Meningococcal Cases Linked to Recent Travel

The Centers for Disease Control and Prevention (CDC) today issued a Health Alert Network (HAN) Health Advisory to notify healthcare providers about cases of meningococcal disease associated with Umrah, which is conducted in the Kingdom of Saudi Arabia (KSA).

Meningococcal disease, caused by Neisseria meningitidis, is a rare but severe illness with a 10–15% case-fatality rate.

Since April 2024, 12 cases of meningococcal disease linked to travel to KSA for Umrah have been reported to national public health agencies in the United States (5 cases), France (4 cases), and the United Kingdom (3 cases).

Ten cases were in patients who traveled to KSA, and two were in patients who had close contact with travelers to KSA. Ten cases were caused by Neisseria meningitidis serogroup W (NmW), one U.S. case was caused by serogroup C, and the serogroup is unknown for one U.S. case.

The isolates from the one U.S. NmC case and two NmW cases (one U.S., one France) were resistant to ciprofloxacin; based on whole-genome sequencing, the remaining eight NmW isolates were all sensitive to penicillin and ciprofloxacin.

Nine of these patients were unvaccinated.

Umrah is an Islamic pilgrimage to Mecca, KSA, that can be performed at any time of the year, while the Hajj is an annual pilgrimage that will take place from June 14 to 19, 2024.

Meningococcal disease outbreaks have occurred previously in conjunction with mass gatherings, including the Hajj pilgrimage.

The most recent global outbreak of meningococcal disease associated with travel to KSA for Hajj was in 2000–2001, primarily caused by NmW.

Since 2002, KSA has required all travelers aged one year or older performing Hajj or Umrah to provide vaccination documentation. KSA's requirement aligns with the CDC's recommendations for revaccinating U.S. travelers to endemic areas.

MenACWY conjugate vaccination is routinely recommended for travelers to countries where meningococcal disease is hyperendemic or epidemic, including a booster dose of MenACWY if the last dose was administered 3–5 or more years previously (depending on the age at the most recent dose received). 

In the U.S., various meningococcal vaccines are offered at pharmacies and travel vaccine clinics.

The unedited HAN CDCHAN-00508 is posted at this CDC link.