KUALA LUMPUR, August 3 — Health experts have urged Muslims who plan to go on their pilgrimage to Mecca next year to take the pneumococcal vaccine to avoid falling seriously ill, as pneumonia is a common cause of death in individuals all over the world.1,2
Muslims planning to undertake the annual Hajj or year-round long Umrah in Saudi Arabia in 2022, when more countries may reopen during the Covid-19 pandemic, are recommended to get both the pneumococcal and Covid-19 shots.2,4,5
A study published in the year 1995, Annals of Saudi Medicine journal, found that respiratory diseases affected 74 per cent of all Hajj pilgrims, with pneumonia (45.8 per cent) being the most common disease among pilgrims6.
Other surveys published between 2006-2009 — cited in the International Journal of Infectious Diseases — showed that overcrowded conditions during the annual pilgrimage make respiratory infections the leading cause of morbidity in pilgrims.7
Prof Dr Abdul Razak Mutttalif, senior consultant chest physician and professor (Head of Medicine) at Malaysian Allied Health Sciences Academy (MAHSA) University, said lung diseases and pneumonia are among the first or second causes of hospital admission and mortality during the Hajj.8,21
He said this is due to pneumonia, either from virus or bacteria, with pneumococcal pneumonia noted to be among the common bacterial causes of pneumonia in numerous studies8.
People with the pneumococcal disease can spread the bacteria to others when they cough or sneeze. Pneumococcus can cause infections in many parts of the body, including the lungs (pneumonia), blood (bacteremia), and brain and spinal cord tissue (meningitis), according to the US Centers for Disease Control and Prevention..9
“The risk of pneumonia is high among the elderly. In addition, those with comorbidities like hypertension, diabetes, asthma and chronic obstructive pulmonary disease (COPD) have higher risks of pneumonia and [pneumonia-related] mortality2.
“Hajj pilgrims usually make up of seniors with numerous comorbidities3. Therefore, it is advised that vaccination be taken at least two weeks or a month before travel to the holy land1,” Dr Abdul Razak told CodeBlue when contacted recently.
There are two types of pneumococcal vaccination, namely the polysaccharide vaccine and conjugate vaccine. Each vaccine is able to protect against certain strains of pneumococcal bacteria11, said Dr Abdul Razak.
“It is advised that both vaccines are given. If the conjugate vaccine is given as a first dose, there should be a minimum six-month interval before the polysaccharide vaccine is administered.9 However, if the polysaccharide vaccine is given first, then the conjugate vaccine dose should be given after one year.”10,11
Dr Abdul Razak said the conjugate vaccine18 has a few advantages, namely that the vaccine generates good immune memory, gives prolonged protection, reduces carriage of pneumococcal bacteria in the nose and has herd effect (or herd immunity).11
Dr Razul Md Nazri Md Kassim, consultant chest physician and pulmonologist at Kedah Medical Centre in Alor Setar, Kedah, said pneumococcal vaccination will allow Muslim pilgrims to have a more productive Hajj or Umrah as vaccinations have proven to reduce the risk of pneumococcal infections and their complications,8 which include respiratory failure.12
“One study showed that vaccines were able to reduce the incidence of radiologically-confirmed pneumonia by 54.3 per cent13,” he said. “It may also reduce the risk of severe pneumococcal infection by up to 10 years.”14
Dr Razul particularly recommends Hajj and Umrah pilgrims with chronic kidney and lung disease to opt for pneumococcal vaccination, assuring them that the side effects are minimal19,19a,20.
Given the current Covid-19 inoculation drive, both Dr Razul and Dr Abdul Razak said Malaysians could get vaccinated for pneumococcal and coronavirus diseases simultaneously. However, it is advised that there be a gap of two weeks to avoid any overlapping side effects.15
Dr Abdul Razak also said public awareness on pneumococcal vaccination remains low among Malaysian pilgrims, noting it is important that all parties involved in the Hajj mission educate and advise pilgrims on the need for vaccination.16
Pilgrim fund Lembaga Tabung Haji, which manages Hajj operations involving Malaysian pilgrims, conducts regular lectures on health, including pneumococcal vaccination, with pilgrims as part of preparations for the Hajj.17
Dr Abdul Razak said advice by medical doctors on pneumococcal vaccination – including how to prevent disease from pneumococcal infection by getting inoculated – should be given in these lectures.
“It is really difficult to prevent transmission of lung infections at the holy land as the pilgrims move very close, stay close in hotels and pray in a closed environment.21,22 Thus, it is better to prevent the infection via vaccination.”20
Disclaimer: The comments stated herein are based on the experts’ own views, thoughts, and opinions.
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12. Center of Infectious Disease, Clinical Features – Pneumococcal. Last accessed on 11 July 2021.
13. Session Ii. Immunity To Encapsulated Bacteria Prevention Of Pneumococcal Infection By Immunization With Capsular Polysaccharides Of Streptococcus Pneumoniae: Current Status Of Polyvalent Vaccines The Journal Of Infectious Diseases. Vol. 136, Supplement. August 1977.
14. Prevention of Pneumococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Last accessed on 11 July 2021
15. Vaccination: What You Need to Know. Last accessed on 11 July 2021.
16. Uptake of Recommended Vaccines and Its Associated Factors Among Malaysian Pilgrims During Hajj and Umrah 2018. Front. Public Health 7:268. doi: 10.3389/ fpubh.2019.00268.
17. Standard Operational Procedure in Health Quality for Hajj Pilgrims by Lembaga Tabung Haji, Pages 44-54 Received: 03 Jun, 2020 Revised: 07 Jul, 2020 Published Online: 13 Sep, 2020.
18. About conjugate vaccines – WHO Vaccine Safety Basics. Last accessed on 18 July 2021.
19. Vaccination of Adults with Renal Disease | Center of Disease Control and Prevention. Last accessed on 18 July 2021.
19a. Chronic Kidney Disease and Pneumococcal Disease: Do You Know the Facts? | National Kidney Foundation. Last accessed on 18 July 2021.
20. Vaccination of Adults with Lung Disease Including Asthma | Centers for Disease Control and Prevention. Last accessed on 18 July 2021.
21. Saudi Arabia: Hajj/Umrah Pilgrimage – Chapter 10 – 2020 Yellow Book | Travelers’ Health | Centers for Disease Control and Prevention. Last accessed on 18 July 2021.
22. The impact of crowd control measures on the occurrence of stampedes during Mass Gatherings: The Hajj experience, Yasser A et al, Travel Medicine and Infectious Disease (2017) 15, 67e70.