Ridda Iman, King Catherine, Rashid Harunor
National Centre for Immunisation Research and Surveillance of Infectious Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Locked Bag 4001, Westmead NSW 2145, Australia.
Infect Disord Drug Targets. 2014;14(3):177-84. doi: 10.2174/1871526514666141014150323.
Hajj attendance increases the risk of respiratory infections including pneumonia. Streptococcus pneumoniae is a frequently identified pathogen, found in about 10% of respiratory tract samples of symptomatic Hajj pilgrims; and at least 20% of these isolates are penicillin resistant. However, the burden of pneumococcal disease at Hajj is not precisely defined at serotypic level, and it is postulated that due to intense mixing of pilgrims the distribution of pneumococcal serotypes at Hajj could be different from pilgrims' country of origin or of Saudi Arabia. In Saudi Arabia, the most prevalent pneumococcal serotypes are 23F, 6B, 19F, 18C, 4, 14, and 19A, and 90% of the serotypes are covered by 13-valent pneumococcal conjugate vaccine (PCV-13) as well as 23-valent pneumococcal polysaccharide vaccine (PPV-23). However, due to lack of Hajj-specific data, the Saudi Arabian Ministry of Health has not yet recommended pneumococcal vaccine for pilgrims, and the immunisation recommendation and uptake vary greatly across countries. As at least one third of Hajj pilgrims are 'at risk' of pneumococcal disease either by virtue of age or pre-existing medical conditions, consideration should be given to vaccinating high risk pilgrims against pneumococcal disease. Other preventive measures such as smoking cessation, pollution reduction and vaccinations against influenza and pertussis should also be considered. Precisely defining the epidemiology of pneumococcal disease to identify an optimum vaccination schedule for Hajj pilgrims is a current research priority.
参加朝觐会增加包括肺炎在内的呼吸道感染风险。肺炎链球菌是一种常见病原体，在有症状的朝觐朝圣者约10%的呼吸道样本中被发现；这些分离株中至少20%对青霉素耐药。然而，朝觐时肺炎球菌疾病的负担在血清型水平上尚未得到精确界定，据推测，由于朝圣者的密集混合，朝觐时肺炎球菌血清型的分布可能与朝圣者的原籍国或沙特阿拉伯不同。在沙特阿拉伯，最常见的肺炎球菌血清型是23F、6B、19F、18C、4、14和19A，90%的血清型可由13价肺炎球菌结合疫苗（PCV - 13）以及23价肺炎球菌多糖疫苗（PPV - 23）覆盖。然而，由于缺乏朝觐相关的具体数据，沙特阿拉伯卫生部尚未建议朝圣者接种肺炎球菌疫苗，而且各国的免疫建议和接种情况差异很大。由于至少三分之一的朝觐朝圣者因年龄或既有医疗状况而有患肺炎球菌疾病的“风险”，应考虑为高危朝圣者接种肺炎球菌疫苗。还应考虑其他预防措施，如戒烟、减少污染以及接种流感和百日咳疫苗。精确界定肺炎球菌疾病的流行病学情况，以确定朝觐朝圣者的最佳疫苗接种时间表是当前的研究重点。
