Invasive meningococcal disease cases reported in US, Europe, linked to travel to Saudi Arabia

Twelve cases of invasive meningococcal disease (IMD) have been reported in France (4), the United Kingdom (UK) (3), and the United States (US) (5) in travelers to Saudi Arabia (KSA) as of May 17.

Photo by Sardar Faizan on Unsplash

Almost all cases reported performing Umrah pilgrimage while in the Saudi Arabia. The majority of cases belong to meningococcus serogroup W and have no history of meningococcus vaccination.

Meningococcal disease is caused by the bacterium Neisseria meningitidis. The bacterium is often detected in the nasopharynx without causing disease, a situation described as asymptomatic carriage. The bacteria occasionally invade the body and cause meningococcal infection, which is an acute severe bacterial infection. Invasive meningococcal disease (IMD) is a major cause of meningitis and septicemia. The disease often has a rapid progression, with an 8–15% case-fatality ratio. The highest incidence occurs in young children, with a second disease peak among adolescents and young adults. 

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European health authorities recommends the following measures to EU/EEA public health authorities: 

• Ensure that travellers to the Hajj and Umrah zones in KSA eligible for vaccination are counselled to receive the quadrivalent (ACWY) meningococcal vaccine at least 10 days before departure.

• Raise awareness among clinicians for early suspicion of meningitis in returning travellers and include travel history in their assessment of IMD cases, particularly where there has been travel to KSA for religious purposes.

• Appropriately manage newly-detected cases. Early suspicion and treatment, isolation of meningitis cases, identification of close contacts, provision of chemoprophylaxis, and monitoring of close contacts for clinical symptoms for at least 10 days from the last possible exposure are essential for the management of cases. Healthcare workers managing suspected or confirmed cases should follow their national infection, prevention and control protocols.

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• Continue surveillance, including molecular surveillance, as well as antibiotic susceptibility testing of all IMD cases, to inform prevention and control measures. IMD cases, particularly if linked to travel to the Hajj and Umrah zones, should be promptly reported to the EpiPulse platform [through nominated persons] to allow better risk assessment and the provision of updated recommendations.

• Meningococcal isolates should be genotyped by whole genome sequencing and reported to pubmlst.org or to the European Meningococcal Epidemiology in Real Time database (EMERT-II) to allow for the rapid identification and control of multinational clusters. ECDC can provide sequencing support upon request.