Bushra H E, Mawlawi M Y, Fontaine R E, Afif H
Department of Preventive Medicine, Ministry of Health, Riyadh, Saudi Arabia.
East Afr Med J. 1995 Nov;72(11):715-8.
Jeddah is the main point of entry to the holy places in Saudi Arabia. An outbreak of meningococcal disease (MCD) occurred during the fasting lunar month for Muslims, Ramadan (March-April) of 1992. To assess the threat of local spread of MCD within Jeddah, the effects of previous and a mass vaccination programme against MCD during the outbreak, we reviewed the medical records of confirmed cases (CC) of MCD (defined as a bacteriologically confirmed case or a case diagnosed by latex test) and their vaccination status in the last five years before the outbreak. There were 41 CC of meningitis due to Neisseria meningitidis (group A). The ratio of males to females was 4.1:1. Thirty two percent of the cases were religious visitors. About one fourth (22%) of the cases were Pakistani. More than half (57%) of the cases, who were residents of Jeddah, lived in the north-eastern part of the city, as did half of the Pakistani cases. The case-fatality rate among CC was 19.5%. Persons who visited the Makkah (Mecca) during Ramadan were more likely to get the disease than those who did not (odds ratio [OR] = 6.1; 95% confidence interval [CI] 1.4-40.7). Unvaccinated persons were more likely to get the disease than those who were vaccinated against MCD (OR = 13.9; 95% CI 1.8-296). Meningococcal vaccine (MCV) against MCD was effective in preventing the disease. However, MCV was of no protective value if it had been administered more than five years before the outbreak. The reason mentioned most frequently for not being vaccinated by both cases (84%) and controls (57%) was lack of knowledge about the disease. Health education programmes should be strengthened and promoted. A good collaborative surveillance system between Jeddah and other holy cities, especially Makkah, is needed to abort outbreaks among religious visitors and to prevent the spread of MCD outbreaks.
吉达是进入沙特阿拉伯圣地的主要入口。1992年斋月（3月至4月），即穆斯林的禁食月期间，发生了一起脑膜炎球菌病（MCD）疫情。为评估MCD在吉达市内局部传播的威胁、此前及疫情期间大规模MCD疫苗接种计划的效果，我们查阅了MCD确诊病例（CC，定义为细菌学确诊病例或经乳胶试验确诊的病例）的医疗记录及其在疫情爆发前五年内的疫苗接种情况。有41例因A群脑膜炎奈瑟菌引起的脑膜炎确诊病例。男女比例为4.1:1。32%的病例为宗教访客。约四分之一（22%）的病例为巴基斯坦人。吉达居民中超过一半（57%）的病例居住在该市东北部，巴基斯坦病例的这一比例也为一半。确诊病例的病死率为19.5%。斋月期间前往麦加的人比未前往的人更易感染该病（优势比[OR]=6.1；95%置信区间[CI]1.4 - 40.7）。未接种疫苗的人比接种过MCD疫苗的人更易感染该病（OR = 13.9；95%CI 1.8 - 296）。预防MCD的脑膜炎球菌疫苗（MCV）对预防该病有效。然而，如果在疫情爆发前五年以上接种MCV，则没有保护作用。病例（84%）和对照（57%）最常提到的未接种疫苗的原因是对该病缺乏了解。应加强和推广健康教育计划。需要在吉达和其他圣城，尤其是麦加之间建立良好的协作监测系统，以阻止宗教访客中的疫情爆发并防止MCD疫情蔓延。
