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From the Centers for Disease Control and Prevention
March 21, 2001

Risk for Meningococcal Disease Associated With the Hajj 2001

JAMA. 2001;285(11):1438. doi:10.1001/jama.285.11.1438-JWR0321-3-1

MMWR. 2001;50:97-98

Every year approximately two million pilgrims from more than 140 countries gather in Saudi Arabia for a pilgrimage to the holy places of Islam known as the Hajj. Coinciding with the Hajj pilgrimage during March 2000, Saudi Arabian health officials identified an outbreak of meningococcal disease; a substantial proportion of the isolates were the bacterial strain Neisseria meningitidis serogroup W-135. Four cases of meningococcal disease subsequently were identified among the estimated 15,000 pilgrims returning to the United States, their close contacts, and community. In addition, approximately 400 cases of meningococcal disease caused by N. meningitidis serogroup W-135 were identified worldwide during 2000.1 Whether an outbreak of meningococcal disease will recur in 2001 is unknown.

Following an outbreak of serogroup A meningococcal disease associated with the Hajj during 1987, the Saudi Arabian government required all pilgrims to receive the meningococcal polysaccharide vaccine.2 In the United States, the available vaccine, quadrivalent meningococcal polysaccharide vaccine, contains serogroup W-135 polysaccharide. However, vaccination does not protect against asymptomatic nasopharyngeal carriage of the bacteria. Persons may transmit N. meningitidis infection to close contacts upon their return from Saudi Arabia, and taking an antibiotic can reduce the risk for transmission and disease. It is not known whether returning pilgrims will have increased rates of acquisition of nasopharyngeal carriage of N. meningitidis.

To assess the risk for meningococcal disease in returning pilgrims and their close contacts, CDC is planning to evaluate nasopharyngeal carriage among a set of pilgrims returning from the Hajj. The results of this evaluation and any recommendations will be posted on the World-Wide Web, http://www.cdc.gov/travel, when they become available. Information also will be available by telephone, (888) 232-3228.

References
1.
Popovic  TSacchi  CTReeves  MW  et al.  N. meningitidis serogroup W135 isolates associated with the ET-37 complex [Letter]. Emerg Infect Dis. 2000;6428- 9Article
2.
Moore  PSHarrison  LHTelzak  EE  et al.  Group A meningococcal carriage in travelers returning from Saudi Arabia. JAMA. 1988;2602686- 9Article
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