Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-14T22:05:17.964Z Has data issue: false hasContentIssue false
  • English
  • Français

Epidemiological investigation of an outbreak of meningococcal meningitis in Makkah (Mecca), Saudi Arabia, 1992

Published online by Cambridge University Press:  15 May 2009

Y. M. Al-Gahtani ,
H. E. El Bushra ,
S. M. Al-Qarawi ,
A. A. Al-Zubaidi  and
R. E. Fontaine
Y. M. Al-Gahtani
Affiliation:
Field Epidemiology Training Program, Department of Preventive Medicine, Ministry of Health, Riyadh, Saudi Arabia
H. E. El Bushra*
Affiliation:
Field Epidemiology Training Program, Department of Preventive Medicine, Ministry of Health, Riyadh, Saudi Arabia
S. M. Al-Qarawi
Affiliation:
Field Epidemiology Training Program, Department of Preventive Medicine, Ministry of Health, Riyadh, Saudi Arabia
A. A. Al-Zubaidi
Affiliation:
Field Epidemiology Training Program, Department of Preventive Medicine, Ministry of Health, Riyadh, Saudi Arabia
R. E. Fontaine
Affiliation:
Field Epidemiology Training Program, Department of Preventive Medicine, Ministry of Health, Riyadh, Saudi Arabia Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
*
* For correspondence and reprints: Dr H. E. El Bushra, P.O. Box 62281, Riyadh 11585, Kingdom of Saudi Arabia
Rights & Permissions [Opens in a new window]

Summary

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

During March and April of 1992, the health surveillance system began detecting increasing numbers of cases of meningococcal disease (MCD) in the Islamic holy city of Makkah (Mecca). We identified 102 bacteriologically confirmed cases (CC) and 80 suspected cases (SC) of MCD. Neisseria meningitidis was identified as Group A. III-1 clone. The ratio of male:female cases was 2·9:1. All age groups of males were affected. There was only one case among women aged 10–30; 50% of the adult female cases were 55 or older. The case-fatality ratio (CFR) was 14·7% among CC. Pakistanis, who comprised about one-third of the CC. had a CFR of 26·7%. Fifty-nine percent of CC were religious visitors. CC in residents were most common in persons living near the Holy Mosque (Haram), where the carriage rate reached 86%. A mass vaccination program against MCD was instituted, using AC bivalent meningococcal vaccine (MCV). An abrupt drop, from a mean of 15 CC per week to 2 CC per week (only in visitors), coincided with vaccinating 600000 persons over 2 weeks. Makkah residents who had been vaccinated against MCD were less likely to have contracted MCD (OR = 0·17, 95% CI: 0·06–0·50). MCV was of no significant protective value if it had been administered 5 years before the outbreak. The main reason for not being vaccinated as stated by both cases (71%) and controls (45%) was not knowing about the disease. The age and sex differences probably relate to differences in exposures to crowded conditions. Health education should illuminate the seriousness of the disease and the importance of vaccination.

Type
Research Article
Information
Epidemiology & Infection , Volume 115 , Issue 3 , December 1995 , pp. 399 - 409
Copyright
Copyright © Cambridge University Press 1995

References

1.Moore, PS, Reeves, MW, Schwartz, B, Gellin, BG, Broome, CV, Intercontinental spread of an epidemic group A Neisseria meningitidis strain. Lancet 1989; ii: 260–3.CrossRefGoogle Scholar
2.Salih, MA, Ahmed, HS, Karrar, ZA et al. , Features of a large epidemic of group A meningococcal meningitis in Khartoum, Sudan in 1988. Scand J Infect Dis 1990; 22: 161–70.CrossRefGoogle Scholar
3.CDC. Epidemic meningococcal disease – Kenya and Tanzania: recommendations for travelers, 1990. MMWR 1990; 39: 13–4.Google Scholar
4.CDC. Meningococcal disease among travelers returning from Saudi Arabia. MMWR 1987; 33: 559.Google Scholar
5.Novelli, VM, Lewis, RG, Dawood, ST. Epidemic group A meningococcal disease in Haj pilgrims. Lancet 1987; ii: 863.CrossRefGoogle Scholar
6.Wahdan, MH. Epidemiology of meningococcal meningitis: an overview of the situation in the eastern Mediterranean region. Intercountry meeting on preparedness and response to meningococcal meningitis outbreaks. Damascus, 02 4–7, 1989. (WHO: EM/INC.MTG.PPD.REPNMO/4).Google Scholar
7.Ministry of Health Annual Health Report. Saudi Arabia. 1987 (1407 Hijra), 279.Google Scholar
8.Ministry of Health Annual Health Report. Saudi Arabia. 1987 (1407 Hijra), 207.Google Scholar
9.WHO. Vaccination requirements: pilgrimage to Mecca (Hajj). Weekly Epidemiol Rec 1994; 69: 17.Google Scholar
10.Al-Amin, EO. Meningitis in children in Almadinah AlMunowar. Ann Saud Med 1992; 12: 321–2.Google Scholar
11. Meteorological and Environmental Protection Administration (MEPA). Ministry of Defense and Aviation, Kingdom of Saudi Arabia.Google Scholar
12.Dean, AG, Dean, JA, Burton, AH, Dicker, RC. Epi Info, Version 5·01b wordprocessing, database, and statistics program for epidemiology on microcomputers. Stone Mountain, GA: USD Incorporated, 1990.Google Scholar
13.Colton, T. Inference on means. In: Statistics in medicine. Boston: Little, Brown and Company, 1974: 99–150.Google Scholar
14.Noah, ND. Transmissible agents. In: Holland, WW, Deteles, R, Knox, G, eds. Oxford textbook of public health, 2nd edn, vol 2. OxfordUniversity Press, 1991: 417–34.Google Scholar
15.Moore, PS, Harrison, LH, Telzak, EE, Ajello, GW, Broome, CV. Group A meningococcal carriage in travelers returning from Saudi Arabia. JAMA 1988; 260: 2686–9.Google Scholar
16.Cochi, SL, Markowitz, LE, Joshi, DD et al. , Control of epidemic group A meningococcal meningitis in Nepal. Int J Epidemiol 1987; 16: 91–7.Google Scholar
17.Binkin, N, Band, J. Epidemic of meningococcal meningitis in Bamako, Mali: Epidemiologic features and analysis of vaccine efficacy. Lancet 1982, ii: 315–8.CrossRefGoogle Scholar
18.Al-Hamdan, NA, Mawlawi, M. Meningococcal meningitis vaccination coverage in Makkah 1413 H (1993). Paper presented at a Symposium on Health Problems During Hajj. May 18, 1993. Hera general Hospital, Makkah (Mecca), Saudi Arabia. Sponsored by Directorate of Health Affairs, Makkah. Saudi Arabia.Google Scholar
19.Mawlawi, M, El Bushra, HE, Fontaine, RE, Afif, H. Meningococcal meningitis in Jeddah, Saudi Arabia, 1992. Paper presented at the Eleventh Annual Meeting of the International Clinical Epidemiology Network with participation of the Field Epidemiology Training Program (INCLEN XI) in Cairo, Egypt (January 24–29, 1993) and the Epidemic Intelligence Service (EIS) 42nd Annual Conference (April 19–23, 1993) Centers for Disease Control and Prevention, Atlanta, GA, U.S.A.Google Scholar