Health officials are urging clinicians to ensure patients making a pilgrimage to Saudi Arabia are vaccinated against meningococcal disease and watch for illness in return travelers.
The Centers for Disease Control and Prevention (CDC) issued a health advisory Monday warning there have been 12 cases linked to these pilgrimages since April including five in the U.S., four in France and three in the United Kingdom. Two of the cases were in children.
Ten of the cases were in people who made the Umrah Islamic pilgrimage to Mecca, Saudi Arabia while two were close contacts, according to the advisory. In addition to the Umrah pilgrimage that can take place any time of year, the Hajj Islamic pilgrimage is taking place June 14-19.
The CDC recommends routine vaccination of adolescents and vaccination for travelers to certain countries including a booster dose if vaccination was three to five or more years ago. Saudi Arabia requires pilgrims 1 year and older to be vaccinated. However, at least nine of the recent cases were unvaccinated while the status of the other three was unknown.
Quadrivalent vaccines protect against Neisseria meningitidis serogroups A, C, W and Y. Ten of the current cases were caused by serogroup W while one was serogroup C and one was unknown.
Clinicians should watch for symptoms of meningococcal disease in returning travelers and their close contacts. Infections often present as meningitis with symptoms that may include fever, headache, stiff neck, nausea, vomiting, photophobia, or altered mental status, according to the CDC. They may also present as a meningococcal bloodstream infection with symptoms that may include fever, chills, fatigue, vomiting, cold hands and feet, severe aches and pains, rapid breathing, diarrhea, or, in later stages, a petechial or dark purple rash.
About 10%-15% of cases are fatal and survivors may experience deafness, amputations or other long-term effects. Clinicians who suspect a patient has meningococcal disease should begin immediate antibiotic treatment without waiting for lab test results and should immediately notify their health department. Three of the recent cases were resistant to ciprofloxacin while eight isolates were sensitive to penicillin and ciprofloxacin, according to the CDC.
Close contacts of people with meningococcal disease should receive antibiotic chemoprophylaxis as soon as possible after exposure, regardless of immunization status. The CDC recommends clinicians consider using rifampin, ceftriaxone, or azithromycin instead of ciprofloxacin for chemoprophylaxis of close contacts of meningococcal disease cases associated with travel to Saudi Arabia.
In 2000-2001 there was an outbreak of meningococcal disease linked with the Hajj pilgrimage. It was primarily caused by Neisseria meningitidis serogroup W, which has made up most of the recent cases as well.
Resources
