Surveillance of Australian Hajj pilgrims for carriage of potentially pathogenic bacteria: Data from two pilot studies.

AIM: To estimate the pharyngeal carriage rate of Neisseria meningitidis (N. meningitidis), Streptococcus pneumoniae (S. pneumoniae) and Staphylococcus aureus (S. aureus) among Australian Hajj pilgrims. METHODS: In 2014, surveillance was conducted in two phases among Australian Hajj pilgrims: The first phase during Hajj in Mina, and the second phase soon after returning home to Australia. Nasopharyngeal or oropharyngeal swabs were taken from participants then tested, firstly by nucleic acid testing, and also by standard culture. RESULTS: Of 183 participants recruited in the first phase, 26 (14.2%) tested positive for S. pneumoniae; 4 had received pneumococcal conjugate vaccine (PCV13). Only one tested positive for N. meningitidis (W). Of 93 2nd phase samples cultured, 17 (18.3%) grew S. aureus, all methicillin sensitive, 2 (2.2%) grew N. meningitidis (on subculture; one serotype B, one negative), and 1 (1%), from an unvaccinated pilgrim, grew S. pneumoniae. CONCLUSION: Relatively high carriage of S. pneumoniae and little meningococcal carriage was found. This indicates the importance of a larger study for improved infection surveillance and possible vaccine evaluation.

Barriers of vaccinations against serious bacterial infections among Australian Hajj pilgrims.

OBJECTIVES: 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. CONCLUSION: 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.

Changes in the prevalence of influenza-like illness and influenza vaccine uptake among Hajj pilgrims: A 10-year retrospective analysis of data.

BACKGROUND: Influenza is an important health hazard among Hajj pilgrims. For the last ten years, pilgrims are being recommended to take influenza vaccine before attending Hajj. Vaccination coverage has increased in recent years, but whether there has been any change in the prevalence of influenza-like illness (ILI) is not known. In this analysis, we examined the changes in the rate of ILI against seasonal influenza vaccine uptake among Hajj pilgrims over the last decade. METHOD: Data for this analysis is a synthesis of raw and published data from eleven Hajj seasons between 2005 and 214. For seven Hajj seasons the data were obtained from studies involving pilgrims of UK, Saudi Arabia and Australia; and for the remaining four Hajj seasons data were abstracted from published studies involving pilgrims from multiple countries. The data from both sources were synthesised to estimate the relative risk (RR) of acquisition of ILI in vaccinated versus unvaccinated pilgrims. RESULTS: The pooled sample size of the included studies was 33,213 with most pilgrims being in the age band of 40-60 years (range: 0.5 to 95 years) and a male to female ratio of 1.6. The pilgrims originated, in order of frequency, from Iran, Australia, France, UK, Saudi Arabia, Indonesia, India, Algeria, Ivory Coast, Nigeria, Somalia, Turkey, Syria, Sierra Leone and USA. Except for one year (2008), data from individual years did not demonstrate a noticeable change in the rate of ILI against influenza vaccine coverage, however the combined data from all studies suggest that the prevalence of ILI decreased among Hajj pilgrims as the vaccine coverage increased over the last decade (RR 0.2, P<0.01). CONCLUSION: This analysis suggests that influenza vaccine might be beneficial for Hajj pilgrims. However, controlled trials aided by molecular diagnostic tools could confirm whether such an effect is real or ostensible.

Extending total parenteral nutrition hang time in the neonatal intensive care unit: is it safe and cost effective?

AIM: To investigate the effects of prolonging hang time of total parenteral nutrition (TPN) fluid on central line-associated blood stream infection (CLABSI), TPN-related cost and nursing workload. METHODS: A before-after observational study comparing the practice of hanging TPN bags for 48 h (6 February 2009-5 February 2010) versus 24 h (6 February 2008-5 February 2009) in a tertiary neonatal intensive care unit was conducted. The main outcome measures were CLABSI, TPN-related expenses and nursing workload. RESULTS: One hundred thirty-six infants received 24-h TPN bags and 124 received 48-h TPN bags. Median (inter-quartile range) gestation (37 weeks (33,39) vs. 36 weeks (33,39)), mean (±standard deviation) admission weight of 2442 g (±101) versus 2476 g (±104) and TPN duration (9.7 days (±12.7) vs. 9.9 days (±13.4)) were similar (P > 0.05) between the 24- and 48-h TPN groups. There was no increase in CLABSI with longer hang time (0.8 vs. 0.4 per 1000 line days in the 24-h vs. 48-h group; P < 0.05). Annual cost saving using 48-h TPN was AUD 97,603.00. By using 48-h TPN, 68.3% of nurses indicated that their workload decreased and 80.5% indicated that time spent changing TPN reduced. CONCLUSION: Extending TPN hang time from 24 to 48 h did not alter CLABSI rate and was associated with a reduced TPN-related cost and perceived nursing workload. Larger randomised controlled trials are needed to more clearly delineate these effects.