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Risk of antibiotic resistant meningococcal infections in Hajj pilgrims

BMJ 2019; 366 doi: (Published 23 August 2019) Cite this as: BMJ 2019;366:l5260
  1. Alimuddin Zumla, professor1,
  2. Ziad A Memish, professor2
  1. 1Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
  2. 2Infectious Diseases Division, Department of Medicine and Department of Research, Prince Mohamed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
  1. Correspondence to: Z A Memish zmemish{at}

Have a high index of suspicion if people fall ill on returning home

On 22 July Public Health England issued an important public health announcement—the unusual occurrence in the UK of three people with non-groupable meningococcal infections connected with recent travel to Mecca, Saudi Arabia.1 Two presented with conjunctivitis just days after returning from a pilgrimage. The third person, who was a close contact of one case but had not travelled to Mecca, developed invasive meningococcal disease.1Neisseria meningitidis isolates from all three individuals had the same phenotype (NG;NT;P1.15); they were resistant to ciprofloxacin and had only intermediate susceptibility to penicillin. Meningococcal conjunctivitis is known to carry a high risk of invasive disease123 and requires immediate treatment, along with antibiotic prophylaxis for close contacts.

Ciprofloxacin is the recommended chemoprophylaxis in both the UK and Saudi Arabia. The identification of resistant meningococcal conjunctivitis in people returning from Mecca, highlights the urgent need to review currently recommended prophylactic measures for Hajj pilgrims, how best to prevent …

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