W135 meningococcal pericarditis: report of two cases and review of the literature.

Pericarditis is a rare but recognized complication of meningococcal disease. After the 2000 and 2001 hajj in Saudi Arabia, a worldwide outbreak of meningococcal W135:2a:P1.2,5 (epidemic strain) was reported including the United Kingdom. Cases of meningococcal disease occurred in pilgrims and their household contacts; and community spread occurred among non-Muslims. Between July 2001 and January 2002, 2 children with pericarditis associated with W135 meningococcal disease were admitted to our hospital in east London.

Meningococcal W135 carriage; enhanced surveillance amongst east London Muslim pilgrims and their household contacts before and after attending the 2002 Hajj.

BACKGROUND: For two successive years, 2000 and 2001, there was a world-wide outbreak of W135 meningococcal disease amongst pilgrims who attended the Hajj and in their contacts after returning home. METHODS: Beginning January 2002, we offered meningococcal quadrivalent polysaccharide vaccine (against serogroups A, C, Y and W135) to pilgrims and collected a throat swab for meningococcal W135 carriage before and after their pilgrimage. RESULTS: The overall Neisseria meningitidis carriage pre-Hajj was 8.3% and 6.3% post-Hajj. We found W135 carriage rates of 0.8% before and 0.6% after Hajj, respectively. 21% (36/174) of the pilgrims were treated with antibiotics for respiratory illness. CONCLUSION: The carriage of meningococcus W135 among UK pilgrims who visited the Hajj in 2002 was low. This contrasts with another study suggesting pilgrims frequently acquired N. meningitidis W135 carriage during 2001 Hajj. The use of the quadrivalent vaccine may account for this difference.