Invasive meningococcal disease reported in Umrah pilgrims in 2025

If you are planning to visit Saudi Arabia for Hajj 1446H or Umrah in 2025, make sure you are vaccinated

On 11 April 2025, the World Health Organization (WHO) highlighted 17 confirmed cases from multiple countries of invasive meningococcal disease (IMD) linked with travel to Kingdom of Saudi Arabia (KSA) for religious pilgrimage. Initial reports from the KSA highlighted 11 cases in unvaccinated pilgrims who performed Umrah in the KSA between 7 January and 18 March 2025. A further six cases were reported to the WHO in pilgrims recently returned from Umrah, with two of the six confirmed as serogroup W [1].

Due to large crowds, mass gatherings like Hajj and Umrah are associated with unique health risks [2]. Every year, KSA's Ministry of Health (MoH) publishes their requirements and recommendations for entry visas for pilgrims and seasonal workers planning to visit KSA for Hajj or Umrah.

Requirements for Hajj 1446H (2025) and Umrah 1446H (2025) state travellers aged over one year arriving for Umrah, and all travellers arriving for Hajj or for seasonal work in Hajj zones, must have proof of vaccination with a quadrivalent (ACWY) meningococcal vaccine received at least 10 days prior to the planned arrival to Hajj or Umrah areas [3, 4].

As of 10 March 2025, the KSA authorities estimate that only 54% of international Umrah pilgrims had complied with meningococcal vaccination requirements. The significant number of pilgrims visiting KSA from countries with higher number of cases of meningococcal disease means there is a risk of international spread during these gatherings [1].

WHO strongly advised that all individuals planning to attend mass gatherings such as Hajj and Umrah receive the quadrivalent meningococcal conjugate vaccine, which covers serogroups A, C, W, and Y at least 10 days before traveling to KSA[1].? The UK Health Security Agency also recommends this vaccine to protect United Kingdom (UK) residents planning to visit KSA for pilgrimage and seasonal work against IMD types A, C, W and Y [5].

In May 2024, a total of 12 confirmed cases of IMD, including three cases in the UK, were reported, linked to travellers who performed Umrah in KSA. Most of these cases were infected with IMD serogroup W and had not received a Men ACWY vaccine before they travelled [1, 6].

Advice for travellers

Before you travel

Make sure you are protected against IMD, a serious and potentially fatal group of infections:

Vaccination with ONE of the following vaccines is acceptable to the KSA government:

• Quadrivalent (ACWY) polysaccharide vaccine within the last three years (this vaccine has not been available in the UK for over three years)
• Quadrivalent (ACWY) conjugate vaccine within the last five years

If the type of vaccine is not written on the vaccine record, it will be considered valid for three years from the date of vaccination [3, 4].

Other vaccine recommendations and general health advice for travel to KSA is available from our Country Information pages.

See our Hajj and Umrah factsheet for specific advice about travel for pilgrims and seasonal workers.

Before making plans, you should check:

• Current Foreign, Commonwealth & Development Office (FCDO) travel advice for KSA
• Ministry of Hajj and Umrah guide on applying to perform Hajj available on the Nusuk Hajj platform

FCDO social media channel @ukinsaudiarabia and the Ministry of Hajj and Umrah social media channel @MoHU_En also provide information and guidance. You can also sign up for free FCDO email updates.

Before you travel make sure you are aware of the symptoms of IMD.

While you are away

• Follow good hand hygiene rules
• Try to avoid any contact with other people's respiratory or throat secretions (mucus and saliva/spit) - never share drinks and eating utensils [7]
• Try to avoid close contact with anyone who appears to be ill and avoid sharing their personal belongings

When you return

IMD can be hard to identify at first because it can be like a bad case of flu, but anyone affected will usually become seriously ill within a few hours.

If you are ill after your trip make sure you are aware of the symptoms of IMD (for example with fever, headache, a stiff neck or a rash, severe pains and aches in limbs and joints). If you become worried about your own or someone else's health, particularly if symptoms are getting worse, get medical help urgently. Early treatment can be life-saving.

Remember to tell your doctor/health professional you recently travelled to KSA for Umrah or Hajj.

Advice for health professionals

Health professionals advising those who plan to travel to KSA for Hajj and Umrah should offer the quadrivalent meningococcal conjugate vaccine, which covers serogroups A, C, W and Y, ideally at least 10 days before travel [1].

Health professionals should also check our KSA Country Information pages for other vaccine recommendations and travel health advice.

Health professionals should consider the possibility of IMD in returned Hajj or Umrah travellers with a fever or any other IMD symptoms. Early diagnosis and treatment is critical because IMD is potentially fatal. Diagnosis can be confirmed by isolation of the organism from the blood or cerebrospinal fluid through culture. Antigen detection techniques or polymerase chain reaction is also used [7].

Further information is available from the UK Health Security Agency - Meningococcal disease: guidance on public health management.

If any travel-related infection is suspected, this should be discussed urgently with your local microbiology, virology or infectious diseases consultant, giving a full travel/clinical history. They may advise that appropriate samples are sent for testing to specialist laboratory facilities in the UK.