Protection for pilgrims and travellers

Meningococcal infection can cause meningitis, septicaemia or both. Five strains of meningococcal bacteria (A, B, C, W135 and Y) cause most cases. Although it occurs in all countries, it is much more common in certain areas. There are epidemics in the ‘meningitis belt’ of sub-Saharan Africa, usually due to meningococcal A or W135 bacteria, and from time to time there are outbreaks in other countries.

Large epidemics of meningococcal disease have been linked to the Hajj pilgrimage, at first due to A-strain and then in 2000/2001 to W135[1]. Cases of meningococcal disease also occurred world-wide after pilgrims returned to their own countries[2].

Because of these epidemics, quadrivalent ACWY vaccination has been a compulsory entry requirement into Saudi Arabia for pilgrims on Hajj and Umrah, and for other travellers in Hajj season since 2002. It protects against meningitis and septicaemia caused by four different strains: A, C, W135 and Y. Vaccination is also recommended for travel to sub-Saharan Africa and certain other countries, especially if travellers will be living or working with local people or visiting during an outbreak. An up-to-date list of countries with potential risk can be obtained from www.nathnac.org.

Pilgrims on Hajj or Umrah are required to present a certificate of vaccination with ACWY, issued at least 10 days, but not more than 3 years before arrival. This also applies to seasonal workers in Hajj areas.

What vaccines are available?

There are three ACWY vaccines available. Menveo® and Nimenrix® are the most advanced vaccines, called ‘conjugate’ vaccines (see box right), ACWY Vax® is an older vaccine that does not work very well in young children. Although all vaccines are suitable for travel, the Department of Health recommends that children over 5 years of age and adults are vaccinated with a conjugate vaccine because they provide better and longer lasting protection. Children under 5 should always be vaccinated with conjugate vaccines. Those over 1 year of age should receive a single dose of either Nimenrix® or Menveo®. Babies under one year of age, should receive two doses of Menveo® one month apart for protection[3].

The Muslim Council of Britain (MCB) have set up a national network of vaccination clinics in England, Scotland and Wales where Menveo® is offered to pilgrims travelling on Hajj or Umrah at a reduced price of no more than £35. This cost includes the cost of the vaccine, administration and the certificate. For more information, or to find your nearest clinic visit www.mcb-vac.co.uk or call 08455 521 4160. The MCB network of vaccination clinics doesn’t cover Northern Ireland. GP practices and travel clinics can be contacted for information on vaccination.



Safety and acceptability

The ingredients of both the older polysaccharide vaccine and the newer conjugate vaccines have been in use for many years. Although mild side effects are fairly common, including pain where the vaccine was injected, and sometimes headache, or nausea, these reactions are similar to the reactions caused by routine vaccines.

Menveo® has been certified as Halal by the Indonesian Council of Ulama and the Islamic Services of America. Nimenrix® has been certified as Halal by the Halal Food Council of Europe.

Know the symptoms

Remember there are strains of meningitis that cannot be prevented, so it is important to know the symptoms to look out for, because early treatment saves lives.

Where can I go for further information and support?

Meningitis Research Foundation has a free information service called MeningitisWise, operating 365 days a year.

We provide audio and written information about symptoms and about quadrivalent vaccine for pilgrims on Hajj in many languages including Arabic, Bengali (Sylheti), Gujarati, Punjabi, Somali, Turkish and Urdu here.

An interpretation service in 150 languages is available through the helpline on Freefone 080 8800 3344.

Can you catch meningitis and septicaemia from other travellers on the same aeroplane, ship, bus, or train or in the same hotel or resort?

Getting meningitis and septicaemia from this sort of contact is unlikely. While at least 10% of the people you meet every day carry meningococcal bacteria in the back of their nose and throat, usually, this causes no harm. It is never possible to be completely certain that bacteria will not be transmitted, but the risk in these settings not generally any higher than in every day situations where contact with other people is neither intimate nor prolonged.

Can you catch meningitis and septicaemia from recycled air in air-conditioning systems?

Meningococcal bacteria are very fragile and can only live outside the body for a few moments. It is therefore not an airborne disease, and cannot linger in the air or on objects.

References
  1. Lingappa, J.R., et al., Serogroup W-135 meningococcal disease during the Hajj, 2000. Emerg Infect Dis, 2003. 9(6): p. 665-71.
  2. Hahne, S.J., et al., W135 meningococcal disease in England and Wales associated with Hajj 2000 and 2001. Lancet, 2002. 359(9306): p. 582-3.
  3. 'Green Book'. Department of Health. Immunisation against infectious diseases. Chapter 22: Meningococcal. Updated April 2011. http://www.dh.gov.uk/en/Publichealth/Healthprotection/Immunisation/Greenbook/DH_4097254.
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Conjugate Vaccines

Conjugate vaccines are made by linking part of the bacteria’s sugar coat to a protein. This allows the immune system to recognise and attack bacteria with the same sugar coat when they enter the body. Conjugate vaccines are effective in babies as young as 2 months of age and trigger a long-lasting immune response.