Mitigating the risk of invasive meningococcal disease in the umrah setting: Epidemiology, surveillance, and vaccination strategies

Background:Invasive meningococcal disease (IMD) poses a persistent public health challenge during religious mass gatherings, particularly the Umrah pilgrimage in Makkah, Saudi Arabia, which occurs year-round. Despite mandatory quadrivalent MenACWY vaccination, IMD cases continue to emerge, often linked to unvaccinated international pilgrims.Methods:This study reviewed IMD epidemiology and surveillance data related to Umrah, focusing on vaccination coverage, laboratory-confirmed cases, and public health interventions conducted during the 2025 Ramadan season. Surveillance strategies, carriage assessments, and vaccination campaigns targeting high-risk occupational groups were analysed. International reports and genomic data were also examined to assess cross-border transmission risks.Results:During Ramadan 2025, confirmed IMD cases were reported among unvaccinated international Umrah pilgrims, with serogroup W identified in sequenced samples. Most cases occurred in male pilgrims from countries such as Sri Lanka, India, and Indonesia, with full recovery and no local transmission. National campaigns vaccinated over 20,000 high-risk workers and conducted more than 2,700 oropharyngeal swabs, all testing negative for N. meningitidis. Despite robust national policies, gaps remain due to inconsistent global vaccine practices, particularly the use of polysaccharide vaccines which fail to reduce bacterial carriage.Conclusions:Saudi Arabia’s surveillance and vaccination measures have effectively contained IMD during Umrah. However, international disparities in vaccination coverage and enforcement remain a threat. Enhancing global pre-travel vaccination enforcement, prioritising conjugate vaccines, expanding surveillance, and fostering international data sharing are critical. Lessons from the Umrah context can inform health policies for other mass gatherings and support the global goal of defeating meningitis by 2030