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Group A meningococcal carriage in travelers returning from Saudi Arabia
P S Moore1, L H Harrison, E E Telzak
1Division of Bacterial Diseases, Centers for Disease Control, Atlanta, GA 30333.
Abstract:
In August 1987, an outbreak of group A meningococcal meningitis occurred during the annual pilgrimage to Mecca, Saudi Arabia, resulting in an attack rate among American pilgrims of 640 per 100,000. To determine risk factors for carriage, throat cultures were taken from passengers arriving on four consecutive flights from Saudi Arabia to the United States. Pilgrims were more likely to be group A meningococcal carriers than were nonpilgrims (relative risk, 11.1; 95% confidence interval, 3.7 to 33.1). Smoking, crowding, and meningococcal vaccination were not significantly associated with group A carriage. Pilgrims complaining of recent fever or sore throat, however, were more likely to be group A carriers, consistent with previous reports linking carriage and disease to preceding viral infections. Serogrouping of invasive meningococcal isolates can be used to monitor for indigenous transmission of this unusual strain in the United States, and we recommend routine vaccination of pilgrims to prevent future outbreaks of meningococcal disease.
Insights
Pilgrims undertaking the annual Mecca pilgrimage were significantly more likely to carry group A meningococcal bacteria. This finding highlights the need for routine vaccination to prevent future meningitis outbreaks.
Area of Science:
- Epidemiology
- Infectious Diseases
- Microbiology
Background:
- An outbreak of group A meningococcal meningitis occurred during the 1987 Mecca pilgrimage.
- This resulted in a high attack rate among American pilgrims (640 per 100,000).
Purpose of the Study:
- To identify risk factors associated with group A meningococcal carriage among pilgrims.
- To understand transmission dynamics during mass gatherings.
Main Methods:
- Throat cultures were collected from passengers on four flights arriving in the US from Saudi Arabia.
- Carriage rates were compared between pilgrims and non-pilgrims.
Main Results:
- Pilgrims showed a significantly higher likelihood of being group A meningococcal carriers (relative risk, 11.1).
- Recent fever or sore throat was associated with increased carriage, suggesting a link to preceding viral infections.
- Smoking, crowding, and vaccination status were not significantly associated with carriage.
Conclusions:
- The study identified pilgrims as a high-risk group for group A meningococcal carriage.
- Routine vaccination of pilgrims is recommended to prevent future outbreaks.
- Monitoring meningococcal isolates in the US is crucial for detecting indigenous transmission of unusual strains.