Public Response, Anxiety and Behaviour during the First Wave of COVID-19 Pandemic in Saudi Arabia.

This study aims to investigate public response attitude, anxiety, practices and trust in the authorities' mitigation plan during the first wave of COVID-19 pandemic. A national cross sectional phone survey was conducted among Saudi residents aged 16 years and above. A total of 90,421 (45.2%) individuals participated in the study. Of those, the overall rate of COVID-19 correct knowledge was 82% (mean: 9.84); social media was the most reported source of knowledge. Younger age, low levels of education and foreign residents were associated with poor knowledge. Overall, 49.5% scored 5 or more on the GAD-7 test, indicating anxiety symptoms, 19.2% of them scored 10 and above, suggesting moderate to severe anxiety. Majority of participants (>78%) trusted and supported the interventions implemented by the government to control COVID-19. Social distancing practices among participants was as following, 72.5% stayed at home and avoid going out for nonessential business and 49.5% avoided attending social events and family gatherings. Trust in authorities, being anxious, worry and levels of knowledge about the disease, were the most common factors affecting adoption of the recommended practices. Continuous evaluation of public response about COVID-19, and the effectiveness of protective measures is essential to better inform policy-makers and identify ways of encouraging behaviour change among public during pandemic.

Tracking Australian Hajj Pilgrims' Health Behavior before, during and after Hajj, and the Effective Use of Preventive Measures in Reducing Hajj-Related Illness: A Cohort Study.

This study assessed Australian Hajj pilgrims' knowledge, attitude and practices throughout their Hajj journey to understand their health behaviors, use of preventative measures and development of illness symptoms. A prospective cohort study with data collection at three phases (before, during and after Hajj) was conducted among Australian pilgrims between August and December 2015. Baseline data were collected from 421 pilgrims before Hajj, with 391 providing follow-up data during Hajj and 300 after their home return. Most participants (78% [329/421]) received one or more recommended vaccines; travel agents' advice was the main factor affecting vaccination uptake. Most participants (69% [270/391]) practiced hand hygiene with soap and sanitizers frequently, followed by disposable handkerchief use (36% [139/391]) and washing hands with water only (28% [111/391]). During Hajj 74% (288/391) of participants reported one or more illness symptoms, 86% (248/288) of these symptoms were respiratory. Cough was less often reported among pilgrims who received vaccinations, cleaned their hands with soap or alcoholic hand rubs, while a runny nose was less common among those who frequently washed their hands with plain water but was more common among those who used facemasks. This study reveals that most Australian Hajj pilgrims complied with key preventative measures, and that tour group operators' advice played an important role in compliance. Pilgrims who were vaccinated and practiced hand hygiene were less likely to report infection symptoms.

Acute respiratory tract infection symptoms and the uptake of dual influenza and pneumococcal vaccines among Hajj pilgrims.

BACKGROUND: Hajj pilgrims are encouraged to take influenza and pneumococcal vaccines prior to their travel to safeguard against acute respiratory tract infections (ARTIs). It is unclear whether dual immunisation with influenza and pneumococcal vaccines have had any impact on ARTI symptoms. To this end, we have examined the data of the last several years to assess whether combined influenza and pneumococcal vaccination has affected the rate of ARTI symptoms among Hajj pilgrims. MATERIALS AND METHODS: Hajj pilgrims from United Kingdom, Australia, Saudi Arabia and Qatar who attended the congregation between 2005 and 2015 were included in this study. Data from surveillance studies or clinical trials involving Hajj pilgrims were used. In this analysis we have made use of the raw data to construct a trend line graph with the prevalence of combined cough and fever (as a proxy for ARTI) against the uptake of combined influenza and pneumococcal vaccines, and to estimate the relative risk (RR) of ARTI with 95% confidence interval (95% CI). RESULTS: Data of a pooled sample of 9350 pilgrims, aged 0.5-90 years with a male to female ratio of 1.1, were analysed. Although vaccination uptake did not rise significantly over the years, there was also no observed meaningful benefit of combined vaccination (RR = 1.1; 95% CI 0.8-1.4), the rates of ARTI symptoms demonstrated a decline over the last several years. The findings of this analysis highlight that the prevalence of 'cough and fever' among Hajj pilgrims is on decline but the uptake of combined influenza and pneumococcal vaccines remains unchanged over years, and the decline can not be attributed to dual influenza and pneumococcal vaccination. CONCLUSIONS: Acute respiratory tract infections among Hajj pilgrims are decreasing, it is unclear if the reduction is due to vaccine uptake, but the data and analysis have some limitations.

Barriers of vaccinations against serious bacterial infections among Australian Hajj pilgrims.

OBJECTIVES: Vaccination against serious bacterial infections is recommended for Hajj pilgrims. Although the uptake of mandatory vaccines among Hajj pilgrims is acceptable, the uptake of other recommended vaccines remains suboptimal. In this study, we have explored the barriers to vaccination against serious bacterial infections among Australian Hajj pilgrims. METHODS: Travellers aged 18 years and older planning to attend Hajj in the years 2014 and 2015 were surveyed at the immunization clinic of the Children's Hospital at Westmead, Sydney, Australia. A questionnaire-based survey was conducted to explore pilgrims' vaccination histories for their previous visits to Mecca, the reasons for non-receipt of vaccination, and to assess knowledge about the transmission of infections. RESULTS: A total of 300 participants aged 18-76 (median 41) years completed the survey. Most (233 [77.7%]) were born outside Australia. Overall, 113 (37.7%) had performed pilgrimage in the past; 19 (16.8%) of them reported receiving pneumococcal vaccine and 16 (14.1%) diphtheria, tetanus and pertussis (DTP) vaccine. Lack of awareness about the availability of the vaccines was the main reason for non-receipt of pneumococcal and DTP vaccines (respectively 41.1% and 44.7%). Most pilgrims (266 [88.7%]) believed that travel vaccines are necessary before embarking on a journey; however, some expressed concerns about adverse reactions (156 [52.0%]), cost (114 [38.0%]), and permissibility of the vaccine according to their religion (6 [2.0%]). Respectively, 187 (62.3%), 145 (48.3%) and 86 (28.7%) respondents did not correctly know how meningococcal and pneumococcal diseases and pertussis transmit. Nevertheless, most (256 [85.3%]) indicated that they trust their family doctor for medical information and most (203 [67.7%]) preferred to receive the medical information in English. CONCLUSION: The uptake of recommended vaccines against serious bacterial infections among Australian Hajj pilgrims is low. Lack of awareness about the availability of vaccines, misperceptions surrounding the safety of vaccines and high cost are key barriers of uptake.