3 July 2019 – The Hajj is the yearly pilgrimage Muslims can make to Islam’s holiest city, Mecca in Saudi Arabia to engage in practices to deepen faith and increase a sense of unity and humility within the Muslim community. It is one of the five pillars of Islam and a meaningful and important experience.
All Muslims are expected to make this journey at least once in their lifetime given financial and physical ability, and as such, Hajj draws masses (over 2 million people) from around the world to one location. These large crowds can be favourable to disease transmission, specifically acute respiratory infections. In fact, almost 60% of Hajj pilgrims have reported illness related to respiratory complaints . How can public health assist in facilitating a healthy journey for Hajj pilgrims? In a recent commentary  from the journal Vaccine, Koul, Bali and Koul present a case for the quadrivalent Southern hemisphere influenza vaccine.
Among Hajj pilgrims, a primary cause of respiratory infection is influenza  and to protect the pilgrims, the influenza vaccine is strongly recommended . However, the international gathering draws people from a range of geographies with varying influenza circulation patterns and strains . Mismatch between the influenza strains in circulation and those included in the vaccine is always an issue that impacts vaccine effectiveness and may be of particular concern for international gatherings such as the Hajj pilgrimage that bring together people from countries with varying influenza patterns and strains .
The trivalent vaccine contains two influenza A strains and only one influenza B strain and past mismatches using the trivalent vaccine have led to significant influenza B infections . This is important as influenza B will often co-circulate with influenza A, influenza B can, in some seasons, be the dominant virus and influenza B can lead to more hospitalizations than influenza A . As Koul et al. point out, the circulation patterns of the two influenza B lineages in the home regions of Hajj pilgrims can result in the mismatch between the circulating viruses among Hajj pilgrims and those contained in the trivalent vaccine given its limitations to one influenza B lineage.
To address these issues, Koul et al. recommend the quadrivalent over the trivalent vaccine because it includes an additional influenza B strain. The authors further suggest use of the Southern hemisphere quadrivalent vaccine over the next decade given during this time, Hajj will fall between April and August for which influenza activity is higher in the Southern hemisphere as well as in tropical/subtropical areas. The authors recognize that this would require regions that follow a Northern hemisphere vaccine schedule, such as North America and Europe, procure and administer the Southern hemisphere quadrivalent vaccine for those planning to make the Hajj journey.
As with other vaccines, Koul et al. acknowledge Hajj pilgrims may face significant barriers to receiving the influenza vaccine including lack of national influenza immunization programs in the home country, poor vaccine awareness, vaccine misconceptions and financial limitations. The IFA supports vaccination across the life-course and believes the best available evidence should be considered when recommending vaccinations to determine those that offer the greatest health benefits in combination with policy-level action that addresses barriers individuals face to vaccination. https://www.sciencedirect.com/science/article/abs/pii/S1477893915002094  https://www.ncbi.nlm.nih.gov/pubmed/31104882  https://wwwnc.cdc.gov/travel/yellowbook/2018/select-destinations/saudi-arabia-hajj-umrah-pilgrimage  https://academic.oup.com/cid/article/59/11/1519/1746422
IFA Guest Blogger: Ms Morgan Dixon
A chronic lung disease diagnosis can be frightening, and the misconceptions about living with chronic lung disease can make that fear worse, particularly for older people. However, with continued research on chronic lung disease and various treatments, the fact is that people are able to manage their disease and often live normally. Though chronic lung disease does affect older people in greater proportion than it does younger people, it is possible to live a full and active life, no matter your age at diagnosis.
Let’s demystify some common misconceptions about living with chronic lung disease, and talk about how to continue your normal daily activities even with chronic lung disease symptoms.
Misconception: You cannot live a normal life after being diagnosed with chronic lung disease.
Truth: With treatment and early detection, your disease can be well managed and you can continue living a full and active life. Often, when people are diagnosed with chronic lung disease, they believe they will be relegated to inactivity in order to fend off breathlessness. Older people are often most worried, believing the diagnosis will end their freedom and independence, and ultimately shorten their life span. In reality, with proper treatment and small adjustments, most people are able to continue their regular daily activities for quite some time. This is especially true with people in the earlier stages of chronic lung disease, which is why early detection is essential. The earlier your disease is detected, the sooner you can begin treating the symptoms and slowing the disease’s progression.
Misconception: Only older people are diagnosed with chronic lung disease.
Truth: While chronic lung disease is more common in people over the age of 40, younger people in higher-risk groups can develop chronic lung disease.
Chronic lung disease has many risk factors, and those risk factors can contribute to earlier development of chronic lung disease, even in younger people. While older people may be at a higher risk of chronic lung disease diagnosis, aging does not cause chronic lung disease. Rather, it is the repeated exposure to lung irritants that typically puts older people at a higher risk of developing chronic lung disease.
Misconception: Chronic lung disease only occurs in smokers.
Truth: While smoking dramatically increases the risk of developing chronic lung disease, nonsmokers can also be diagnosed.
