Influenza vaccine effectiveness among Hajj pilgrims: a test-negative case-control analysis of data from different Hajj years

ABSTRACT

Background: Influenza is a common respiratory infection at Hajj. Thus, influenza vaccine is recommended for Hajj pilgrims but data on its effectiveness from a large sample are unavailable. This analysis aims to assess the effectiveness of the trivalent seasonal influenza vaccine (TIV) among Hajj pilgrims.

Patients and methods: A ‘test-negative’ case–control analysis using data from individual studies was conducted. Included studies involved participants from Saudi Arabia, India, Australia and the United Kingdom who attended Hajj in Makkah, Saudi Arabia in different years between 2005 and 2015. Pilgrims who developed symptoms of respiratory infection during Hajj were included in these studies. Participants’ vaccination histories were recorded and respiratory samples were collected to test for influenza by PCR. Vaccine effectiveness (VE) was calculated after adjusting for potential confounders.

Results: A total of 1,569 pilgrims were included in this analysis. Influenza vaccine uptake was 52.2% and the attack rate of influenza was 8.2%. The estimated overall VE was 43.4% (95% CI 11.4% to 63.9%, P = 0.01). VE against a specific subtype of influenza was not significant.

Conclusion: The current analysis has shown that TIV is moderately effective among Hajj pilgrims, but the vaccine uptake has been suboptimal. Power was much reduced when testing for influenza subtypes.

KEYWORDS:

• Hajj
• influenza
• test-negative case-control
• vaccine effectiveness

Author contributions

HR, RB, GK, MA, and OB conceived the idea, designed the study, and applied for funding the trial components of the study; MA, OB, PK, A-MB, HB, MT, MB, and members of Hajj Research Team collected data. MA, OB, PK, A-MB, HB, and MT collated and entered the data. MA prepared the tables. RB, HEB, OB, and PK are contact persons for ethics, respectively, in Australia, Qatar, Saudi Arabia, and India. MA, OB, PK, A-MB, HB, and MT coordinated logistics of the trials. HR is the guarantor of the study. MA, PK, and HR wrote the first draft of the manuscript, all other authors revised it, and approved the final version.

Declaration of interest

R Booy has received funding from Baxter, CSL, GSK, Merck, Novartis, Pfizer, Roche, Romark and Sanofi Pasteur for the conduct of sponsored research, travel to present at conferences or consultancy work; all funding received is directed to research accounts at The Children’s Hospital at Westmead. G Khandaker has received funding from Sanofi Pasteur to travel and present at conferences. H Rashid has received fees from Pfizer, Sanofi Pasteur and Novartis for consulting or serving on an advisory board. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Notes

