Abstract
Meningococcal disease is a systemic infection caused by a bacterium Neisseria meningitidis. There are an estimated 1.2 million worldwide cases of invasive meningococcal disease every year, resulting in up to 135,000 fatalities. Incidence of meningococcal disease fluctuates globally, with the highest annual incidence found in the African meningitis belt. High-risk behaviors such as active and passive smoking, intimate relationships (e.g., kissing), and semi-closed crowded settings (e.g., residence in university halls, military barracks, and bar patronage) perpetuate transmission of the organism.
Mass gatherings can serve as epicenters for disease transmission. Hajj is the largest annual mass gathering that brings millions of Muslim pilgrims from around the world to amass in Makkah, Saudi Arabia. Intense congestion during Hajj, as well as shared accommodation and high-risk personal behaviors, magnify disease transmission including meningococcal disease. This pilgrimage is the most notable mass gathering and frequently magnifies meningococcal transmission and outbreaks. An outbreak in 1987 caused by serogroup A affected nearly 2000 individuals globally. A second outbreak caused by serogroup W occurred in 2000–2001, affecting more than 2400 individuals across the globe. Invasive meningococcal disease outbreaks in non-Hajj/Umrah mass gatherings have been reported in university hall residents, military establishments, refugee camps, and sports and leisure events; these were mainly caused by serogroups A and C and also led to an international spread. Mass immunization with multivariate vaccines and antibiotic chemoprophylaxis is a mainstay for invasive meningococcal disease prevention, successfully reducing morbidity and mortality. Without prevention, such mass gatherings can influence global meningococcal epidemiology, likely by introducing invasive N. meningitidis strains to other regions.
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Sebastian, S., Badahdah, AM., Khatami, A., Rashid, H. (2020). Meningococcal Disease During Hajj, Umrah, and Other Mass Gatherings. In: Laher, I. (eds) Handbook of Healthcare in the Arab World. Springer, Cham. https://doi.org/10.1007/978-3-319-74365-3_52-1
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