The majority of people diagnosed with chronic lung disease are, or have been, smokers. However, it is not the only cause. Repeated exposure to lung irritants like air pollution, toxic fumes or toxic dust at work or at home can cause chronic lung disease, too. Genetic conditions like cystic fibrosis, lung cancer and pulmonary hypertension are also a cause. Since smoking is the most common cause, particularly for older people, it is important not to smoke, or to quit smoking as soon as possible to preserve your lung function and health. Quitting smoking does not eliminate your chance of developing chronic lung disease, nor will it cure chronic lung disease. Once smoking damages your lungs, that damage cannot be reversed. However, quitting helps minimize further damage and allows treatments to work more effectively. Be aware that secondhand smoke is a significant lung irritant as well, so avoiding all tobacco smoke is critical to keeping your lungs as healthy as possible.
Misconception: Chronic lung disease is untreatable.
Truth: While there is no cure for most chronic lung diseases, all types of chronic lung disease can be treated to help ease symptoms and make breathing easier.
While the majority of chronic lung diseases cannot be cured, all types can be treated, regardless of age or the stage of the disease. If you are diagnosed with chronic lung disease, talk to your doctor about the best course of treatment for you. In most cases, treatment will include some of the following:
Misconception: Older people always experience more severe chronic lung disease symptoms.
Truth: While symptoms usually progress with age, some studies show that older adults show less limitation than younger people with similar lung function impairment.
Being diagnosed with chronic lung disease at an older age does not automatically mean that symptoms will be more pronounced than those of a younger patient. In fact, one study indicates that older patients actually perceive less of an impact on their daily activities than younger patients. This study found that older adult study participants were less likely to report that their chronic lung disease significantly impacted their activities, and that they were less likely to describe their health status as fair or poor when compared with younger study participants. Moreover, older adult participants with chronic lung disease had better lung function when compared with younger adult participants, with higher test results for ventilator capacity and exercise capacity. These results may be due in part to different perceptions about limitations, more time to adapt to chronic lung disease over time and more positive attitudes about quality of life and overall health. Still, older adults consistently reported less impairment and limitation. So, while older people may recover more slowly from illness and may be more likely to develop a chronic lung disease, they may still experience less impact on their lives overall than a younger person. As such, if you are diagnosed when you are older, do not lose hope. You might be surprised by your resilience.
Misconception: Treating chronic lung disease requires carrying around unwieldy oxygen tanks for the rest of your life.
Truth: While oxygen therapy is one common method of treating lung disease, it can be delivered in a number of different ways.
Oxygen is often prescribed to help chronic lung disease patients breathe better and get necessary oxygen. However, while traditional compressed oxygen tanks are still used, they are not the only oxygen delivery system available. Compressed oxygen, liquid oxygen and oxygen concentrators can all help you treat your chronic lung disease symptoms, including shortness of breath, chronic cough, wheezing and chest tightness. Portable oxygen concentrators are particularly compact and lightweight, making them convenient and easy to carry. Because portable oxygen concentrators require no refills and only need the power to provide an endless supply of oxygen, they are an ideal choice for people who are worried that oxygen therapy might get in the way of their daily activities. In fact, one of the greatest portable oxygen concentrator benefits is that it makes many activities easier. Additionally, oxygen therapy may not be forever for you. It is temporary for some people, providing necessary relief until symptoms become manageable again.
These misconceptions could keep you from pursuing life-changing treatments—do not let them. A chronic lung disease diagnosis does not have to mean the end of a normal life. Find out more about how to maintain your quality of life while living with your chronic lung disease by talking to your doctor and contacting Inogen for more information about oxygen therapy supplies.
Ageing can pose challenges for any population, but the LGBTQI community faces a specific set of obstacles that make the experience of ageing more difficult than it is for others. Research has proven that older LGBTQI individuals face elevated rates of poverty, social isolation, depression and disability to name but a few.
While many adults outside of the LGBTQI community face these barriers, it is important to understand that for the older LGBTQI people these barriers are not mutually exclusive, rather they represent the cumulative impact of a life of discrimination and stigma. Legal, structural and systemic discrimination left many LGBTQI individuals with an inability to find consistent work and housing, leading to financial instability and economic insecurity that has followed them into later life. Lack of legal recognition has prevented many LGBTQI individuals from being able to depend on social supports like spousal benefits after a partner has passed or children who often take on roles of caregiving in later life.
With social support often undermined by systemic discrimination, the LGBTQI population was disproportionately dependent on ‘chosen family’, their partners, friends and community. The AIDS epidemic however, which had a devastating impact on the LGBTQI community, effectively decimated these chosen support systems for many older LGBTQI individuals leaving them not only alone as they age but carrying the sustained trauma of having had to bury a generation of their loved ones.
Despite this seemingly bleak summation, the LGBTQI community continues to strive for ways to tackle these barriers, a life time of activism has allowed for older LGBTQI individuals to create meaningful and purposeful solutions, such as the creation of LGBTQI friendly residences and diverse mentorship programs connecting younger generations with LGBT elders. However, the burden of addressing these complex barriers cannot be the sole responsibility of the LGBTQI community.
The IFA believes that all individuals irrespective of race, age, culture, ability, ethnicity or nationality, gender identity and expression, sexual orientation, religious affiliation, and socioeconomic status should be enabled and empowered to age equally and with pride. As such, the IFA is committed to supporting individuals and organizations who advocate and drive policy, project, and program development which enables healthy and active ageing across the life-course for older LGBTQI individuals.
IFA, in partnership with Egale Canada and SAGE, continue to call on governments, industry, and organizations to protect the rights of older LGBTQI people through the implementation of appropriate and effective policies, programs and practices. Show your support by signing the pledge today, click here to learn more.