Meningococcal carriage in Umra pilgrims returning from Saudi Arabia

Abstract

Background: Moslems from all over the world go to Mecca and Medina in Saudi Arabia for two types of pilgrimage: the major pilgrimage (hajj) and the minor (umra). An international outbreak of meningococcal disease with serogroup W-135 occurred in association with hajj pilgrimage in the years 2000 and 2001, and it has been shown that pharyngeal carriage of a single W-135 strain was high in returning hajj pilgrims. We investigated the meningococcal carriage in umra pilgrims to determine the extent of circulation of this strain, during the minor pilgrimage.

Method: Tonsillopharyngeal swabs were taken from umra returnees. Serogrouping and pulsed field gel electrophoresis were performed on all meningococcal isolates. Subjects were questioned about the occurrence of symptoms of upper respiratory tract infection and use of antibiotics during the pilgrimage.

Results: were compared with those previously reported in hajj pilgrims. Results: We enrolled 160 pilgrims returning from the umra pilgrimage in 2001. The meningococcal carriage rate was 1.3%, which is significantly lower compared with the hajj pilgrimage (17%; p<0.001). None of the umra pilgrims carried serogroup W-135, whereas 90% of the isolates in returning hajj pilgrims were Neisseria meningitidis W-135.

Conclusions: Meningococcal carriage during the umra pilgrimage was significantly lower compared with the hajj pilgrimage in the year 2001. No carriage of N. meningitidis W-135 was documented in umra pilgrims, whereas this was the predominant serogroup in hajj pilgrims. Public health measures to reduce the potential introduction of N. meningitidis W-135 into the countries of origin of returning pilgrims need to be prioritized for the hajj pilgrimage.