Surveillance for meningococcal carriage by Muslims returning from the Hajj to Hat Yai Airport, Thailand.

This study had three objectives: firstly, it aimed to examine an appropriate model for preventing and controlling the risk of meningococcal disease as a result of an epidemic carrying by returning pilgrims at Hat Yai International Airport; secondly, it aimed to establish the number of meningococcal carriers among pilgrims returning from Saudi Arabia; thirdly, it considered the health problems that arose during the Hajj pilgrimage. A structured questionnaire was used to collect data from 374 pilgrims at the Hat Yai airport checkpoint between March 15th and April 2nd, 2001. Each subject provided a naso-pharyngeal swab and reported on their health status by postcard once they had reached their homes 7-10 days later. It was found that most of the pilgrims were from Satun Province (23%). The average age was 50.5 years (range 20 to 86; SD 12.8). More than half of the pilgrims had some knowledge of meningococcal meningitis. Most, about 80.7%, knew that vaccination against meningococcal infection is required before traveling to Saudi Arabia. About 77.8% were vaccinated at the Provincial Health Office (PHO) in their hometown. Nearly 19% had underlying diseases such as chronic cough, asthma, diabetes, hypertension, headache and rheumatism. During their pilgrimage some were troubled by symptoms of respiratory tract disease, fever and headache. All had negative laboratory results. Only 16.6% returned postcards describing their self-assessed health status. About 30.6% described themselves as healthy. Among those who reported sick, coughs, sore throats and stomach aches were prevalent. Health education and public information about vaccine need to be strengthened. The best place to get the vaccination is their hometown PHO. Trained health personnel, instead of tour leaders or guides, should pay attention to the health of the pilgrims. The tour leaders are an important target group for improved health knowledge because most pilgrims will trust and follow them. Even though there were negative laboratory results, it is worth having a good surveillance system for meningococcal meningitis in order to prevent epidemics and reduce mortality among returning pilgrims.