Ahead of Hajj, CDC warns doctors to watch out for travel-related meningococcal disease in Saudi Arabia

CNN
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The U.S. Centers for Disease Control and Prevention urges doctors to be alert for cases of life-threatening 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 of 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 lives, at a time of year called Hajj. This year’s Hajj will take place from June 14 to 19.

Five of the pilgrims who fell ill this year live in the United States. France has had four cases and the United Kingdom three. Ten of the people who fell ill had been to Mecca, and two had a close relationship with someone who had been there.

Meningococcal disease is very contagious among unvaccinated people. Among patients whose vaccination status is known, nine were not vaccinated.

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

Research shows that about 10 to 15 percent of cases result in death, even with proper treatment.

In the United States, the number of cases is increasing, according to the CDC. This year, 143 cases were reported by the end of March, compared to 81 for the same period last year. There were 422 cases in all of 2023, the highest number since 2014, according to the CDC.

Meningococcal disease can be treated with antibiotics if caught early enough. However, diagnosis is often delayed because symptoms may resemble those of other infectious diseases such as Covid-19 or the flu. Symptoms include fever, headache, nausea or vomiting, difficulty walking, neck stiffness, rash, sensitivity to light, and brain fog.

Testing of the newly confirmed cases showed that in one case in the United States and one in France, the bacteria 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 that all Umrah or Hajj pilgrims aged one year and older have received the quadrivalent meningococcal vaccine, also known as meningococcal conjugate vaccine or MenACWY. It protects against four widely distributed bacteria variants: A, C, W, and Y. Overall, most cases in the United States are linked to serogroup Y.

In the United States, doctors may also recommend the MenB vaccine to protect against the B variant of the bacteria.

A vaccine made by Pfizer and approved in the United States last year, Penbraya, protects against the five most common serogroups that cause meningococcal disease.

Most of the pilgrims who fell ill tested positive for the W variant. One case in the United States was due to serogroup C.

In the United States, the vaccine is routinely recommended for all preteens and adolescents, as well as some young children and adults in specific circumstances. One such example occurs before traveling to countries where meningococcal disease is more common. This includes a recommendation for a booster if the last time a traveler received the vaccine was three to five years or more before their trip.

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

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

The CDC has asked health departments and providers to consider using several of the preferred antibiotics. used to treat meningococcal disease in humans associated with the journey to Mecca.

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

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