Matar, Atheer Alshareif, Israa Kalantan, Eatimad Alalawi, Afnan AlGhamdi, Amani Koshak, Ameerah Alkhaldi, Inaam Al-Nami, Anwar Howsawi, Bashaier Fairaq, Bushra Maghrabi, Tafaol Murad, Hanan Alzahrani, Kholood Almehmadi, Doaa Milibari, Rehab Hafiz, Rawdhah Kalantan, Shahad Al-Ansari, Aeshah Rajab, Anood Alfahmy, Ghaida Ali, Fatimah Abu naji, Lujin Hassan, Lulwah Althumali, Layla Farhat, Najlaa Baddour, Hibh Alandanusi, Waad Alqurashi, Sumayyah Fallata, Azhar Alharbi, Joud Bahakeem, Abrar Alshareef, Badr Rawa, Ahmed Alghamdi, Ahmed Muqadimi, Osama Alamri, Jehad Qutub, Abdulrahman Al-Ghamdi, Abdurrahman Mirza, Abdulghafur Alandijani, Omar Qoqandi, Faisal Mandourah, Muhammad Alghamdi, Mohammed Mahboob, Mohannad Alsulami, Moayyd Hinnawi, Naif Hawsawi, Nawaf Dhabab, Ahmed Balamash, Mohammed Bawazir, Raif Nassir, Mohammed AlAsmari, Faisal Alzahrani, Abdulrahman Alomari, Ahmad Makeen, Ibraheem Almani, Ahmed Baabdullah, Osama Alamoudi, Ahmed Alzhrani, Ahmed Bagabas, Ahmad Ahmad, Anwar Alammari, Ayman Alghamdi, Badr Alaifan, Badr Al Dahlawi, Turki Almalki, Thamer Zoghbi, Hussam Patwa, Hasan Ghannam, Hussien Alkully, Samir Alsulaimani, Samee Al Heraki, Saad AlGhamdi, Sultan AlBalawi, Sultan Albukhari, Saleh Algamdi, Abdululah Alsolami, Abdullah Alghanmi, Abdulellah Alturkistani, Abdullrhman Alayad, Abdulrahman Althagafi, Abdulrahman Makki, Abdulrahman Khinkar, Abdulaziz Alalawi, Abdulaziz Alhoqail, Abdulaziz Alshoaibi. Abdullah Aldour, Abdulhadi Towairqi, Ali Ali, Ali Alshubaily, Firas Atwah, Majed Daqeeq, Mohammed Aljunaid, Mohammed Alghamdi, Mohammed Alsefri, Mohammed Alamoudi, Mohammed Alghamdi, Mohammad Melibary, Mohammad Bakhaidar, Mohammad Albogami, Mohammed Almoflihi, Muaath AlGhamdi, Mutaz Abdulhaq, Monther Farghali, Mohannad Khyyat, Moayad Banjar, Wael Almaghthawi, Wael Khalifa, Yasser Halabi, Mohanad Aljohani, Riyadh Alharbi, Moayad Sumnudi, Sultan Al Jaid, Rayan Makeen, Mahmoud Eid, Mohammed Alaryni, Abdulrahman Qahtani, Saud Bakhsh, Turki Alkharji, Ahmed Qadah, Albraa Kashegari, Ahmad Alabbasi, Abdulmohsen Al-Sofi, Meshary Alhassni, Nawaf Alharbi, Ahmad Al Ahdal, Abdulghani Alserafi, Ibrahim Alomry, Mohammed Kadi, Abdulrahman Almalki, Bassel Katib, Ibrahim Sameer, Fares Alnajjar, Mohammed Hawsawi, Rayan Mohammad, Ebtihal Turkistani, Abrar Tawakoul, Arwa Bajabaa, Areej Alzaidi, Ashar Almusallam, Asraa Turkistani, Asmaa Alattas, Alshaima Alghamdi, Esraa Kashkari, Elaf Altwairqi, Elaf Alrehaili, Elaf Khalifa, Inas Magharbil, Abrar Salloma, Arwa Alzaidi, Arej Fadel, Afnan AL Gothami, Amal Al-Saedi, Alaa Binsalman, Aya Kutbi, Baraah Tatwany, Basmah Fallata, Bashayer Al Mutairi, Bashaer Alrefaie, Bashayer Al-huthali, Bashayer Alsaati, Bashaer ALzahrani, Bushra Fallatah, Bushra Alattas, Bushra Alhajjaji, Banan Almalki, Bayan Zamil, Tamador Alghamdi, Tahani Al-Ghamdi, Jenan Jawi, Haneen Sibieh, Kholoud Natto, Duaa Eid, Reem Alamoodi, Sumaia Felimban, Etaf