Meningococcal Disease and Immunization Activities in Hajj and Umrah Pilgrimage: a review

Abstract

Invasive meningococcal disease (IMD) outbreaks associated with Hajj and Umrah pilgrimage events in the Kingdom of Saudi Arabia (KSA) are well recognized. Past outbreaks have been associated with substantial intercontinental spread of specific Neisseria meningitidis serogroups. The emergence of meningococcal serogroup W (MenW) was a global concern following the 2000/2001 Hajj outbreaks. Broader compulsory meningococcal serogroups A, C, W and Y (MenACWY) immunization S. Badur (&) EM, Vaccines Scientific Affairs and Public Health, GSK, Bu ¨yu ¨kdere Caddesi No:173,

Immunogenicity and safety of a quadrivalent meningococcal conjugate vaccine (MenACYW-TT) administered as a booster to adults aged ≥59 years: A phase III randomized study

“… 3–9 Vaccination against N. meningitidis with a quadrivalent (serogroup A, C, W, and Y) conjugate vaccine (MCV4) is recommended for children and adolescents in many countries, as well as for those at increased risk of the disease due to occupation or travel to endemic areas. 10–12 In particular, the Hajj pilgrimage to Mecca has been associated with outbreaks of meningococcal disease among travelers who have returned to their home countries 13 , 14 and therefore the Kingdom of Saudi Arabia requires visitors going on Hajj or Umrah to submit a valid vaccination certificate indicating receipt of either a quadrivalent polysaccharide meningococcal vaccine within the last 3 years, or a quadrivalent conjugate vaccine within the last 5 years. 10 , 14 , 15 This requirement stems from evidence demonstrating that protection following MCV4 vaccination may wane 3–5 years after primary vaccination.…”

Meningococcal disease within the Gulf Cooperation Council Countries

“…The high proportion of non-citizen workers in GCC Countries, and the often-substantial proportion of IMD cases involving non-citizen residents is such that a top-level appraisal of local IMD epidemiology in worker origin countries is relevant (in particular as a high proportion of pilgrims attending Hajj/Umrah events within SA also originate from these countries). 56 Although surveillance is often inconsistent, low-level endemic IMD exists in most Asian worker origin countries (i.e., India, Pakistan, Bangladesh, Nepal, Sri Lanka and the Philippines) and in other Arab countries (e.g., Egypt, Syria and Yemen) and N. meningitidis is an important cause of bacterial meningitis in all. 56 With the exception of Egypt (where infant polysaccharide MenA-C vaccination has been available since 1992), most countries have no formal meningococcal immunization policy.…”

“… 56 Although surveillance is often inconsistent, low-level endemic IMD exists in most Asian worker origin countries (i.e., India, Pakistan, Bangladesh, Nepal, Sri Lanka and the Philippines) and in other Arab countries (e.g., Egypt, Syria and Yemen) and N. meningitidis is an important cause of bacterial meningitis in all. 56 With the exception of Egypt (where infant polysaccharide MenA-C vaccination has been available since 1992), most countries have no formal meningococcal immunization policy. In India, although surveillance data is limited, and IMD under-reported, historic outbreaks associated with MenA are well-reported, 57 , 58 and a low level of endemic disease due to other serogroups (MenB, C, Y and W) is also observed.…”

“… 59 Similar observations can be made for Pakistan and Bangladesh, where an increasing prevalence of disease due to MenB has been reported. 42 , 56 In Nepal, most reported cases are in infants, chiefly due to MenA. 42 In the Philippines, around 100 IMD cases are typically reported annually, with 50% occurring in those <5 years of age; most cases are MenA, although MenB is also observed.…”

“… 72 For Hajj between 1.5 and 2.5 million pilgrims attend annually, with 1.86 million external pilgrims visiting in 2019 (Hajj 1440), along with ~634,000 domestic pilgrims from within SA (of which two-thirds were non-Saudi nationals). 56 , 73 However, although Hajj numbers are smaller, social crowding is more intense as nearly all pilgrims gather for 5 days in Mecca. While visiting pilgrims travel from more than 184 countries, in 2019 almost two-thirds of external Hajj pilgrims originated from countries in South and South-east Asia (Indonesia, India, Pakistan, Bangladesh, and Malaysia), Africa (Egypt, Algeria, Nigeria, Morocco and Sudan) or from Iraq, Iran and Turkey.…”