Disease transmission and mass gatherings: a case study on meningococcal infection during Hajj

Abstract

Background: Mass gatherings can not only trigger major outbreaks on-site but also facilitate global spread of infectious pathogens. Hajj is one of the largest mass gathering events worldwide where over two million pilgrims from all over the world gather annually creating intense congestion.

Methods: We developed a meta-population model to represent the transmission dynamics of Neisseria meningitidis and the impact of Hajj pilgrimage on the risk of invasive meningococcal disease (IMD) for pilgrims population, local population at the Hajj site and country of origin of Hajj pilgrims. This model was calibrated using data on IMD over 17 years (1995-2011) and further used to simulate potential changes in vaccine policy and endemic conditions.

Results: The effect of increased density of contacts during Hajj was estimated to generate a 78-fold increase in disease transmission that impacts not only pilgrims but also the local population. Quadrivalent ACWY vaccination was found to be very effective in reducing the risk of outbreak during Hajj. Hajj has more limited impact on IMD transmission and exportation in the pilgrim countries of origin, although not negligible given the size of the population considered.

Conclusion: The analysis performed highlighted the amplifying effect of mass gathering on N. meningitidis transmission and confirm vaccination as a very effective preventive measure to mitigate outbreak risks.

Keywords: Mass gathering; Mathematical model; Neisseria meningitis; Vaccine; transmission dynamics.

Fig. 1

Observed and simulated number of IMD cases (A) pilgrims, B non-pilgrim population in Mecca (C) non-pilgrim population in KSA outside Mecca. Calibration period (1995–2001), validation period (2002–2011)

Fig. 2

Reverse cumulative distribution of annual IMD cases according to pilgrim vaccination coverage. A pilgrims, B non-pilgrim population in Mecca (C) non-pilgrim population in KSA outside Mecca. Distributions are calculated over a 20 years period

Fig. 3

Reverse cumulative distribution of annual IMD cases in case of vaccine shortage in one cluster. A pilgrims, B non-pilgrim population in Mecca (C) non-pilgrim population in KSA outside Mecca. Distributions are calculated over a 20 years period

Fig. 4

Impact of Hajj density effect and baseline endemicity on IMD cases among pilgrims.Variation of the average annual number of IMD cases among pilgrims (over a 20 years period) (A) according to the magnitude of the Hajj density effect in the absence of vaccination (B) according to the magnitude of the Hajj density effect with quadrivalent ACWY vaccination for pilgrims and the local population (C) according to the level of baseline endemicity in the pilgrim population in the absence of vaccination (D) according to the level of baseline endemicity in the pilgrim population with quadrivalent ACWY vaccination for pilgrims and the local population. Black dots corresponding to the number of IMD cases using calibrated values