Kassem, Faten Althobaiti, Fadya Althobaiti, Maria AL-Jehani, Muneerah Al-youbi, Nadeen Bugis, Duaa Aiash, Duaa Assaqaf, Duaa Almouallimi, Rania Iraqi, Rasha Qurashi, Rasha Baqis, Raghad Jamal Aldeen, Ruqaiah Baharoon, Ranad Medhir, Renad Gashlan, Renad Aljohani, Randa Al-Bloushy, Raneen Abu Saadah, Rahaf Shafi, Rawan Gaafar, Reem Alshareef, Zahra Othman, Sara Aljuaid, Sara Al-Ghfari, Salma Sait, Samaa Sangouf, Samar Alsubhi, Sahar Alharbi, Samar Al-harbi, Sana’a Kelantan, Shahad Aldor, Shahd Alshareef, Shaimaa Halabi, Shaimaa Hawsawi, Seba AlHarbi, Azzah Azzouz, Alyaa Idris, Fatimah Alosaimi, Fatimah Alsomali, Lujain Al-Thakafi, Lujain Abdalwassie, Lama Alarabi, Lina Alsaiari, Majedah Alshammari, Mahacen Alnadwi, Mada Abdulhaq, Mada Al Zahrani, Maradi Murad, Maram AlShareef, Marwah Hadidi, Nojoud Benhli, Najwa Mohammad, Nada Almuqati, Noor Alessa, Noura Bakhsh, Nuran Sultan, Norah Alotaibi, Heba Waez, Heba Al-Qethami, Heba Alsheikh, Hebah Alwafi, Hoda Al-Sayid, Hadeel Khoj, Wejdan Makeen, Woud AlMusallam, Waed Yaseen, Wafa Sohail, Sara Fallata, Abdel Mejid Mohamed, Abdulkarim Al-Sabyani, Abdullah Elhosiny, Abdullah Alsayed, Abdullah Nawab, Abdullah Alharbi, Abdulraheem Al-Sadat, Abdulrahman Aldarkhbani, Abdulrahman Alnaser, Abdulrahman Allahyani, Abdulrahman Bazaid, Abdulrhman Al-Malki, Abdulrhman Kinsara, Abrar Khalil, Abrar Ainousa, Abrar Ghulam, Afaf Ebraheem Mas, Ahmad Charbatji, Ahmad Altalhi, Ahmad Bimah, Ahmad Maqadmi, Ahmad Albeshri, Ahmed Sindi, Ahmed Aljuhani, Ahmed Almikhlafi, Aisha Muhammed Memon, Alaa Khoja, Alaa Habib, Alhassan Alhasani, Ali Medher, Ali Alkhathami, Ali Al-Attas, Abdullah Alqarni, Amal Faheem, Amal Alsaedi, Amani Hussin, Amir Khogeer, Ammar Alfattni, Ammar Almaghrabi, Ammar Alaaddin, Anas Salman, Anwar Alharbi, Aqeel Alkhiri, Areej Abdul-Gader, Arwa Shaheen, Arwa Alasmari, Asma Mansoor, Asmah Aldobashi, Ataa Mesbah, Awnallah Al-Otaibi, Ayah Istanbouli, Badriah Aldeaiq, Banan Bawazeer, Bandar Ghonaim, Bashayer Alsaadi, Bassam Elkhouly, Bassil Aladani, Bayan Fatani, Bshaer Badakhan, Bushra Al-Harbi, Dania Shaikh, Daniah Alnemari, Deemah Alindonosi, Elaf Tayeb, Elaf Albasheri, Emad Alharbi, Eman Al Hindi, Eman Almarwani, Ensaf Fatani, Eyaad Ghallab, Faisal Alterazi, Faisal Almaabadi, Faisal Mahmood, Ghadah Althbiti, Ghadi Alotaibi, Ghaliah Al-Haqas, Hadeel Alhassani, Hamad Alhilabi, Hamis Alalhareth, Hanadi Al-Thobaiti, Hashem Moafa, Hassan Almalki, Hayaa Zaki, Heba Aziza, Hind Alrefai, Hisham Alkhuzaei, Horia Abou Shousha, Huda Mansoor, Hussain Jammal, Hussam Rawas, Jawaher Alqurashi, Jomana Ajawi, Jumana Melebari, Jumanah Al-Saedi, Khadeejah Aljifri, Khalid Alsubaie, Leenah Abdulgader, Lin Charbatji, Linah Zamzami, Maan Alraddadi, Mahmood Yasawy, Mahmoud Chaker, Majed Alamoudi, Majid Jawa, Malek Alsairafi, Maram Albarakati, Marium Iqbal, Marwa Hawsawi, Masheal Bawahhab, Mohammad Alzhrani, Mohammad