Department of Family and Community Medicine, Faculty of Medicine in Rabigh , King Abdulaziz University , Jeddah , Saudi Arabia.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Alfelali
authors.affiliation: a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.|b Discipline of Paediatrics and Child Health, Sydney Medical School , University of Sydney , Sydney , Australia.
authors.forename: Mohammad Irfan
authors.initials: MI
authors.lastname: Azeem
authors.affiliation: a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.
authors.forename: Fayeza Nusrat
authors.initials: FN
authors.lastname: Fatema
authors.affiliation: a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.|b Discipline of Paediatrics and Child Health, Sydney Medical School , University of Sydney , Sydney , Australia.|d The Executive Administration of Research , King Abdullah Medical City (KAMC) , Makkah , Saudi Arabia.
authors.forename: Osamah
authors.initials: O
authors.lastname: Barasheed
authors.affiliation: a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.|e School of Public Health , The University of Sydney , Sydney , Australia.
authors.forename: Amani Salem
authors.initials: AS
authors.lastname: Alqahtani
authors.affiliation: a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.
authors.forename: Hatice
authors.initials: H
authors.lastname: Tekin
authors.affiliation: a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.|b Discipline of Paediatrics and Child Health, Sydney Medical School , University of Sydney , Sydney , Australia.|f Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School , University of Sydney , Sydney , Australia.
authors.forename: Harunor
authors.initials: H
authors.lastname: Rashid
authors.affiliation: a National Centre for Immunisation Research and Surveillance (NCIRS) , The Children's Hospital at Westmead , Sydney , Australia.|b Discipline of Paediatrics and Child Health, Sydney Medical School , University of Sydney , Sydney , Australia.|f Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School , University of Sydney , Sydney , Australia.|g WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events , Flinders University , Adelaide , Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Booy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000208:ethnology; D001364:Awareness; D003430:Cross-Sectional Studies; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage* / Q000191:economics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010465:Perception; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000191:economics; D012529:Saudi Arabia / Q000453:epidemiology; D014195:Travel; D055815:Young Adult
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D022242:Pneumococcal Vaccines
keywords: Australia; Hajj; attitude and practice; knowledge; serious bacterial infection; vaccine uptake