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Meningococcal Disease Among Travelers Returning From Saudi Arabia
Since August 9, 1987, two definite and three probable cases of
meningococcal disease caused by Neisseria meningitidis serogroup A
have been reported among the 1,250 pilgrims returning to the United
States from Mecca and Medina, Saudi Arabia. Onset of symptoms has
been
within 4 days of return to the United States. An additional
traveler,
who was not a pilgrim, was hospitalized recently with serogroup A
meningococcal meningitis 4 days after her return to the United
States.
This woman had not traveled to Mecca or Medina, but had spent 5
weeks
in Jedda, where she had reportedly had some contact with pilgrims.
Pilgrims returning on all recent direct flights from Jedda to New
York
(August 18, 20, and 25) received prophylaxis with rifampin at the
New
York airport.
Reported by: HR Ragazzoni, DVM, New Jersey State Dept of Health.
New
York Quarantine Station; S Schultz, MD, New York City Dept of
Health.
Div of Field Svcs, Epidemiology Program Office; Div of Quarantine,
Center for Prevention Svcs; Meningitis and Special Pathogens Br,
Div
of Bacterial Diseases, Center for Infectious Diseases, CDC. Editorial Note
Editorial Note: An estimated 3,000 cases of invasive meningococcal
disease occur in the United States each year. Two to three percent
of
these are caused by N. meningitidis serogroup A. No large serogroup
A
meningococcal epidemics have occurred in the United States since
1946,
and it is unlikely that serogroup A carriers returning from Saudi
Arabia will have an impact on the rate of disease among the general
U.S. population.
Pilgrims returning from Saudi Arabia following this year's
pilgrimage should receive rifampin chemoprophylaxis. Since the risk
of
disease rapidly decreases as the time following exposure increases,
rifampin is recommended only if it can be given within 1 week of a
person's leaving Saudi Arabia. Rifampin is not recommended for
other
travelers, unless they have been in close contact with a patient
with
meningococcal meningitis.
This year's pilgrimage is now over, and associated crowded
conditions have subsided. However, while the potential risk to
persons
now traveling to Saudi Arabia is not known, it is likely that the
serogroup A strain is circulating in the population. Therefore, it
would be prudent for future travelers to Saudi Arabia to receive
the
meningococcal vaccine at least 10 days prior to departure. The only
vaccine licensed in the United States is manufactured by Connaught
Laboratories; it is quadrivalent and contains serogroups A, C, Y,
and
W-135 (1). If local distributors are not able to supply the
vaccine,
Connaught Laboratories may be contacted at 1-800-VACCINE.
Physicians are encouraged to report additional cases among
returning travelers from Saudi Arabia to their state and local
health
departments and to forward the meningococcal isolates to CDC
through
their state public health laboratories.
References
Immunization Practices Advisory Committee. Meningococcal
vaccines.
MMWR 1985;34: 255-9.
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