Prevalence and Risk of Meningococcal Disease or Carriage During Mass Gatherings and Associated Travel: Systematic Review and Meta-Analysis
Abstract
1. Introduction
2. Materials and Methods
2.1. Literature Search
2.2. Eligibility Criteria
2.3. Study Selection and Data Extraction
2.4. Risk of Bias
2.5. Strategy for Data Synthesis
3. Results
3.1. Study Selection Process
3.2. Study Characteristics
3.3. Characteristics of the Included Participants
3.4. Methodological Quality of Included Studies
3.5. Primary Outcomes
3.5.1. Prevalence of Meningococcal Disease
3.5.2. Exploration of Heterogeneity Through Subgroup Analysis
3.5.3. Results of Meta-Regression Analysis
3.5.4. Prevalence of Serogroup a Meningococcal Disease or Carriage
3.5.5. Prevalence of Serogroup B Meningococcal Disease or Carriage
3.5.6. Prevalence of Serogroup W135 Meningococcal Disease or Carriage
3.5.7. Prevalence of Serogroup C Meningococcal Disease or Carriage
3.5.8. Prevalence of Serogroup 29E Meningococcal Disease or Carriage
3.5.9. Prevalence of Serogroup W Meningococcal Disease or Carriage
3.5.10. Prevalence of Serogroup X Meningococcal Disease or Carriage
3.5.11. Prevalence of Serogroup Y Meningococcal Disease or Carriage
3.5.12. Prevalence of Serogroup Z Meningococcal Disease or Carriage
3.5.13. Prevalence of Non-Groupable Meningococcal Disease or Carriage
3.5.14. Prevalence of Auto-Agglutinable Meningococcal Disease or Carriage
3.5.15. Effect of Vaccination on Prevalence of Meningococcal Diseases or Carriage
3.5.16. Risk Factors Associated with the Prevalence of Meningococcal Disease or Carriage
3.6. Secondary Outcomes
3.6.1. Mortality
3.6.2. Other Outcomes
3.7. Publication Bias
3.8. Sensitivity Analysis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
CDC | Centers for Disease Control and Prevention |
PROSPERO | International Prospective Register of Systematic Reviews |
CRD | Part of the PROSPERO Registration Number |
PECOS | Participant, Exposure, Comparator, Outcome, and Study |
MeSH | Medical Subject Heading |
IQR | Interquartile Range |
CSF | Cerebrospinal Fluid |
RR | Risk Ratio |
RevMan | Review Manager Software |
MGs | Mass Gatherings |
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Author, Year | Study Country | Study Design | Place of Data Collection | Type of Exposure | Type of Gathering | Country of Participants | Total Number of Participants | Male (%) | Age | Vaccinated (n) | Vaccination (%) |
---|---|---|---|---|---|---|---|---|---|---|---|
Balkhy HH, 2004 [29] | Saudi Arabia | Cross-sectional | Clinic/hospital | Mass Gathering | Hajj | Multi-national (n = 29) | 344 | 45% | 0–50 *** | 245 | 71.2 |
Yezli S, 2023 [30] | Saudi Arabia | Prospective | Place of residence | Mass Gathering | Hajj | Multi-national (n = 13) | 3921 | 52.4% | 55 (13.4) * | 3921 | 100.0 |
Alasmari A, 2021 [31] | Saudi Arabia | Cross-sectional | Airport | Mass Gathering | Hajj | Multi-national (n = 11) | 2973 | 68% | 11–65 *** | 2117 | 71.2 |
Fazio C, 2019 [32] | Italy | Retrospective | Public database | Mass Gathering | Hajj | Italy | 2357 | NR | 26 * | NR | N/A |
Pavli A, 2016 [33] | Greece | Cross-sectional | Public database | Travel | World Travel | Greece | 5283 | 64.30% | 39.2 * | 1150 | 21.8 |
Metanat M, 2015 [34] | Iran | Cross-sectional | Airport | Mass Gathering | Hajj | Iran | 422 | 42.20% | 21–95 *** | 422 | 100.0 |
