Carriage of Neisseria meningitidis Among Umrah Pilgrims: Circulating Serogroups and Antibiotic Resistance

Figures & data

Table 1 Characteristics of the Umrah Pilgrims Enrolled in the Study

Variable	Number	Percentage (%)
Pilgrims enrolled	616
Gender	584
Male	312	53.4
Age (years)	580
≤25	12	2.1
>25–35	52	9.0
>35–45	69	11.9
>45–55	170	29.3
>55–65	184	31.7
>65	93	16.0
Country of residence	611
Africa	325	53.2
Middle East	154	25.2
South Asia	126	20.6
Europe	6	1.0
Level of education	604
No formal education	234	38.7
Primary education	99	16.4
Secondary education	128	21.2
University/higher education	143	23.7
Occupation/status	442
Other occupations	425	95.3
Health worker	11	2.5
Military recruit	6	1.3
Student	4	0.9
Underlying health conditions	606
Yes	197	32.5
Chronic kidney disease	1	0.2
Chronic liver disease	0	0.0
Chronic lung disease	7	1.2
Cardiovascular disease	33	5.4
Hypertension	116	19.1
Cancer	1	0.2
Immunosuppressive illness	0	0.0
Diabetes	106	17.5
Stroke	0	0.0
Travel outside current country of residence in the previous 6 months	610
Yes	36	5.9
Visited KSA in the past year	600
Yes	56	9.3
Reasons for visiting KSA in the past year	53
Hajj	15	28.3
Umrah	36	67.9
Other	6	11.3
Smoking (Current)	611
Yes	50	8.2
Vaccination
Meningococcal	56	100
Pneumococcal	-	-
Yellow fever	55	100
Polio	-	-
Influenza	12	100
Visited/planning to visit Medina	375
Yes	358	95.5
Wore a mask during Umrah	610
Never	601	98.5
Always	1	0.2
Most of the time	1	0.2
Sometimes	5	0.8
Rarely	2	0.3
Shared a room during Umrah	263
Yes	259	98.5
Currently suffusing ILS	598
Yes	207	34.6
Used antibiotics during Umrah	606
Yes	72	11.8
Used antibiotics during the previous week	608
Yes	49	8.0

Abbreviations: KSA, Kingdom of Saudi Arabia; ILS, Influenza-like symptoms.

Figure 1 Country of residence of the enrolled 2019 Umrah pilgrims.

Figure 2 Influenza-like symptoms among the enrolled 2019 Umrah pilgrims.

Table 2 Bacteria Isolated from Oropharyngeal Swabs Obtained from Umrah Pilgrims

		Growth on Selective Media(n = 61)	Carriage Rate Among Pilgrims (n = 616)
Isolate	n	%	%
Neisseria spp.	20	32.8	3.25
Haemophilus influenzae	14	23.0	2.27
Moraxella spp.	10	16.4	1.62
Neisseria lactamica	6	9.8	0.97
Neisseria meningitidis	3	4.9	0.49
Moraxella catarrhalis	3	4.9	0.49
Neisseria cinerea	2	3.3	0.32
Neisseria polysaccharea	2	3.3	0.32
Haemophilus parainfluenzae	1	1.6	0.16

Table 3 Antimicrobial Susceptibility of Neisseria meningitidis Serogroup B Isolated During the Umrah Study

Antibiotic	MIC (µg/mL)	Interpretation
Benzylpenicillin	0.064	Sensitive^E
Ampicillin	0.094	Sensitive^E
Amoxicillin	0.023	Sensitive^E
Cefotaxime	0.016	Sensitive^E
Ceftriaxone	0.016	Sensitive^E
Ciprofloxacin	0.04	Resistant^E
Rifampicin	0.008	Sensitive^E
Azithromycin	0.023	Sensitive^C
Trimethoprim-sulfamethoxazole	3.0	Intermediate^C

Notes: ^EEuropean Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints, ^CClinical & Laboratory Standards Institute (CLSI) breakpoints.

Table 4 Characteristics of Neisseria meningitidis Carriers During Umrah

Variable	Carrier 1	Carrier 2	Carrier 3
Serogroup	B	A	A
Gender	Female	Male	Female
Age (years)	58	47	64
Nationality	Algeria	India	Afghanistan
Country of residence	Algeria	India	Afghanistan
Level of education	NFE	NFE	NFE
Underlying health conditions	None	None	NR
Travel outside current country of residence in the past 6 months	No	No	No
Visited KSA in the past year	No	No	No
Current smoker	No	Yes	No
Meningococcal vaccine	NR	NR	NR
Pneumococcal vaccine	NR	NR	NR
Yellow fever vaccine	NR	NR	NR
Polio vaccine	NR	NR	NR
Influenza vaccine	NR	NR	NR
Duration of stay in KSA	10 days	8 days	12 days
Wore face mask during Umrah	Never	Never	Never
Shared room during Umrah	Yes (4 people)	Yes (4 people)	Yes (3 people)
Currently suffering ILS	No	No	Yes
Used antibiotics during Umrah	No	No	No
Used antibiotics in the previous week	No	No	No

Abbreviations: KSA, Kingdom of Saudi Arabia; ILS, influenza-like illness symptoms; NFE, No formal education; NR, not reported.