Mitigating the risk of invasive meningococcal disease in the umrah setting: Epidemiology, surveillance, and vaccination strategies.

Invasive meningococcal disease remains a public health challenge during the year-round Umrah pilgrimage to Makkah, Saudi Arabia. Although the MenACWY vaccination is mandatory, imported cases still occur. We reviewed surveillance findings from the Ramadan 2025 season, including confirmed cases, vaccination activities, carriage screening, and genomic data. The confirmed disease occurred in unvaccinated international pilgrims from Sri Lanka, India, and Indonesia, and serogroup W was identified in the sequenced samples. All patients recovered and no local transmission was observed. National campaigns have vaccinated more than 20,000 high-risk workers and collected over 2700 oropharyngeal swabs, all of which were negative for Neisseria meningitidis. Ongoing risks reflect uneven global vaccine uptake and continued use of polysaccharide vaccines, which do not reduce carriage. Stronger pretravel enforcement, wider conjugate vaccine use, expanded surveillance, and international data sharing are required to support the elimination of meningitis by 2030.