Shaheen, Mohammed Algarni, Mohammed Alzahrani, Mohammed Al-Fageeh, Mohammed Alaamri, Mohammed Al-Jeddawi, Mohammed Alshreef, Mohammed Alsaggaf, Mohammed Dumyati, Mohammed Al- Mikhlafi, Mohsen Alzamanan, Mona Alghamdi, Muhab Hindi, Muteb Almarwani, Nada Telmesani, Nada Mohammed, Naif Alhowaiti, Nasser Alshehri, Nedaa Karami, Neveen Awad, Nizar Almaghrabi, Nojoud Hli, Nuha Jazzar, Omar Alzhrani, Omar Alotaibi, Osama Alharbi, Qutaibah Aldurrah, Raghad Namnqani, Rahma Al-Ghamdi, Raid Alghamdi, Rana Almimoni, Rana Abbas, Raneem Rawa, Rayyan Alqurayyan, Razan Melibari, Reem Altaifi, Reem Bajunaid, Reem Altowairqi, Reem Alenazi, Reem Alghamdi, Refal Aziz Al-Rahman, Reham Bin Hassan, Roaa Khan, Rowaynah Aziz Al-Rahman, Ruba Alshaikh, Saad Algarni, Saadiah Balkhy, Saeed Balubaid, Safa’A Al-Hasani, Sahar Futtiny, Salman Melhem, Salwa Alotaibi, Samah Alqurashi, Samaher Melybari, Sana Nargis, Sara Alshehtha, Sarah Radwan, Saud Bakhsh, Shahad Bamani, Shahad Alharbi, Shahd Hafiz, Shoroug Alkhabiry, Sofana Alqawsi, Sultan Alzahrani, Sultan Shaqra, Thamer Alanazi, Wafa Alkhuzaie, Wafa Sidiqqi, Wafaa Altaezi, Wafaa Alharbi, Walid Almutairi, Wasaif Aljuhany, Wed Jawa, Yaser Badawood, Yasser Hadi, Yousef Alzahrani, Abaad Al-Mutairi, Abdulaziz Ajaj, Abdullah Tai, Abdullah Ashour, Abdullah Aljohni, Abdullah Alshehri, Abdullateef Allebdi, Abdullateef Alzhrani, Abdulmajeed Alzahrani, Abrar Alnami, Adel Almaymuni, Afnan Joudah, Ali Fadel, Ali Alshehri, Ali Alelyani, Ali Alkhulaifi, Amal Alnakhli, Amani Alharbi, Anas Heji, Arwa Badakhan, Asal Arbaeen, Asmaa Nassir, Basim Almutairi, Atrab Bayazeed, Bushra Alahmadi, Dania Almunami. Dareen Alsaidalany, Ebtehal Yamani, Ebtesam Alghamdi, Eman Alharbi, Eman Kotbi, Fahad Altowairqi, Faisal Althobaiti, Faisal Alsobyani, Farraj Al-Zahrani, Ghadah Althbiti, Ghadah Alshehri, Hadeel Alqahtani, Hanan Mughallis, Haneen Taher, Heba Bayoumi, Hesham Essa, Hussein Alshamrani, Khalil Alghamdi, Malak Alshammari, Maram Albarakati, Marwah Bin-Garhom, Marwan Albeshri, Mohamed Bayoumi, Mohammad Althobaiti, Mohammed Toras, Mohammed Al Thebyani, Naif Alzahrani, Nasheal Bawahhab, Noura Al-Zahrani, Ohoud Alharbi, Radwan Badr, Rahma Aljedaani, Rakan Alnefaie, Rawa’A Al-Maghrabi, Rehab Alshamrani, Reham Abdulgader, Riyadh Alharbi, Sara Al-Ghfari, Sarah Aljoudi, Saud Alzhrani, Somayah Alsolami, Suliman Badi, Sultan Alghamdi, Tawfiq Al Laylah, Wasfi Almusaddi, Wijdan Alzhrani, Haitham El Bashir]

Additional information

Funding

This paper was funded by The Royal Embassy of Saudi Arabia, Canberra; Saudi Arabian Cultural Mission, Canberra; King Abdulaziz University, Jeddah; King Abdullah Medical City, Makkah; Ministry of Health (Professor Tariq A Madani), Riyadh; Ministry of Hajj (Mr Hatim Qadi), Makkah; The Custodian of the Two Holy Mosques Institute for Hajj and Umrah Research (Professor Abdulaziz Seroji), Makkah; and volunteers in the Hajj Research Team.