Emergencies preparedness, response

2000 - Meningococcal disease in Francen(Update), United Kingdom (Update), Oman, Saudi ARabia, Netherlands

21 April 2000

Disease Outbreak Reported

There have been a number of cases of meningococcal disease which are associated with returnees from the Haj and their close contacts.

France- Update. The number of cases of meningococcal disease associated with pilgrims who have travelled for the Haj has increased, and the total number of cases to date is 14, including 4 deaths. Eleven of the confirmed cases were of meningococcal serogroup W135.

United Kingdom- Update. The number of cases of meningococcal disease linked to pilgrims has increased, and is now 22 with 4 deaths. Twenty of the confirmed cases are of meningococcal serogroup W135 and 1 of N. meningitidis serogroup A. The onset of the last case of meningococcal disease reported to date (in a contact) was on 11 April.

Oman. There have been 12 cases to date, all have recovered. Of these, 3 were pilgrims (2 males aged 40 and 55 years and 1 female aged 60 years) returning from the Haj, and 9 cases were close contacts of those returned from the Haj. The ages of these patients ranged from 6 months to 80 years. The date of onset of the first case was 20 March, and the most recent case was reported on 6 April. Seven of the confirmed cases are of meningococcal serogroup W135 and 2 of Neisseria meningitidis serogroup A.

Saudi Arabia. A total of 199 cases with 55 deaths has been reported since the Haj last month. Bacteriological investigations have revealed N. meningitidis serogroup A in 55 cases, serogroup W135 in 30 and serogroup B in 1 case. A record number of pilgrims (around 1.3 million) travelled to Saudi Arabia for the Haj this year, with an increase in the number from South-East Asia. The health authorities are monitoring the situation closely. Case management and contact tracing are taking place.

Netherlands. There have been 2 confirmed cases and 1 probable case of meningococcal disease in close contacts of pilgrims returning from the Haj. The dates of onset in the confirmed cases were 5 and 6 April. Serogroup W135 Neisseiria meningitidis has been isolated from both.

Meningococcal disease. As with all types of meningococcal disease, early diagnosis and treatment are essential. The symptoms of group W135 meningococcal disease are the same as for other groups of the disease: sudden onset of intense headache, high fever, nausea, and vomiting, photophobia and stiff neck. The most severe clinical form of the disease, meningococcal septicaemia can be presented by abrupt onset, high fever, petechial rash or purpura.

WHO recommends that chemoprophylaxis be given to close contacts of the cases, such as persons sleeping in the same dwelling. In most countries rifampicin is recommended. Immunization against meningococcal disease A+C has been an entry requirement by Saudi Arabia for pilgrims travelling to the Haj. However, the meningococcal A+C vaccine does not protect against group W135 infection.

WHO encourages national reference laboratories to closely monitor meningococcal disease.