Meningococcal meningitis is another target in routine vaccinations. While the risk of meningococcal disease in travellers is generally low, especially if travelling to industrialised countries, there is still the risk of exposure to sporadic cases. However, when a non-resident population assembles in large numbers, that potential increases.7

Pilgrims visiting Mecca for the Hajj or Umrah are an example. Around 25,000 people now travel annually from the UK for the Hajj, joining 3.7 million other pilgrims from around the world. Saudi authorities require a certificate of vaccination with a quadrivalent vaccine protecting against meningococcal disease caused by serogroups A, C, W and Y, a significant factor in the absence of outbreaks in recent years.7,8,9

While not mandatory, a pneumococcal vaccine is also recommended. The Saudi Thoracic Society pneumococcal vaccination guidelines of 2016 for pilgrims to Mecca recommend that all people aged 50 or over, as well as younger immune-compromised people, should be vaccinated.10