By Ethan Covey
Twelve cases of meningococcal disease have been identified in travelers or their household contacts who went to Saudi Arabia for the Umrah pilgrimage.
The cases, experts said, highlight the need for increased quadrivalent meningococcal vaccination (MMWR Morb Mortal Wkly Rep 2024;73[22]:514-516).
“This report highlights multiple cases of meningococcal disease that occurred in pilgrims performing Umrah in the Kingdom of Saudi Arabia (KSA),” Madhura S. Vachon, PhD, an Epidemic Intelligence Service officer with the CDC, told Infectious Disease Special Edition. “It increases awareness about the risk of contracting meningococcal disease at mass gatherings, which include Hajj and Umrah pilgrimages.”
According to the report, during 2024, an estimated 30 million pilgrims performed Umrah during the month of Ramadan, approximately 13.5 million of whom were international travelers.
As of May 29, a total of 12 meningococcal disease cases have been identified in the United States (five), France (four) and the United Kingdom (three). The 10 cases that occurred in adults were all among individuals who traveled to KSA. Two pediatric cases occurred in household contacts of a non-patient asymptomatic adult.
“The risk is not only to travelers themselves but also close contacts of travelers,” Dr. Vachon said. “It emphasizes the importance of meningococcal serogroup A, C, W, Y [MenACWY] vaccination for Hajj and Umrah travelers to prevent severe illness and notifies both the public and healthcare providers about the emergence of ciprofloxacin-resistant strains.”
Nine of the case patients were unvaccinated, and vaccination status is unknown for the other three.
Among 11 isolates, which were available for whole-genome sequencing, 10 were identified as Neisseria meningitidis serogroup W and one as serogroup C. Ciprofloxacin-resistant strains were identified in three of the 11 tested cases that had antimicrobial susceptibility testing data.
“The findings provide evidence of multiple strains of N. meningitidis circulating among travelers performing Umrah pilgrimage in KSA,” Dr. Vachon said. “Travelers performing Hajj or Umrah have the potential to become severely ill from meningococcal infection and should receive MenACWY vaccine prior to travel.
“The emergence of ciprofloxacin-resistant strains is particularly concerning given that ciprofloxacin is one of the first-line antibiotics for prophylaxis of close contacts for meningococcal disease cases, and antibiotic prophylaxis is critical for prevention of secondary cases,” Dr. Vachon added. “Further analysis of the identified strains and, in particular, the ciprofloxacin-resistant strains will give us a better understanding of the distribution of these ciprofloxacin-resistant strains around the world.”
