Meningococcal carriage among Hajj pilgrims, risk factors for carriage and records of vaccination: a study of pilgrims to Mecca

Abrar Alasmari*, Joanna Houghton, Brian Greenwood, David Heymann, Phil Edwards, Heidi Larson, Abdullah Assiri, Fathia Ben-Rached, Arnab Pain, Ron Behrens, Amaya Bustinduy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objective: The Saudi government requires that all pilgrims receive a quadrivalent meningococcal vaccine at least 10 days before the Hajj. We conducted a study to determine the uptake of meningococcal vaccine and antibiotic use. We also investigated risk factors of meningococcal carriage and carriage of Neisseria meningitidis pathogenic serogroups A, C, W and Y. Methods: A cross-sectional oropharyngeal carriage survey was conducted in 2973 Hajj pilgrims in September 2017. A real-time polymerase chain reaction (rt-PCR) assay was used to identify N. meningitidis from the oropharyngeal swabs. A questionnaire investigated potential risk factors for carriage of N. meningitidis. Results: Two thousand two hundred forty nine oropharyngeal swabs were obtained. The overall prevalence of carriage of N. meningitidis was 4.6% (95% CI: 3.4%–6%). Carriage of pathogenic serogroups was not associated significantly with any of the meningococcal risk factors evaluated. 77% of pilgrims were vaccinated but 22.58 % said they were carrying unofficial vaccination cards. Conclusion: Carriage of serogroups A, C, W and Y was not significantly associated with any of the risk factors investigated. Almost a quarter of pilgrims were unlikely to have been vaccinated, highlighting a need to strengthen compliance with the current policy of vaccination to prevent meningococcal disease outbreaks during and after the Hajj.

Original languageEnglish (US)
Pages (from-to)453-461
Number of pages9
JournalTropical Medicine and International Health
Issue number4
StatePublished - Apr 2021

Bibliographical note

Funding Information:
We gratefully acknowledge the permission and assistance given to conduct this study provided by the Health Surveillance Centres at King Abdulaziz International Airport and its head Ayman Samman, as well as Dr. Homoud Algarni and all the medical students who assisted with the data collection. We would like to acknowledge the valuable advice and support provide by Ray Borrow, Steve Gray and Chrissy Roberts. This work was partially supported by a faculty baseline fund (BAS/1/1020‐01‐01) from the King Abdullah University of Science and Technology (KAUST) to AP and by the Royal Embassy of Saudi Arabia Cultural Bureau in London, United Kingdom.

Publisher Copyright:
© 2021 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd


  • antibiotic
  • Hajj
  • meningococcal
  • Neisseria meningitides
  • pharyngeal carriage
  • vaccination

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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