Saudi Arabia (SA) has experienced recurrent occurrence of Meningococcal Meningitis (MCM) mainly in the two Holy Mosque cities (Makkah & Madinah) that occasionally extends to other cities within SA and other countries internationally. There are no documents available for the source of infection (locally or imported) even among all studies that have reported a strong correlation of pilgrims with MCM epidemics. This study aims to determine the Carriage Rate of Meningococci among the two Holy Mosque residents before Hajj, identify its serotypes, and evaluate the effectiveness of Ciprofloxacin in eradicating colonization.
Methodology
An observational study was conducted using a cross sectional approach. Two thousand eight hundred (2800) participants were randomly selected from workers of the two Holy Mosques in Makkah and Madinah, workers in commercial sites adjacent to the two Holy Mosques (high risk), and from Primary Health Care Centers (low risk). All participants were interviewed face to face, and a naso-pharyngeal swab was taken. A single dose of Ciprofloxacin was given to positive carriers.
Results
Among 2797 naso-pharyngeal swabs taken from Makkah and Madinah, 86 (3%) were culture positive (49 from Makkah and 37 from Madinah) for different types of Meningococci. The carriage rate for N. meningitidis was 1.1% in Makkah and only 0.1% in Madinah. There was no significant difference between the high risk (0.7%) and low risk (0.6%) populations. The study demonstrated that the Makkah population was 8 times likely to become carriers than the Madinah population. Males were at higher predisposition of becoming carriers than females (OR=1.88), and Saudis were at a lower risk than other nationalities (OR=0.61). No association was identified between participants bedroom space area and becoming a carrier (OR=1.2). All 18 N. Meningitidis carriers who were given a single dose (500 mg) of Ciprofloxacin were identified as culture negative after 48 hours.
Conclusion
This study demonstrated that MCM is not endemic in Makkah and Madinah. A single dose of 500 mg of Ciprofloxacin was found to be 100% effective in eradicating colonization. It is recommended that the vaccination campaign along with health education should be started early before arrival of religious visitors, along with continuous use of the single dose of Ciprofloxacin (500 mg) at arrival to SA, especially among those coming from endemic areas of MCM. Ciprofloxacin is also indicated for returning domestic pilgrims to reduce the risk of transmission to close contacts. International Health Missions should be advised to administer Ciprofloxacin to their pilgrims at the time of return to their home countries.