Proof of vaccination is required for travellers 2 years of age and older who are Hajj or Umra pilgrims, seasonal workers, and workers in contact with pilgrims. Vaccination with quadrivalent ACYW135 (either polysaccharide or conjugate) must be issued not less than 10 days before arrival and not more than 3 years (polysaccharide vaccine) or 5 years (conjugate vaccine) before arrival. The immunization certificate should clearly state if the traveller was vaccinated with the conjugate vaccine for the 5-year validity to apply.
In addition, travellers from Africa’s meningitis belt (Benin, Burkina Faso, Cameroon, Chad, Central African Republic, Cote d’Ivoire, Eritrea, Ethiopia, Gambia, Guinea, Guinea-Bissau, Mali, Niger, Nigeria, Senegal, South Sudan, and Sudan) will be administered vaccination upon arrival.
Meningococcal Meningitis is primarily caused by Neisseria meningitidis bacteria transmitted from person to person through infected air droplets, saliva, or respiratory secretions. The infection spreads easily when an infected person comes into close proximity or has long term contact with others. Staying in overcrowded housing, dormitories, cruise ships, attending a sports or cultural event, as well as sharing utensils, coughing, sneezing, or kissing can contribute to outbreaks. The bacteria target the meninges – the thin lining that surrounds the brain and the spinal cord. Of the 12 Meningococcal Meningitis serogroups identified, the following five cause illness: A, B, C, Y, and W135. Note that other meningitis infections can also be caused by viruses, fungi, and parasites.
Long-term travellers, persons on work assignments, students, military recruits, persons with a weakened immune system, children under five years of age, men having sex with men, and persons attending large cultural or sporting events are at risk.
The bacteria are present worldwide with variable geographic occurrence. Regional outbreaks can occur anytime. The highest risk areas are in the Meningitis Belt – the semi-arid area of sub-Saharan Africa that extends from the Atlantic Ocean to the Red Sea. Large outbreaks have also occurred in other sub-Saharan African countries.
Usually symptoms appear 4 to 10 days after exposure to the bacteria and typically include sudden onset of headache, fever, stiff neck, sensitivity to light, confusion, and vomiting. The infection can lead to brain damage, hearing loss, or cognitive disabilities in some. Meningococcal Meningitis can cause death in 5% to 10% of patients even if they received prompt treatment. The infection can progress to Meningococcal Sepsis, also known as Meningococcemia, causing a rash, hemorrhaging, and multi-organ failure. A lumbar puncture may be performed to diagnose the illness. Treatment includes antibiotics and supportive care of symptoms.
Quadrivalent vaccination against serotypes ACYW135 is recommended for travellers going to the Meningitis Belt of Africa or to areas with current outbreaks.
There are several inactivated and Meningococcal-containing combined vaccines available in Canada and the USA. There is also a vaccine against serotype B, but it isn’t available in all countries. Discuss your options with a healthcare provider regarding boosters and / or re-vaccination.
Information last updated: April 29, 2019