Meningococcal Meningitis and International Travel

What Is Meningococcal Disease?

Meningococcal disease is a serious bacterial infection caused by Neisseria meningitidis. It can cause meningitis, which is inflammation of the tissues surrounding the brain and spinal cord, or a dangerous bloodstream infection known as meningococcal septicemia.

The bacteria spread through close or prolonged contact with an infected person’s respiratory or throat secretions. Examples include living in the same household, sharing accommodation, kissing, or spending extended time in crowded settings.

The illness can progress rapidly. Common warning signs include sudden fever, severe headache, stiff neck, nausea, vomiting, sensitivity to light, confusion, unusual sleepiness and a dark purple or red rash.

Main Destinations with Increased Risk

Meningococcal disease occurs worldwide, but the highest recurring epidemic risk is found in the African meningitis belt. This region extends across sub-Saharan Africa from Senegal in the west to Ethiopia in the east.

Countries commonly associated with the meningitis belt

The exact boundaries and affected areas can change, but the meningitis belt generally includes all or parts of the following countries:

Meningococcal Vaccines for U.S. Travelers

Several meningococcal vaccines are licensed and available in the United States. The vaccine used for international travel is usually selected according to the destination, the traveler’s age, previous doses and the meningococcal groups causing disease in that region.

Routine meningococcal vaccination in the United States

CDC routinely recommends a MenACWY dose for U.S. adolescents at 11 or 12 years of age, followed by a booster at age 16. Younger children and adults may also need meningococcal vaccination when they have certain medical conditions, face an outbreak risk or plan travel to a high-risk destination.

Previous routine vaccination does not always mean that a traveler remains protected. A booster may be needed when the last MenACWY dose was received several years earlier and the traveler continues to face an increased risk.

When should travelers receive the vaccine?

Travelers should arrange a travel-health consultation as early as possible. The vaccine should generally be administered at least 7 to 10 days before potential exposure so the body has time to develop protective antibodies.

Travelers going to Hajj or Umrah must follow the timing and certificate-validity rules issued by Saudi Arabian authorities. A vaccine given too close to arrival may not satisfy the entry requirement.

Hajj and Umrah Vaccination Requirements

Saudi Arabia requires travelers arriving for Hajj or Umrah to present proof of vaccination with a quadrivalent meningococcal ACWY vaccine. The requirement generally applies to pilgrims one year of age and older.

The certificate must show that the vaccine was administered within the accepted validity period and at least 10 days before arrival. The precise validity period can depend on whether a conjugate or polysaccharide vaccine was used.

Who Should Consider Vaccination?

A healthcare professional may recommend MenACWY vaccination for U.S. travelers who:

• Will visit the African meningitis belt during the dry season.
• Will live or work for an extended period in a high-risk area.
• Plan close contact with local communities in an affected region.
• Will stay in crowded housing, dormitories, camps or military facilities.
• Will attend Hajj or Umrah in Saudi Arabia.
• Will attend a large gathering in an area with active transmission.
• Are traveling to an area experiencing a meningococcal outbreak.
• Have certain medical conditions that increase the risk of severe disease.

How Travelers Can Reduce Their Risk

Vaccination is the most important preventive measure for travelers at increased risk. Because no vaccine prevents every meningococcal infection, sensible respiratory and personal-hygiene precautions remain important.

Symptoms Requiring Emergency Care

Meningococcal disease can become life-threatening within hours. Seek emergency medical care immediately if a traveler develops:

• Sudden high fever.
• Severe headache.
• Stiff or painful neck.
• Confusion, extreme sleepiness or difficulty waking.
• Repeated vomiting.
• Strong sensitivity to light.
• Cold hands and feet, rapid breathing or severe muscle pain.
• A red, purple or bruise-like rash that does not fade when pressed.

Pre-Travel Checklist

• Confirm whether your destination is within the African meningitis belt.
• Check whether your travel dates fall within the December-to-June dry season.
• Review your previous MenACWY vaccination dates.
• Ask whether a booster is needed for continuing travel risk.
• Arrange vaccination at least 7 to 10 days before possible exposure.
• Obtain an official certificate when traveling for Hajj or Umrah.
• Check the latest destination outbreak and entry information.
• Know the symptoms that require immediate emergency care.