In our experience among French pilgrims, we also observed that self-reported dTP vaccination (19%–23% for tetanus, 15%–16% for diphtheria and poliomyelitis) was significantly lower than those reported from studies of French population cohorts and French traveler cohorts.2,3

French citizenship, higher level of education, better French fluency, and no previous travel to country of origin were the strongest and most significant determinants of dTP vaccination status among pilgrims.3 Also and much more worrying, we observed low vaccination rates of 11% against pertussis,2 5% against pneumococcal Alectinib order infections in those with risk factors for pneumococcal infection (unpublished data), and 27%–34% against influenza,2,4 although these vaccinations are recommended to Hajj pilgrims regarding the burden of these vaccine-preventable diseases

in Hajj-associated diseases.5,6 French Hajj pilgrims’ low socioeconomic and social status, in addition to their unifying linguistic, cultural, and religious identity, defines them as a particularly disadvantageous group in France, and in other migrant-receiving countries, they would qualify as a minority group. To face this situation, we decided in our Travel Clinic in Marseille to offer dTP and influenza vaccination for free to pilgrims at the moment they consult to get their selleck kinase inhibitor mandatory vaccination against meningococcal infections.7 Contrary to our colleagues from the Netherlands, from 2007 to 2009, 100% of our cohorts accepted the proposed update of dTP vaccination (unpublished data), and 97%–100% accepted the seasonal flu vaccination Phosphoprotein phosphatase when well informed of their benefit.8,9 Patients requiring pneumococcal

vaccination were given a prescription, as the vaccine was not available for free at our consultation, resulting in a lower 41% acceptance rate (unpublished data). We also observed that French pilgrims’ knowledge about face-mask, hand hygiene, and disposable handkerchief use as preventive measures against respiratory tract infection was very low. However, when informed about the effectiveness of those prevention measures, most pilgrims were willing to apply them during the Hajj.10 The demonstration of high acceptability of vaccination and simple physical use to prevent acute respiratory infections encourages the education of pilgrims during the pretravel encounter. Although updating dTP coverage as well as influenza vaccination will likely have an individual and public health benefit, whether these last physical measures will be effective in preventing communicable diseases efficiently in the very specific context of a mass-gathering, such as the Hajj, remains to be evaluated.9 Philippe Gautret 1 , Philippe Parola 1 , and Philippe Brouqui 1 “
“Background. We previously identified foreign travel as a risk factor for acquiring infections due to CTX-M (active on cefotaxime first isolated in Munich) producing Escherichia coli.