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Meningococcal Disease Among Travelers Returning From Saudi Arabia

Since August 9, 1987, two definite and three probable cases of meningococcal disease caused by Neisseria meningitidis serogroup A have been reported among the 1,250 pilgrims returning to the United States from Mecca and Medina, Saudi Arabia. Onset of symptoms has been within 4 days of return to the United States. An additional traveler, who was not a pilgrim, was hospitalized recently with serogroup A meningococcal meningitis 4 days after her return to the United States. This woman had not traveled to Mecca or Medina, but had spent 5 weeks in Jedda, where she had reportedly had some contact with pilgrims. Pilgrims returning on all recent direct flights from Jedda to New York (August 18, 20, and 25) received prophylaxis with rifampin at the New York airport. Reported by: HR Ragazzoni, DVM, New Jersey State Dept of Health. New York Quarantine Station; S Schultz, MD, New York City Dept of Health. Div of Field Svcs, Epidemiology Program Office; Div of Quarantine, Center for Prevention Svcs; Meningitis and Special Pathogens Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: An estimated 3,000 cases of invasive meningococcal disease occur in the United States each year. Two to three percent of these are caused by N. meningitidis serogroup A. No large serogroup A meningococcal epidemics have occurred in the United States since 1946, and it is unlikely that serogroup A carriers returning from Saudi Arabia will have an impact on the rate of disease among the general U.S. population.

Pilgrims returning from Saudi Arabia following this year's pilgrimage should receive rifampin chemoprophylaxis. Since the risk of disease rapidly decreases as the time following exposure increases, rifampin is recommended only if it can be given within 1 week of a person's leaving Saudi Arabia. Rifampin is not recommended for other travelers, unless they have been in close contact with a patient with meningococcal meningitis.

This year's pilgrimage is now over, and associated crowded conditions have subsided. However, while the potential risk to persons now traveling to Saudi Arabia is not known, it is likely that the serogroup A strain is circulating in the population. Therefore, it would be prudent for future travelers to Saudi Arabia to receive the meningococcal vaccine at least 10 days prior to departure. The only vaccine licensed in the United States is manufactured by Connaught Laboratories; it is quadrivalent and contains serogroups A, C, Y, and W-135 (1). If local distributors are not able to supply the vaccine, Connaught Laboratories may be contacted at 1-800-VACCINE.

Physicians are encouraged to report additional cases among returning travelers from Saudi Arabia to their state and local health departments and to forward the meningococcal isolates to CDC through their state public health laboratories.

References

  1. Immunization Practices Advisory Committee. Meningococcal vaccines. MMWR 1985;34: 255-9.

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