title: Changes in epidemiological pattern of Meningococcal disease in Saudi Arabia. Does it constitute a new challenge for prevention and control?
abstract: OBJECTIVE
  Meningococcal meningitis epidemics, which occurred in the Kingdom of Saudi Arabia (KSA) coincided with Hajj and Umra seasons; the 2 major pilgrims to Muslims. In many countries, the disease showed major changes of its epidemiological determinants, in particular to age and prevailing serogroup. This study was conducted to determine the epidemiological trend of meningococcal meningitis disease in KSA.
  
  
  METHODS
  All confirmed meningococcal meningitis cases reported in KSA during the period from January 1999 to December 2002 were studied retrospectively. Confirmation of cases was based on isolation of the causative organism from cerebrospinal fluid (CSF) or blood culture or detection of antigen in the CSF. Personal, clinical and laboratory results were analyzed using Epi info version 6 software. Categorical data were tested using chi2 test.
  
  
  RESULTS
  A total of 729 cases were reported, 304 cases (42%) were among people coming from abroad for Hajj or Umra and 425 (58%) were among local population. Nearly half of the later (48%) were reported at the 2 holy areas of Makkah and Madinah, KSA. Thirty-nine percent of cases were children aged <2 years and 58% were <5 years of age. Proportion of cases affected with serogroup W135 increased over time (up to 95%) and significantly affected children aged <5 years (p<0.001).
  
  
  CONCLUSIONS
  Continuous monitoring of epidemiological determinants is essential to guide vaccination policy.
authors.affiliation: Department of Preventive Medicine, Ministry of Health, Riyadh, Kingdom of Saudi Arabia. yalmazrou@hotmail.com
authors.forename: Yagob Y
authors.initials: YY
authors.lastname: Al-Mazrou
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Al-Jeffri
authors.forename: Mohamed N
authors.initials: MN
authors.lastname: Abdalla
authors.forename: Sirag A
authors.initials: SA
authors.lastname: Elgizouli
authors.forename: Amin A
authors.initials: AA
authors.lastname: Mishskas
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000900:Anti-Bacterial Agents; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000458:organization & administration*; D003906:Developing Countries; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008585:Meningitis, Meningococcal / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000008:administration & dosage*; D011336:Probability; D015397:Program Evaluation; D012189:Retrospective Studies; D018570:Risk Assessment; D012529:Saudi Arabia / Q000453:epidemiology; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome; D014611:Vaccination / Q000592:standards
chemical_list: D000900:Anti-Bacterial Agents; D022401:Meningococcal Vaccines