Adherence to Influenza Vaccination and Reasons of Hesitance to Get the Vaccine among Umrah and Hajj Attendants, Makkah, 1439

Background: Mass gathering in Makkah during Umrah and Hajj is coincidental to the spread of influenza virus infection
with its serious complications. Influenza vaccine proved effective in disease prevention or mitigating its complications.
Objectives: To assess adherence to influenza vaccination among Muslims visiting Makkah to perform Umrah and Hajj,
and to explore reasons behind hesitancy to receive the vaccine among the unvaccinated.
Methods: This work was a cross-sectional interview survey carried out on a conventional sample of adult Muslims
coming to Makkah for Umrah/Hajj during 1439.
Results: Overall, 997 successful interviews were completed, of them 912 (91.5%) were coming from outside Saudi
Arabia; 398 (39.9%) were coming for Umrah and 599 (60.1%) for Hajj. Participants affiliated to Arab, Southeast Asia,
South Asia, African and Western countries were 173 (17.4%), 402 (40.3%, 211 (21.2%), 111 (11.1% and 100 (10.0%)
respectively. Females (293) constituted 29.4%.
Overall, 709 (71.1%) were influenza vaccinated with high difference in coverage between Umrah and Hajj attendants
(41.8% vs 91.1%; p<0.001) respectively. Majority 803 (80.9%) were aware about the vaccine and 503 (61.7%) of the
participants have good knowledge about influenza disease and vaccine.
Multivariate logistic regression analysis revealed that, participants who are KSA domestic, coming for Hajj, coming from
Southeast Asia, Africa and Western countries, university educated and aware about influenza vaccine, were
independently associated with receiving the vaccine. Important reasons for not vaccinating were being not aware about
the vaccine (59.7%), not aware when to receive the vaccine (33.7%), the vaccine is costly (29.5%) had no access (22.2%)
and not aware that the vaccine is recommended (15.6%).
Conclusion: Despite good vaccination coverage among participants coming for Hajj, influenza vaccination was poor
among Umrah attendants. Likewise, poor vaccination among participants coming from south Asian countries. Vaccine
unawareness, cost and access were important barriers to receive the vaccine.