Meningococcal Disease Associated with Travel to Saudi Arabia for Umrah Pilgrimage ¡ª United States, United Kingdom, France, and Norway 2024

What did we do?

• Meningococcal disease outbreaks have been linked to Hajj and Umrah, which are Islamic pilgrimages to Mecca, Saudi Arabia. On April 17, 2024, New York City reported two Umrah-associated cases of meningococcal disease to CDC. With Hajj approaching, identifying additional cases and rapidly disseminating public health guidance to the global community was critical to prevent disease.

What did we find?

• By July 8, 2024, 14 cases were identified in the United States (6), France (4), United Kingdom (3), and Norway (1). Ten were among adult travelers, and four were among contacts of travelers. (All were under 18 years of age).
• Traveler's vaccination status was either unvaccinated (7) or unknown (3).
• The genomic marker for ciprofloxacin resistance was found in four isolates.
• Phylogenetic analysis indicated that the NmW cases were distinct from other U.S. serogroup W cases and unlikely to be locally acquired. The 11 NmW cases with sequences available formed two distinct phylogenetic clades: ciprofloxacin-resistant and susceptible isolates, with isolates from multiple countries clustering within each clade.

Why does it matter?

• Meningococcal disease is a serious vaccine-preventable illness caused by the bacterium Neisseria meningitidis (Nm) and transmitted person-to-person through respiratory droplets.
• Efficient laboratory and epidemiology coordination facilitated identification of ciprofloxacin-resistant strains, and phylogenetic analysis supported the relatedness of cases across reporting countries.
• These findings enabled release of rapid communications promoting vaccination for pilgrims and providing alternative guidance for antibiotic chemoprophylaxis.
• This investigation not only documented risk to pilgrims but also potentially severe risk to close contacts of pilgrims, including young children.

Abstract Category: Global Health