Health Alert Network Health Advisory‎

CDC issued a Health Alert Network (HAN) Health Advisory on May 20, 2024, about cases of meningococcal disease linked to Umrah travel to the Kingdom of Saudi Arabia. The HAN discusses the need for vaccination prior to Hajj and Umrah travel and prophylaxis guidance due to ciprofloxacin-resistant strains.

Read the HAN Health Advisory

Clinical Overview of Meningococcal Disease

Key points

  • Meningococcal disease is an uncommon but very serious infection.
  • The two most common syndromes of meningococcal disease are meningitis and septicemia.
  • There are many factors that can increase someone's risk for meningococcal disease.
  • Close contacts of someone with meningococcal disease should receive prophylaxis.
  • Vaccines help prevent meningococcal disease.


Neisseria meningitidis are Gram-negative diplococcal bacteria that cause meningococcal disease.


There are multiple serogroups of N. meningitidis. Serogroups B, C, and Y cause the majority of disease in the United States. Serogroup W and nongroupable strains cause a small portion of disease in the United States.

Risk factors

Anyone can get meningococcal disease, but some factors increase someone's risk.


The following age groups have higher rates of disease than other ages:

  • Infants less than one year of age
  • Adolescents and young adults 16 through 23 years of age
  • Adults over 85 years of age

Close contact

Household or close contacts of case patients are at higher risk.

Medical conditions

People with certain medical conditions are at increased risk:

  • Functional or anatomic asplenia
  • HIV infection
  • Persistent complement component deficiencies

These complement components include C3, C5-9, properdin, factor H, and factor D.

Consider complement testing for meningococcal patients‎

Meningococcal disease is often the first sign someone has a complement deficiency. Recurrent disease may occur for patients with complement deficiency. Consider complement testing in patients with meningococcal disease.


People who receive complement inhibitors (e.g., eculizumab [Soliris®], ravulizumab [Ultomiris™]) are at increased risk.

Healthcare providers typically prescribe complement inhibitors for treatment of

  • Atypical hemolytic uremic syndrome
  • Generalized myasthenia gravis
  • Neuromyelitis optica spectrum disorder
  • Paroxysmal nocturnal hemoglobinuria

Managing risk for patients who receive complement inhibitors‎

Vaccines and antimicrobial prophylaxis likely provide incomplete protection for patients receiving eculizumab or ravulizumab. These patients should seek medical care immediately for meningococcal disease symptoms, regardless of vaccination status or antibiotic use.

Places and settings

The following groups of people have increased risk based on where they work, live, or travel:

  • Microbiologists routinely exposed to isolates of N. meningitidis
  • People identified as being at increased risk because of an outbreak
  • Travelers to certain countries
  • First-year college students living in residence halls
  • Military recruits

How it spreads

People spread meningococcal bacteria to others by exchanging respiratory and throat secretions during close or lengthy contact.

People with meningococcal disease and those who carry the bacteria asymptomatically in the nasopharynx can spread the bacteria.

Humans are the only host.


Prophylaxis and vaccination are two strategies to help prevent this disease.


CDC recommends prophylaxis for close contacts of patients with meningococcal disease, regardless of vaccination status.

When to consider antimicrobial susceptibility testing‎

If ciprofloxacin-resistant strains have been reported in your state within the past 2 years, consider antimicrobial susceptibility testing to inform prophylaxis decisions.


CDC recommends meningococcal vaccination for all preteens and teens. CDC also recommends clinicians vaccinate children and adults who are at increased risk for meningococcal disease.

Diagnosis and treatment

Because of the risks of severe morbidity and death, prompt diagnosis and treatment are important.

Keep Reading: Clinical Guidance

Trends and surveillance

Meningococcal disease is an uncommon but reportable condition in the United States.

Cases of meningococcal disease in the United States have increased sharply since 2021 and now exceed pre-pandemic levels.