CDC warns Muslim pilgrims to Saudi Arabia of meningitis outbreak

Muslim pilgrims attending the annual Hajj could be at risk for meningitis due to outbreaks occurring in Saudi Arabia, U.S. health officials warned this week.

Twelve cases of meningitis linked to Umrah travel to Saudi Arabia have been reported to national health agencies in three countries, the CDC said in a travel health notice.

Umrah is an Islamic pilgrimage to Mecca in Saudi Arabia that can be performed any time of the year, the CDC said.

The Hajj is an annual pilgrimage, scheduled to occur June 14 to 19 this year, in which between 2 to 3 million Muslims travel to Mecca.

Saudi Arabia requires all Hajj and Umrah pilgrims older than 1 year to be vaccinated for meningitis, the CDC noted.

Nevertheless, nine of the meningitis cases were unvaccinated, the CDC said.

Meningitis is a rare but severe disease that kills 10% to 15% of patients, even if they're receiving antibiotics, the CDC said.

The infection causes inflammation of the lining of the brain and spinal cord. Symptoms can include fever, headache, stiff neck, nausea, vomiting, light sensitivity and altered mental status, the CDC said.

The infection also can spread into the bloodstream, with additional symptoms including chills, fatigue, cold hands and feet, severe aches and pains, rapid breathing, diarrhea and a dark purple rash.

Symptoms worsen rapidly and can become life-threatening within hours, the CDC noted. Survivors might wind up deaf or require amputation.

There have been five cases reported in the United States, four cases in France and three cases in the United Kingdom, the CDC said.

Ten cases involve patients who traveled to Saudi Arabia, and two were in people who had close contact with recent travelers.

Two cases were in children younger than 18, four in young adults ages 18 to 44, four in middle-aged folks ages 45–64, and two in adults aged 65 or older, the CDC said.

In the United States, meningitis vaccination is routinely recommended for teenagers and for travelers to countries where meningitis outbreaks are occurring. This could include a booster dose for folks who had their last vaccination three to five years before.

The CDC is urging doctors to make sure that Muslim patients considering a pilgrimage are fully vaccinated against meningitis.

Doctors also should be on the lookout for symptoms of meningitis among any patients returning to the United States following a pilgrimage to Mecca, the CDC said.

The most recent global outbreak of meningitis associated with travel to Saudi Arabia for Hajj was in 2000–2001, the CDC said.

That outbreak was primarily caused by Neisseria meningitidis serogroup W (NmW), the same bacteria responsible for 10 of the cases in this latest outbreak.

Since 2002, Saudi Arabia has required that international travelers provide documentation of meningitis vaccination, the CDC said.

"Nevertheless, meningococcal vaccination coverage among Umrah travelers is known to be incomplete," the CDC said.