Muslims travelling to Saudi Arabia for the annual Hajj religious festival are a high priority for enhanced meningococcal vaccination this year. Thirty-three cases and nine fatalities were reported in England and Wales, a similar number to that reported in 2000, despite the recommendation to use a different vaccine in 2001. Better implementation of control policies are needed to prevent an outbreak of meningococcal disease among pilgrims and their contacts this year, conclude authors of a research letter in this week’s issue of THE LANCET.
An outbreak of a previously rare strain (W135) meningococcal disease was seen in 2000 and 2001 among pilgrims returning from Saudi Arabia and their contacts. The Public Health Laboratory Service (covering England and Wales) set up enhanced surveillance to monitor spread and virulence of the outbreak strain, and to collect data on case characteristics. The incidence of disease amongst pilgrims reported from England and Wales in 2001 was similar (28 per 100,000) to the rate reported during 2000 (30 per 100,000), despite a change in the recommendation for pilgrims to receive the quadrivalent vaccine instead of the bivalent vaccine recommended in 2000. Both the recommendation and vaccine were not available until January, 2001, and coverage among pilgrims to the Hajj 2001 was low (below 47%). The case–fatality ratio was high (20%), and sustained transmission of the virulent outbreak strain was seen.
Mary Ramsay of the PHLS comments: “This outbreak is characterised by a high case-fatality rate that might reflect the virulence of the strain or characteristics of this group of patients. As well as primary prevention, attempts should be made to improve outcome. Preadmission treatment of suspected meningococcal disease in primary care with intravenous benzylpenicillin is recommended, and awareness of continued increased risk in the Muslim population should be improved to enhance early recognition. Transmission of the outbreak strain continues, with nine new cases arising during the 6 months since those described in this paper.”
Contact: Dr Mary Ramsay, c/o PHLS Press Office, 61 Colindale Avenue, London NW9 5EQ, UK; T) +44 (0)20 8358 3004; E) mramsay@phls.org.uk
Journal
The Lancet