title: Meningococcal disease during the Hajj and Umrah mass gatherings.
abstract: The Hajj and Umrah religious mass gatherings hosted by the Kingdom of Saudi Arabia can facilitate the transmission of infectious diseases. The pilgrimages have been associated with a number of local and international outbreaks of meningococcal disease. These include serogroup A disease outbreaks in 1987 and throughout the 1990s and two international serogroup W135 outbreaks in 2000 and 2001. The implementation of strict preventative measures including mandatory quadrivalent meningococcal vaccination and antibiotic chemoprophylaxis for pilgrims from the African meningitis belt has prevented pilgrimage-associated meningococcal outbreaks since 2001. However, the fluid epidemiology of the disease and the possibility of outbreaks caused by serogroups not covered by the vaccine or emerging hyper-virulent strains, mean that the disease remains a serious public health threat during these events. Continuous surveillance of carriage state and the epidemiology of the disease in the Kingdom and globally and the introduction of preventative measures that provide broad and long-lasting immunity and impact carriage are warranted.
authors.affiliation: The Global Centre for Mass Gatherings Medicine, Public Health Directorate, Ministry of Health, Riyadh, Saudi Arabia. Electronic address: saber.yezli@gmail.com.
authors.forename: Saber
authors.initials: S
authors.lastname: Yezli
authors.affiliation: Public Health Directorate, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Abdullah M
authors.initials: AM
authors.lastname: Assiri
authors.affiliation: Public Health Directorate, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Rafat F
authors.initials: RF
authors.lastname: Alhakeem
authors.affiliation: Makkah Regional Health Affairs, Ministry of Health, Jeddah, Saudi Arabia.
authors.forename: Abdulhafiz M
authors.initials: AM
authors.lastname: Turkistani
authors.affiliation: The Global Centre for Mass Gatherings Medicine, Public Health Directorate, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Badriah
authors.initials: B
authors.lastname: Alotaibi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000942:Antigens, Bacterial; D001826:Body Fluids; D003441:Crowding; D004196:Disease Outbreaks / Q000517:prevention & control; D006693:Holidays; D006801:Humans; D007514:Islam; D008589:Meningococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D022401:Meningococcal Vaccines / Q000276:immunology; D011634:Public Health; D012529:Saudi Arabia / Q000453:epidemiology; D065288:Serogroup; D014195:Travel
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D022401:Meningococcal Vaccines
keywords: Hajj; Mass gathering; Meningitis; Meningococcal disease; Outbreak; Umrah