Determinants of case fatality rates of meningococcal disease during outbreaks in Makkah, Saudi Arabia, 1987–97

Bushra, H. E. El; Hassan, Nazia; Al-Hamdan, Nasser; Al-Jeffri, Mohamed; Turkistani, Abdulhafiz M.; Aljumaily, Aosama; Ali, Musab; Rahama, A. M.

doi:10.1017/s0950268800004805

Cited by 16 publications

(12 citation statements)

References 11 publications

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“…26 In 1997 during the month of Ramadan in the Umrah season, an increase in the number of cases of serogroup A disease was noted with over 70% of the cases being religious visitors. 27,28 In response, ciprofloxacin chemoprophylaxis was given to all household contacts of a confirmed or suspected case and a vaccination programme with the bivalent A/C vaccine was initiated. In addition the monovalent A vaccine was temporarily incorporated into the routine Saudi childhood vaccination programme for children aged 3 months to 2 years.…”

Section: Past Strategiesmentioning

confidence: 99%

Prevention of meningococcal disease during the Hajj and Umrah mass gatherings: past and current measures and future prospects

Yezli

Saeed

Assiri

et al. 2016

International Journal of Infectious Diseases

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The Kingdom of Saudi Arabia (KSA) has a long history of instituting preventative measures against meningococcal disease (MD). KSA is at risk of outbreaks of MD due to its geographic location, demography, and especially because it hosts the annual Hajj and Umrah mass gatherings. Preventative measures for Hajj and Umrah include vaccination, targeted chemoprophylaxis, health awareness and educational campaigns, as well as an active disease surveillance and response system. Preventative measures have been introduced and updated in accordance with changes in the epidemiology of MD and available preventative tools. The mandatory meningococcal vaccination policy for pilgrims has possibly been the major factor in preventing outbreaks during the pilgrimages. The policy of chemoprophylaxis for all pilgrims arriving from the African meningitis belt has also probably been important in reducing the carriage and transmission of Neisseria meningitidis in KSA and beyond. The preventative measures for Hajj and Umrah are likely to continue to focus on vaccination, but to favour the conjugate vaccine for its extra benefits over the polysaccharide vaccines. Additionally, the surveillance system will continue to be strengthened to ensure early detection and response to cases and outbreaks; ongoing disease awareness campaigns for pilgrims will continue, as will chemoprophylaxis for target groups. Local and worldwide surveillance of the disease and drug-resistant N. meningitidis are crucial in informing future recommendations for vaccination, chemoprophylaxis, and treatment. Preventative measures should be reviewed regularly and updated accordingly, and compliance with these measures should be monitored and enhanced to prevent MD during Hajj and Umrah, as well as local and international outbreaks.

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Section: Past Strategiesmentioning

confidence: 99%

Prevention of meningococcal disease during the Hajj and Umrah mass gatherings: past and current measures and future prospects

Yezli

Saeed

Assiri

et al. 2016

International Journal of Infectious Diseases

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“…Education campaigns were introduced and made for successful control of serogroup A meningococcal disease. Review of all cases of meningococcal disease at the hospitals in Mecca during the period 1988-97 revealed that 431 (89.2%) of 483 cases were due to strains of serogroup A, 31 (6.4%) to serogroup W135, 16 (3.3%) to serogroup C, and 5 (1%) to serogroup B [35]. In February 1999, because there was no evidence of ongoing epidemic meningococcal disease in the Kingdom of Saudi Arabia, the US Centers for Disease Control and Prevention (CDC) changed its recommendation and lifted the vaccination requirements for people traveling to Saudi Arabia [36].…”

Section: Risk For Travelersmentioning

confidence: 99%

“…Despite all the advances in the therapy, the CFR still remains unacceptably high (5%-10%). Recently published data on the CFR of meningococcal disease during outbreaks in Mecca in 1987-97 shows a higher rate, 16.7% [35]. Chemoprophylaxis may prevent secondary cases (among contacts of cases), but they comprise only 1%-2% of all meningococcal disease; hence, chemoprophylaxis is not considered an ideal method to control endemic and epidemic meningococcal disease.…”

Section: Preventionmentioning

confidence: 99%

Meningococcal Disease and Travel

Memish

2002

Clinical Infectious Diseases

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Invasive meningococcal disease, in both endemic and epidemic forms, is the cause of significant morbidity and mortality worldwide. Despite all advances in therapy, the fatality rate of meningococcal meningitis remains unacceptably high, between 5% and 10%, and a similar proportion suffers long-term neurological sequalae. Prevention of this rapidly fatal disease is of paramount importance. The use of the available internationally licensed meningococcal vaccines would be indicated for individuals with medical conditions that increase the risk of the disease and for travelers to high-risk countries. In the last 2 years, there has been a shift in the epidemic pattern of meningococcal disease during the Hajj (pilgrimage) season, with predominance of Neisseria meningitidis serogroup W135. Recent changes have been made in the policy issued by the Saudi Ministry of Health (Riyadh, Saudi Arabia), which requires visitors from all over the world arriving for purposes of umra and Hajj to show evidence of vaccination against meningitis with the quadrivalent meningococcal vaccine.

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“…5 Hajj and Umrah have been associated with a number of local and international meningococcal disease outbreaks, including a large serogroup A outbreak in 1987 and major serogroup W135 outbreaks in 2000 and 2001. [6][7][8][9] Returning international pilgrims carrying N. meningitidis were the vehicle for the exportation of the disease outside KSA and also the introduction of new serogroups into other regions of the world, affecting the global epidemiology of the disease. 3,10,11 A review of the literature on N. meningitidis carriage among Hajj and Umrah pilgrims and their household contacts was performed.…”

Section: Introductionmentioning

confidence: 99%

Carriage of Neisseria meningitidis in the Hajj and Umrah mass gatherings

Yezli

Wilder‐Smith

Saeed

2016

International Journal of Infectious Diseases

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Meningococcal disease is a serious public health threat, especially during mass gatherings such as Hajj and Umrah which provide optimal conditions for disease transmission. The disease is caused by Neisseria meningitidis and transmitted mainly via asymptomatic carriers. A review of the literature on asymptomatic N. meningitidis carriage among Hajj and Umrah pilgrims and their household contacts was performed. Carriage studies reported carriage rates to be higher in Hajj pilgrims compared to Umrah pilgrims and that these events promote acquisition of carriage among pilgrims. With some outliers, most studies found carriage rates among pilgrims to be comparable to those in populations under non-epidemic settings. However, these results should be interpreted with caution, taking into account the limitations within the studies identified. A wide variety of N. meningitidis serogroups appear to be circulating among Hajj and Umrah pilgrims, with serogroups W135 and B being most prominent. Current Hajj and Umrah meningococcal disease preventative measures do not necessarily prevent carriage and transmission, which may result in local and international outbreaks among susceptible populations. Monitoring carriage states of visitors and local inhabitants in the Kingdom of Saudi Arabia, as well as the implementation of preventive measures that impact carriage, are warranted to reduce the risk of Hajj and Umrah-related meningococcal disease outbreaks.

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Determinants of case fatality rates of meningococcal disease during outbreaks in Makkah, Saudi Arabia, 1987–97

Cited by 16 publications

References 11 publications

Prevention of meningococcal disease during the Hajj and Umrah mass gatherings: past and current measures and future prospects

Prevention of meningococcal disease during the Hajj and Umrah mass gatherings: past and current measures and future prospects

Meningococcal Disease and Travel

Carriage of Neisseria meningitidis in the Hajj and Umrah mass gatherings

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