Respiratory symptom burden, vaccination coverage, and preventive health practices among Sudanese Hajj pilgrims who travelled by sea

Najim Z. Alshahrani^1*Mohammed Ridha Algethami¹Abdulrahman M. Albeshry¹Zuhier Awan²Wael AlZahrani³Bashaier Ahmed Fairaq⁴Harunor Rashid⁵

• ¹Department of Family and community medicine, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
• ²College of Applied Medical Sciences, University of Jeddah, Jeddah, Saudi Arabia
• ³Population Health Management, Jeddah First Health Cluster, Jeddah, Saudi Arabia
• ⁴Population Health Management, Makkah Health Cluster, Makkah, Saudi Arabia
• ⁵Children's Hospital Westmead Clinical School and Sydney Infectious Diseases Institute, University of Sydney,, Westmead NSW, Australia

Background: The risk of respiratory infections amplifies at Hajj. Pilgrims who travel by sea may face an elevated risk of such infections; however, contemporary Hajj literature offers limited data on this subgroup. This study assessed respiratory symptom burden, vaccination coverage, and preventive practices among Sudanese pilgrims who travelled to the 2025 Hajj by sea. Methods: A descriptive cross-sectional survey was conducted among Sudanese Hajj pilgrims who reached Saudi Arabia by sea. Data were collected using a structured, pilot-tested questionnaire covering demographics, medical history, preventive practices, awareness, and symptom experiences. Statistical analysis included descriptive measures, chi-square tests, correlations, and logistic regression to identify predictors of adherence to health recommendations. Results: A total of 370 pilgrims aged 25 to 87 years were recruited, comprising 114 (30.8%) men and 256 (69.2%) women. About 60.5% reported at least one health symptom, with muscle/body aches, cough and sore throat being the leading complaints. Symptom burden was significantly higher among older pilgrims, males, individuals with chronic conditions, and those with prior Hajj experience (p < 0.001 for all). Vaccine uptake was high for mandatory vaccines: meningococcal ACWY (95.1%), influenza (90.5%), and yellow fever (90.5%), but low for non-mandatory vaccines such as polio (8.6%) and hepatitis B (7.0%). A high level of confidence in the Saudi healthcare system (94%), high awareness of risks (86.0%), pre-travel preparedness (83.2%), frequent hand washing (55.9%) and confidence in prevention (89.5%) were strongly associated with adherence to recommended practices. Conclusions: These findings suggest that Sudanese pilgrims who travel by sea generally comply with mandatory preventive measures, but show lower adherence to non-mandatory ones, leaving them vulnerable to infections. Strengthening structured pre-travel health education and ensuring equitable access to vaccinations could significantly improve their health outcomes.