The hajj, the Islamic pilgrimage to Mecca, is the largest annual gathering of people in the world, drawing millions from more than 180 countries3. The massive size and diversity of this event, along with the challenges of pilgrimage– like extreme heat, crowded accommodations, inadequately prepared or stored food, and the advanced age of many pilgrims– makes it a an ideal environment for disease transmission1.
While no major epidemics have come in the wake of the hajj, there have been several related outbreaks of Neisseria meningitides, one of the causative agents of bacterial meningitis and meningococcal disease1,2,3. In response, the Kingdom of Saudi Arabia’s health ministry developed a three pronged approach to disease prevention: 1) compulsory vaccination for all pilgrims, 2) annual vaccination campaigns for people living at pilgrimage sites, and 3) compulsory antibiotic treatment for pilgrims from sub-Saharan Africa, a region with a high incidence of meningitis referred to as the “meningitis belt”1.
These precautions are critical; after they were relaxed in 1999, the disease bounced back. There were 1,300 and 1,109 hajj-related cases of Neisseria meningitides in 2000 and 2001, respectively1. This should serve as a warning to other nations afflicted by the disease, like the US, where there are about 4,100 cases, including 500 deaths, from meningitis each year4. The best offense is a good defense.
Cause: Meningitis is caused by bacteria, viruses, fungi, or parasites infiltrating the fluid surrounding the brain and spinal cord and causing inflammation in the meninges (the membranes that cover the brain and spinal cord). Bacterial meningitis can be transmitted person-to-person through contact with respiratory and throat secretions (aka spit), and, in the case of Listeria monocytogenes, through contaminated food. While bacterial and viral meningitis are readily spread, they are unlikely to cause disease in healthy adults; many people contract the offending pathogens without getting sick. Disease symptoms typically emerge within a week4.
Consequence: The classic triumvirate of symptoms includes the sudden onset of fever, headache, and a stiff neck. People suffering from the disease may also experience nausea, vomiting, confusion, photophobia (increased sensitivity to light), loss of appetite, and lethargy. In severe cases, it can cause seizures or coma. Bacterial meningitis is usually serious, and recovered patients may have permanent complications from the disease, including hearing loss, brain damage, and learning disabilities4.
Cure: Treatment depends on the cause of the disease. There is no treatment for viral or parasitic meningitis; people who fall sick with viral meningitis usually get better on their own within 10 days, while nearly all cases of parasitic meningitis have been fatal. Bacterial and fungal meningitis can be effectively treated with antibiotics and antifungal medications, and early treatment with antibiotics reduces the fatality rate of bacterial meningitis to less than 15%. Prevention is critical; the most effective way to ward off the disease is to complete the recommended vaccine schedule, which protects from common agents of bacterial and viral meningitis4.
- Ahmed, QA, YM Arabi, & ZA Memish. (2006). Health risks at the Hajj. Lancet, 367:1008-1015.
- Khalil, MKM, & R Borrow. (2009). Serogroup B meningococcal disease during Hajj: preparing for the worst scenario. Travel Medicine and Infectious Disease, 7:231-234.
- Memish, ZA, GM Stephens, R Steffen, & QA Ahmed. (2012). Emergence of medicine for mass gatherings: lessons from the Hajj. Lancet Infectious Disease, 12:56-65.
- “Meningitis”. Centers for Disease Control and Prevention. 26 November 2014. Web. 23 December 2014.
Image source: Creative Commons, http://commons.wikimedia.org/wiki/File:The_Hajj_kicks_into_full_gear_-_Flickr_-_Al_Jazeera_English_(8).jpg