Meningococcal disease during the Hajj and Umrah mass gatherings

Abstract

The Hajj and Umrah religious mass gatherings hosted by the Kingdom of Saudi Arabia can facilitate the transmission of infectious diseases. The pilgrimages have been associated with a number of local and international outbreaks of meningococcal disease. These include serogroup A disease outbreaks in 1987 and throughout the 1990s and two international serogroup W135 outbreaks in 2000 and 2001. The implementation of strict preventative measures including mandatory quadrivalent meningococcal vaccination and antibiotic chemoprophylaxis for pilgrims from the African meningitis belt has prevented pilgrimage-associated meningococcal outbreaks since 2001. However, the fluid epidemiology of the disease and the possibility of outbreaks caused by serogroups not covered by the vaccine or emerging hyper-virulent strains, mean that the disease remains a serious public health threat during these events. Continuous surveillance of carriage state and the epidemiology of the disease in the Kingdom and globally and the introduction of preventative measures that provide broad and long-lasting immunity and impact carriage are warranted.

Acquisition of respiratory viruses and presence of respiratory symptoms in French pilgrims during the 2016 Hajj: A prospective cohort study

“…Hajj pilgrimage has long been associated with enhanced transmission of infectious disease agents. Epidemics of cholera [1] and bacterial meningitis [2,3] are emblematic examples of the potential for international spread of life-threatening infections at the Hajj, given its international component with pilgrims originating from up to 180 countries and gathering in Mecca before returning to their home country [4]. More recently, respiratory tract infections at the Hajj have attracted the attention of the medical community because of the frequency of respiratory symptoms among pilgrims consulting at primary health care facilities or hospitalized in Saudi Arabia [5].…”

What is the experience from previous mass gathering events? Lessons for Zika virus and the Olympics 2016

“…21 In 2000 and 2001, 338 and 316 cases of laboratoryverified Neisseria meningitidis were reported; this fell dramatically to 2-4 cases per year (2013-2015) following the introduction of mandatory immunization with the quadrivalent vaccine. 22 The quadrivalent ACWY polysaccharide meningococcal vaccine has been a visa requirement for Hajj and Umrah since 2002. At the same time the Saudi authorities introduced a vaccination programme for children and adults living in Mecca and Medina, healthcare workers, and government personnel serving the pilgrims.…”

Proportion of adult community-acquired pneumonia cases attributable to Streptococcus pneumoniae among Hajj pilgrims in 2016

“…The Hajj religious mass gathering hosted by the Kingdom of Saudi Arabia (KSA) is attended by millions of Muslims annually from all over the globe (Yezli et al, 2017). The event can facilitate the acquisition and transmission of infectious agents, including those responsible for respiratory tract infection, and has been linked to both local and international outbreaks of diseases (Ahmed et al, 2006;Memish et al, 2015a,b;Yezli et al, 2016a). Examples include meningococcal disease and influenza (Salmon-Rousseau et al, 2016;Yezli et al, 2016a).…”