CDC urges meningococcal disease vaccination ahead of Hajj travel

The US Centers for Disease Control and Prevention is urging doctors to be on the lookout for potentially deadly meningococcal disease linked to travel to Saudi Arabia.

Since April, there have been 12 confirmed cases of meningococcal disease associated with travel for Umrah, an Islamic pilgrimage to Mecca, the birthplace of the Prophet Muhammad in Saudi Arabia. Believers in the Muslim faith make Umrah trips to Mecca throughout the year to receive blessings. Muslims also make a longer, more ritualized pilgrimage to Mecca at least once in their lifetime during a set time of year called Hajj. This year’s Hajj is June 14 to 19.

Five of the pilgrims who got sick this year live in the United States. France has had four cases, and the United Kingdom has had three. Ten of the people who got sick had been to Mecca, and two had a close association with someone who did.

Meningococcal disease is highly contagious among unvaccinated people. Of the patients whose vaccination status is known, nine were unvaccinated.

Meningococcal disease, including meningitis, is an uncommon illness caused by the bacteria Neisseria meningitidis. It can cause infection in the lining of the brain and spinal cord that can cause a lifetime of medical problems such as memory and concentration issues, seizures, balance problems, hearing loss and blindness. The disease can also lead to a serious blood infection called septicemia or blood poisoning.

Research shows that an estimated 10% to 15% of cases end in death, even with appropriate treatment.

The number of cases in the US has been on the rise, according to the CDC. This year, 143 cases were reported as of the end of March, compared with 81 for the same period last year. There were 422 cases in all of 2023, the most since 2014, according to the CDC.

Meningococcal disease can be treated with antibiotics if it’s caught early enough. However, diagnosis is often delayed because the symptoms can mimic those of other infectious diseases like Covid-19 or the flu. Symptoms include fever, a headache, nausea or vomiting, trouble walking, a stiff neck, a skin rash, sensitivity to light and brain fog.

Tests of the bacteria in the newly confirmed cases showed that in one case in the US and one in France, it was resistant to ciprofloxacin, one of the first-line antibiotics used to treat meningococcal disease. Eight cases responded to treatment with penicillin or ciprofloxacin.

Vaccines and boosters available

Saudi Arabia requires all Umrah or Hajj pilgrims age 1 and older to have gotten the quadrivalent meningococcal vaccine, also known as the meningococcal conjugate or MenACWY vaccine. It protects against four variations of the bacteria that are in wide circulation: A, C, W, and Y. Overall, most cases in the US are related to serogroup Y.

In the US, doctors may also recommend the MenB vaccine to protect against the B-variation of the bacteria.

A shot made by Pfizer that was approved in the US last year, Penbraya, protects against all five of these most common serogroups that cause meningococcal disease.

Most of the pilgrims who got sick tested positive for the W variation. One case in the United States was caused by serogroup C.

In the US, the vaccine is routinely recommended for all preteens and teens and for some younger children and adults under specific circumstances. One such instance is before travel to countries where meningococcal disease is more common. This includes a recommendation for a booster if the last time a traveler got the shot was three to five or more years before their trip.

The CDC said Monday that health care providers should work with patients who are considering travel for Hajj or Umrah to make sure they have received the MenACWY vaccine within the past five years or get the shot at least 10 days before they leave for their trip.

In the new notice, which was issued through the CDC’s Health Alert Network, the agency also reminded providers to suspect meningococcal disease in anyone who has symptoms after recent travel for Hajj or Umrah.

The CDC told health departments and providers to consider using several of the preferred antibiotics used to treat meningococcal disease in people associated with travel to Mecca.

People who come into close contact with someone with meningococcal disease should get an antibiotic as soon as possible after exposure, regardless of their vaccination status, the CDC said, and ideally within a day after the initial patient has been identified.

The most recent outbreak connected to a mass gathering was in 2000-01, the CDC said, and it was primarily caused by the W variation of the bacteria. It’s only since 2002 that Saudi Arabia has required all pilgrims to provide proof of vaccination against meningococcal disease, but vaccination coverage among these travelers is “known to be incomplete,” the CDC said.

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