Meningococcal meningitis is a major health issue in both developed as well as developing countries. Crowded conditions are at particular risk of outbreaks. Every year approximately two million pilgrims from more than 140 countries gather in Saudi Arabia for a pilgrimage to the holy places of Islam known as Hajj. In recent years many outbreaks have occurred during Hajj. Approximately 400 cases of meningococcal disease caused by N. meningitidis serogroup W135 were identified worldwide during the Hajj season of 2000. Carriers are the primary source of transmission of infection and the risk of epidemic increases with the percentage of carriers in the population. Vaccination does not protect against nasopharyngeal carriage of the bacteria. This study was conducted to determine pre &post Hajj Meningococcal carriage rate among pilgrims during Hajj 1421 H.
Methodology
This study was conducted using a cross - sectional approach. 715 Hajjes arrived and 743 departed Makkah year 1421H by air through King Abdul Aziz International Airport in Jeddah were included in the study. A questionnaire was competed by interview with each Hajji and an oropharyngeal swab was taken and sent for culture and typing. The questionnaire contained demographic data e.g. age, gender, nationality, education level and vaccination status of Hajjes.
Results
There were 57 (8%) meningococcal meningitis carriers pre hajj; 27% were Indians, 27% Bangladeshis, and 15% were Sudanese. Carriage rate according to nationality was 21.3% among Indians, 20.5% among Bangladeshis, 11.1% among Sudanese, and only 3.4% among domestic hajjis. Post hajj there was 77 (10.4%) carriers; the carriage rate was 53.0% among Malaysians, 7.7% among Indonesians, 6.7% among Bangladeshis, and 6.3% among Nigerians. The rate of carriage increased with age from 4% among those aged less than 30 years, to 11% among those aged 60 years and above pre hajj, and from 2.6% among those aged less than 30 years to 17.9% among those aged 60 years and more post Hajj. Half of the pre hajj organisms (50.9%) and 46.8% of the post hajj were non groupable. Post hajj 44.2% were W135.
Conclusion
The Quadrivalent vaccine containing (A, C, Y, W135) should be given to all pilgrims in their home countries at least two weeks before their departure for Hajj. Chemoprophylactic drugs should be continued to all pilgrims coming from endemic countries.