What You Need To Know
Today, the Centers for Disease Control and Prevention (CDC) released a MMWR Notes from the Field for healthcare providers describing recent cases of meningococcal disease associated with travel to Saudi Arabia for Umrah and related vaccine and prophylaxis recommendations. This manuscript serves as a companion piece to the Health Alert Network Health Advisory and Travel Health Notice issued by CDC on May 20.
PLEASE NOTE: CDC is recommending to preferentially consider rifampin, ceftriaxone, or azithromycin in lieu of ciprofloxacin prophylaxis for close contacts of Saudi Arabia travel-associated meningococcal disease cases. Please read the MMWR for more details.
The Hajj is one of the world’s largest religious events, taking place annually. This year, the annual Islamic Hajj pilgrimage will take place between June 14-19, 2024, in Saudi Arabia. Mass gatherings can pose public health challenges to the health of the attendees and the host country population and health services. A number of meningococcal disease cases linked to travel for Umrah have been reported to national public health agencies, including to the CDC. The majority of these cases belong to meningococcus serogroup W (some ciprofloxacin-resistant) and have no history of meningococcus vaccination.
Pilgrims should follow travel health advice, including advice on basic infection control measures to reduce the risk of acquiring and spreading infections. The advice includes vaccination with required and recommended vaccines prior to the Hajj. Vaccination with the quadrivalent (ACWY) meningococcal vaccine at least 10 days before departure is particularly important. It also includes advice on maintaining good handwashing and respiratory etiquette as well as ensuring all food is thoroughly cooked and avoiding mosquito bites.
During or on return from the Hajj, pilgrims should seek immediate medical attention if they experience symptoms of an infection, e.g. fever, respiratory or gastrointestinal infections. Pilgrims should inform their healthcare provider of their travel history to the Hajj.
Recommendations for Healthcare Providers:
- Ensure that they and their staff are up to date on all recommended vaccines.
- Use every opportunity to assess for immunizations to ensure all patients are up to date with their routine immunizations.
- Follow the routine recommended schedule all recommended vaccines.
- Providers should ensure that all eligible persons receive meningococcal vaccine. All adolescents should be routinely immunized with a 2-dose series. People at high risk, including people living with HIV infection, should be immunized.
- Inquire with patients about upcoming travel plans and ensure they are up to date on all travel-related vaccines, as it is especially important for patients to be protected prior to international travel
- Meningococcal (MenACWY) vaccine is needed at least 10 days before arriving in Saudi Arabia for Umrah or Hajj.
- Preferentially consider use of antibiotics other than ciprofloxacin for prophylaxis of close contacts of meningococcal disease cases linked to travel to Saudi Arabia.
Reminders:
- NJ Communicable Disease reporting requirements are available here.
- Cases should be reported to the local health department where the patient resides. If you are unsure which local health department should be contacted, use the locator tool.
- Healthcare providers should remain vigilant for individuals presenting with clinically compatible symptoms of invasive meningococcal disease (meningitis or meningococcemia)
- Ask patients about recent international/domestic travel or visitors, contact with travelers, especially Saudi Arabia.
- Immediately report suspect meningococcal disease cases to the local health department where the patient resides.
- Providers should ensure they and their staff are up-to-date with immunizations, use appropriate precautions, and have access to and are trained to use appropriate personal protective equipment (PPE) when interacting with patients.
- For additional information and resources on meningococcal disease please visit the New Jersey Department of Health's invasive meningococcal website or CDC's meningococcal website.