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

Abstract

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.

Simultaneous Detection of Bacterial Meningitis in Suspected Cases of Meningitis in Children Using PCR Assay, In Taif, Saudi Arabia

“…In regard to Saudi Arabia, there have been some published studies regarding meningitis during the Hajj and Umrah [15] but, to our knowledge, there were no previous studies on the detection of N. meningitidis, S. pneumoniae, H. influenzae type b, and S. agalactiae in CSF specimens of children. Consequently, a greater understanding of the current epidemiology of BM in children is needed.…”

The Epidemic Effect: On the Politics and Economic Burden of Infectious Disease

“…As a robustness check, and to address potential bias concerns in the measurement of our meningitis shock variable, we use an instrumental variables strategy. Motivated by work from epidemiology and public health which links large gatherings of people at the Hajj, a muslim pilgrimage to Mecca that all muslims are expected to undertake at least once during their lifetimes, to outbreaks of meningitis (Lingappa et al, 2003;Shafi et al, 2008;Yezli et al, 2016); and a related literature in economics linking cultural practices to health outcomes (Almond and Mazumder, 2011), we hypothesize that districts with large shares of muslims who happen to be attending the Hajj at the beginning of a meningitis outbreak cycle, may not experience meningitis shocks. The timing of the Hajj is quasi-random and varies yearly according to the Islamic calendar.…”

The annual Hajj pilgrimage—minimizing the risk of ill health in pilgrims from Europe and opportunity for driving the best prevention and health promotion guidelines

“…14 Other infectious disease risks include meningococcal disease, which caused outbreaks during Hajj in the early 2000s owing to overcrowding and high carrier rates of Neisseria meningitidis among pilgrims. 3,[15][16][17] Mosquito species responsible for the transmission of malaria and the arbovirus that causes dengue are present in the KSA, although the country has been classified by the World Health Organization (WHO) as a low, geographically restricted malaria transmission area since 2008. 3…”