The World Health Organization (WHO) said today that more than a dozen cases of invasive meningococcal disease (IMD) have been linked to a religious pilgrimage to Mecca in Saudi Arabia.

In a disease outbreak update, the WHO said Saudi officials reported 11 confirmed cases of IMD on March 13. All 11 cases were associated with pilgrims who had performed Umrah in Saudi Arabia from January 7 to March 12. All case-patients received treatment in Saudi Arabia and have fully recovered.

In addition, officials with the WHO Eastern Mediterranean Regional office reported six isolated cases of IMD among people who had recently returned from Umrah.

IMD is a life-threatening bacterial infection caused by Neisseria meningitidis. Symptoms can include sepsis and meningitis and can progress rapidly without prompt, appropriate treatment. Outbreaks are more likely to occur in settings that promote transmission of infection, such as religious pilgrimages like Hajj and Umrah. 

Low vaccine compliance

The WHO notes that while Saudi Arabia has required quadrivalent (four-strain) meningococcal vaccination prior to traveling to the kingdom for Hajj and Umrah in recent years, vaccination compliance for Umrah has declined over the past 2 years, with only 54% of international Umrah pilgrims complying as of March 10.

"Given the recent notification of these cases linked to Umrah, WHO strongly advises all individuals planning to attend mass gatherings such as Hajj and Umrah to receive vaccination against meningococcal disease at least 10 days prior to travel," the agency said.

Last year, 12 cases of IMD associated with Umrah and/or pilgrimage to Saudi Arabia were reported by US, UK, and French officials.

Mpox activity in African countries continues at a steady pace, with the region averaging about 3,000 new cases each week and the situation intensifying in Uganda, health officials from Africa Centres for Disease Control and Prevention (Africa CDC) said yesterday at a briefing.

Yap Boum, PhD, MPH, deputy incident manager for Africa CDC’s mpox response, said Africa has now received more than 1 million mpox vaccine doses, but officials estimate that the region needs 6.4 million doses over the next 6 months to slow down the spread of the virus. Kenya this week received its first mpox delivery, which consisted about 10,000 doses. 

Striking rise in Uganda

According to Boum, Uganda accounted for 50% of cases over the past week. “This is striking,” he said, adding that Uganda is juggling multiple infectious disease threats, including its Ebola Sudan outbreak and one involving Crimean-Congo hemorrhagic fever. Regarding Ebola, Boum said if no new cases are reported in the weeks ahead, Uganda is on track to declare the event over on April 26. 

Exposure in sexual networks is driving mpox activity in Uganda, which is seeing spread in slums and urban areas. Half of last week’s cases were reported from the cities of Mbarara and Masaka, Boum said, adding that the country is seeing high numbers of deaths in people with underlying health conditions.

In an encouraging development, Uganda received 100,000 more doses of mpox vaccine and immunized 20,000 people in just one week, he said, praising the role of vaccine donors, immunizers, and Ugandans offered the vaccine.

Elsewhere, Boum said steady activity continues in the main hotspot, the Democratic Republic of the Congo (DRC), though testing coverage remains a problem due to insecurity in the eastern part of the country and health funding cuts that have hampered the transport of mpox samples to testing labs.