The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia.
German National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany.
Travel Med Infect Dis. 2019 May-Jun;29:8-15. doi: 10.1016/j.tmaid.2018.08.005. Epub 2018 Aug 23.
Pneumococcal disease is an important cause of morbidity and mortality worldwide with a significant financial burden. Pneumococcal vaccines are available and recommended in many countries for at-risk populations including young children, the elderly and those with underlying medical conditions. The Hajj and Umrah mass gatherings attract millions of Muslim pilgrims to the Kingdom of Saudi Arabia each year. These events increase the risk of pneumococcal disease especially among the large number of elderly pilgrims with co-morbidities. However, there is no unified official policy for vaccination against pneumococcal disease for pilgrims attending Hajj and Umrah, largely due to the lack of a strong evidence-base in the context of these events. Here we review knowledge gaps regarding pneumococcal disease during Hajj and Umrah and highlight important research agendas to strengthen the evidence-base to inform pneumococcal vaccination policy for pilgrims. Available data indicates that the true clinical and financial burdens of pneumococcal disease at Hajj and Umrah are still not determined. There is limited information on antimicrobial resistance among S. pneumoniae isolated from diseased pilgrims and no information on the serotypes involved. Finally, the efficacy and effectiveness of the current vaccines in the context of Hajj and Umrah have not been studied. Research agendas proposed in this article would help fill knowledge gaps regarding pneumococcal disease at Hajj and Umrah and would constitute a strong basis for an informed and potentially unified policy regarding pneumococcal vaccination for these events.
肺炎球菌疾病是全球发病率和死亡率的重要原因，同时也带来了巨大的财政负担。许多国家都为包括儿童、老年人和患有基础疾病的人群在内的高危人群推荐使用肺炎球菌疫苗。朝觐和副朝是全球数百万穆斯林的盛大集会，每年都吸引着大量的朝圣者前往沙特阿拉伯。这些活动增加了罹患肺炎球菌疾病的风险，尤其是在大量患有合并症的老年朝圣者中。然而，由于在这些活动背景下缺乏强有力的证据基础，因此并没有针对参加朝觐和副朝的朝圣者接种肺炎球菌疫苗的统一官方政策。在这里，我们回顾了朝觐和副朝期间肺炎球菌疾病的知识空白，并强调了重要的研究议程，以加强证据基础，为朝圣者的肺炎球菌疫苗接种政策提供信息。现有数据表明，朝觐和副朝期间肺炎球菌疾病的真实临床和财政负担仍未确定。关于从患病朝圣者中分离出的肺炎链球菌的抗生素耐药性的信息有限，也没有关于涉及的血清型的信息。最后，目前在朝觐和副朝背景下的疫苗的疗效和效果尚未研究。本文提出的研究议程将有助于填补朝觐和副朝期间肺炎球菌疾病的知识空白，并为这些活动提供知情且可能统一的肺炎球菌疫苗接种政策提供坚实的基础。
