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Carriage of N. meningitidis at the mass gatherings

The Hajj and Umrah religious mass gatherings in the Kingdom of Saudi Arabia (KSA) are a case in point. These events annually draw millions of Muslims from over 180 different countries to the holy cities of Mecca and Medina for the pilgrimages. The prevention of meningococcal disease during Hajj and Umrah is of the utmost importance for global health security, yet it is extremely challenging given the large numbers of pilgrims participating, the different disease epidemiology profiles in their countries of origin, and the crowded conditions during these events. Hajj and Umrah promote the acquisition of meningococcal carriage and also disease transmission, and have historically been linked to a number of local and international meningococcal outbreaks.

There are several risk factors associated with meningococcal carriage. These include crowded conditions (e.g. military barracks, dormitories, events), travel to endemic areas, personal behaviors(e.g. coughing, smoking). In this context, mass gatherings such as the Hajj and Umrah are very relevant. These events are characterized by heavily overcrowded conditions of a pilgrim population originating from diverse geographical areas. These pilgrims all live for extended periods of time in close proximity to each other, with shared facilities, and perform exhausting religious rites. These are optimal conditions for meningococcal exposure and colonization of susceptible individuals and carrier-to-carrier acquisition of strains, as well as increased rate of new carrier acquisition. Local data show that the carriage rate of N. meningitidis among the population is higher in cities hosting the Hajj and Umrah mass gatherings compared to other regions of KSA.

Carriage studies conducted on Hajj and Umrah pilgrims have shown a wide variety of N. meningitidis serogroups to be circulating during these mass gatherings.

Saudi ministry of health requirements

Vaccination Requirements and Recommendations for International Travelers to and from Saudi Arabia
Visit: https://www.moh.gov.sa/HealthAwareness/Pilgrims-Health/Documents/Hajj-Health-Requirements-English-language.pdf