Meningococcal Disease in Travelers: Vaccination Recommendations

The object of the study was to determine the incidence rate of meningococcal disease in travelers originating in industrialized countries and visiting developing countries. Subjects were intercontinental travelers with meningococcal diseases acquired from 1986 to 1989. Health authorities in 108 countries were contacted; data obtained by postal survey were analyzed. The 56 replying health authorities reported 13 cases of meningococcal disease in tourist or business persons as well as 40 primary and 26 secondary cases in pilgrims in Mecca. The majority of cases were due to serogroup A. The case fatality rate in both groups of patients slightly exceeded 20%. Among the tourists and business persons, several patients had stayed in hotels; in several the onset of symptoms occurred during the flight home. The incidence rate per month of stay was estimated to be 0.4 per million travelers in this group, but 2000 per million in pilgrims to Mecca. Vaccination of pilgrims to Mecca is highly recommended, presently even compulsory. For the usual traveler to endemic countries, the risk of infection abroad seems not to exceed the one at home, thus vaccination may be limited to high-risk groups, such as trekkers.