Memish Ziad A, Al-Tawfiq Jaffar A, Almasri Malak, Azhar Esam I, Yasir Muhammad, Al-Saeed Muneera S, Ben Helaby Huda, Borrow Ray, Turkistani Abdulhafeez, Assiri Abdallah
Ministry of Health, Riyadh, Saudi Arabia; Alfaisal University, College of Medicine, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA.
Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA.
Vaccine. 2017 Apr 25;35(18):2473-2478. doi: 10.1016/j.vaccine.2017.03.027. Epub 2017 Mar 23.
The annual Muslim pilgrimage has the potential of increase risk for acquisition of Neisseria meningitidis. Here, we evaluate the Hajj impact on the prevalence of N. meningitidis carriage in a paired and non-paired cohort of pilgrims. Secondary objectives were to calculate the compliance with recommended vaccination.
This is a prospective paired (arriving and departing), non-paired arriving and non-paired departing cohort study with the collection of nasopharyngeal samples at the start and the end of the Hajj.
The study included unpaired arriving pilgrims at King Abdul Aziz International Airport (N=1055), unpaired departing cohort (N=373), and a paired cohort (N=628) who were tested on arrival and departure. Meningococcal vaccination was received by all pilgrims, 98.2% received quadrivalent polysaccharide vaccine (ACWY), and 1.8% received meningococcal quadrivalent conjugate vaccine (MCV4). Only 1.61% and 23.03% received pneumococcal and influenza vaccines, respectively. Of the 1055 arriving unpaired pilgrim, 36 (3.4%) tested positive for nasopharyngeal carriage of N. meningitidis, and 24 (66.7%) of these were serogroup B, the remainder were non-groupable. Haemophilus influenza was detected among 45 (4.3%), and 11 (1%) carriers were positive for both N. meningitidis and H. influenzae. Out of 373 in the unpaired departing cohort, 6 (1.61%) tested positive for N. meningitidis, and 34 (9.1%) were positive for H. influenzae. Of the 628 paired cohort pilgrims, 36 (5.7%) pilgrims were positive for N. meningitidis at arrival and 16 (2.5%) pilgrims were positive after the hajj.
This the largest study of the epidemiology of N. meningitidis among pilgrims. The study showed a significant difference in the carriage between pilgrims from high endemicity and other pilgrims with a predominance of serogroup B. The continued use of ciprofloxacin as prophylactic antibiotics should be reconsidered as well as the consideration to add serogroup B as a required vaccination.
每年的穆斯林朝圣活动有可能增加感染脑膜炎奈瑟菌的风险。在此，我们评估朝觐对成对和不成对朝圣者队列中脑膜炎奈瑟菌携带率的影响。次要目标是计算推荐疫苗接种的依从性。
这是一项前瞻性的成对（抵达和离开）、不成对抵达和不成对离开队列研究，在朝觐开始和结束时收集鼻咽样本。
该研究包括在阿卜杜勒·阿齐兹国王国际机场的不成对抵达朝圣者（N = 1055）、不成对离开队列（N = 373）以及在抵达和离开时接受检测的成对队列（N = 628）。所有朝圣者均接种了脑膜炎球菌疫苗，98.2%接种了四价多糖疫苗（ACWY），1.8%接种了脑膜炎球菌四价结合疫苗（MCV4）。分别只有1.61%和23.03%的人接种了肺炎球菌疫苗和流感疫苗。在1055名抵达的不成对朝圣者中，36人（3.4%）鼻咽部脑膜炎奈瑟菌携带检测呈阳性，其中24人（66.7%）为B群，其余为不可分型。45人（4.3%）检测出流感嗜血杆菌，11名（1%）携带者同时对脑膜炎奈瑟菌和流感嗜血杆菌呈阳性。在373名不成对离开队列中，6人（1.61%）脑膜炎奈瑟菌检测呈阳性，34人（9.1%）流感嗜血杆菌呈阳性。在628名成对队列朝圣者中，36人（5.7%）抵达时脑膜炎奈瑟菌呈阳性，16人（2.5%）朝觐后呈阳性。
这是对朝圣者中脑膜炎奈瑟菌流行病学的最大规模研究。该研究显示，高流行地区的朝圣者与其他朝圣者之间的携带情况存在显著差异，且以B群为主。应重新考虑继续使用环丙沙星作为预防性抗生素，以及考虑将B群作为必需接种疫苗。
