Meningococcal serogroup A, C, W, and Y serum bactericidal antibody profiles in Hajj pilgrims

Ziad A. Memish*, Saber Yezli, Malak Almasri, Abdullah Assiri, Abdulhafeez Turkestani, Helen Findlow, Xilian Bai, Raymond Borrow

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


Background: The religious seasons of Hajj and Umra in the Kingdom of Saudi Arabia (KSA) have historically been associated with epidemics of meningococcal disease. Due to the effective preventive measures taken in recent years, including vaccination, no meningococcal outbreaks have been reported during Hajj or were Hajj-associated. However, little is known about the immunological profile of pilgrims. The aim of this study was to assess the immunological profile of pilgrims on arrival in KSA against the four meningococcal serogroups, A, C, W, and Y, contained within the quadrivalent vaccine. Methods: Following consent, socio-demographic factors and health-related information was collected from pilgrims arriving at King Abdul Aziz International Airport and a blood sample taken. Antibodies were quantified by serum bactericidal antibody assay using baby rabbit complement (rSBA) against the four meningococcal serogroups, A, C, W, and Y. Results: Serum samples were collected from 796 pilgrims; rSBA results were obtained for all four serogroups for 741 of these samples. A total of 48 (6.5%) Hajjis had previously attended Hajj, ranging from 1 to 14 times (median 2 times); 98.2% had received meningococcal quadrivalent vaccine in the last 3 years. Of the 13 who had not, all originated from Bangladesh, with four reporting no previous meningococcal vaccination and nine reporting having received the vaccination more than 3 years ago. For serogroup A, only one pilgrim from Indonesia had an rSBA titre <8. For serogroups C, W, and Y, the percentages of pilgrims with rSBA titres <8 were 9.9%, 17.4%, and 9.4%, respectively. Of note was the high prevalence of non-complement-mediated lysis in pilgrims originating from Nigeria (28/47; 59.6%) and Afghanistan (21/47; 44.7%), but not the other countries. This may be a reflection of the type and pattern of antibiotic usage among these communities. Conclusion: The vast majority of pilgrims are vaccinated and protected against meningococcal serogroups A, C, W, and Y.

Original languageEnglish
Pages (from-to)171-175
Number of pages5
JournalInternational Journal of Infectious Diseases
Publication statusPublished - 1 Nov 2014

Bibliographical note

Funding Information:
Conflict of interest: We declare the following potential conflicts of interest: R.B., H.F., and X.B. have performed contract research on behalf of Public Health England (funded by Pfizer, Novartis Vaccines, Baxter Bioscience, GlaxoSmithKline, Sanofi Pasteur, Alexion Pharmaceuticals Inc., and Merck).

Funding Information:
This research was funded by the Saudi Ministry of Health.

Publisher Copyright:
© 2014 The Authors.


  • Hajj
  • Meningococcal
  • Pilgrimage
  • Serum bactericidal antibody
  • Vaccine


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