Yezli S, 2022 [35] | Saudi Arabia | Cross-sectional | Place of residence | Mass Gathering | Umrah | Multi-national (n = 17) | 616 | 50.6% | 19–91 *** (53.8) * | 56 | 9.1 |
Tezer H, 2020 [36] | Turkey | Prospective | Airport | Mass Gathering | Hajj | Turkey | 229 | 48.91% | 23–71 *** 56 * | 229 | 100.0 |
Tafuri S, 2012 [37] | Italy | Cross-sectional | Place of residence | Travel | Refugee Migration | Africa | 253 | 88.50% | 19.8 (6) * | NR | N/A |
Memish ZA, 2017 [38] | Saudi Arabia | Prospective | Airport | Mass Gathering | Hajj | Multi-national (n = 10) | 628 | 63.70% | 18–65 *** | 628 | 100.0 |
Dull PM, 2005 [39] | USA | Retrospective | Airport | Both | World Travel | USA | 844 | 61.5% | Pilgrim: 47; non-pilgrim: 35 ** | 840 | 99.5 |
El-Bashir HE, 2004 [40] | UK | Ambispective | Muslim center | Mass Gathering | Hajj | UK | 253 | 70% | 42 (2–82) ** | 253 | 100.0 |
Wilder-Smith A, 2003 [41] | Singapore | Prospective | Muslim center | Mass Gathering | Hajj | Singapore | 373 | 43% | 47 (3–78) ** | 373 | 100.0 |
Wilder-Smith A, 2003 (2) [45] | Singapore | Prospective | Muslim Center | Mass Gathering | Hajj | Singapore | 153 | 48% | 48 (8.07) * | 153 | 100.0 |
Wilder-Smith A, 2003 (3) [42] | Singapore | Prospective | Place of residence | Mass Gathering | Umrah | Singapore | 160 | 36% | 40 (2–80) ** | 160 | 100.0 |
Yousuf M, 2000 [27] | Saudi Arabia | Prospective | Holy Masjid | Mass Gathering | Hajj and Umrah | Multi-national (n = 7) | 15 | 11% | NR | 15 | 100.0 |
Karima TM, 2003 [43] | Saudi Arabia | Prospective | Clinic/hospital | Mass Gathering | Hajj | Multi-national (n = 26) | 105 | 56.2% | 20–80 *** | NR | N/A |
Lingappa JR, 2003 [44] | Saudi Arabia | Retrospective | Public database | Mass Gathering | Hajj | Multi-national | 264 | 53% | 40 (0.2–80) ** | 264 | 100.0 |
Alborzi A, 2008 [51] | Iran | Prospective | Airport | Mass Gathering | Hajj | Iran | 674 | 58.20% | 52 * | 674 | 100.0 |
Nicolas P, 2005 [46] | Morocco, Oman, and Sudan | Prospective | Place of residence | Mass Gathering | Hajj | Morocco | 1186 | NR | NR | NR | N/A |
Oman | 399 | NR | NR | NR | N/A | ||||||
Sudan | 250 | NR | NR | NR | N/A | ||||||
Balkhy HH, 2003 [28] | Saudi Arabia | Prospective | Clinic/hospital | Mass Gathering | Hajj | Saudi Arabia | 28 | 75% | 18–61 *** | 1 | 3.6 |
Wilder-Smith A, 2002 [47] | Singapore | Prospective | Place of residence | Mass Gathering | Hajj | Singapore | 204 | 45% | 48 (24–74) ** | 204 | 100.0 |
Aguilera, 2002 [48] | Europe | Prospective | Place of residence | Mass Gathering | Hajj | UK and France | 38,849 | NR | 50 | 38849 | 100.0 |
Moore PS, 1988 [49] | USA | Cross-sectional | Airport | Both | World Travel | USA | 550 | Pilgrimage: 173 | 43.9 (19.1) * | Pilgrimage: 33/192 | Pilgrimage: 17 |
Jones DM, 1990 [50] | UK | Prospective | Airport | Travel | Hajj | England and Wales | 176 | NR | NR | 176 | 100 |
Author, Year | Study Duration | Test Sample | No. of People Tested (n) | Number Infected (n) | Serogroup (n) |
---|---|---|---|---|---|
Balkhy HH, 2004 [29] | 2003 | TS | 344 | 11 | W-135: 2; B: 1; NG: 8 |
Yezli S, 2023 [30] | 2019 | OPS | 7842 | 58 | B: 2; NG: 2 |
Alasmari A, 2021 [31] | 2017 | OPS | 2249 | 130 | A: 2; B: 10; C: 10; W: 3; X: 6; Y: 3 |
Fazio C, 2019 [32] | 2000–2016 | BIs and/or CS | 2357 | 2357 | 29E: 1; A: 17; B: 1249; C: 861; W: 63; X: 5; Y: 161 |
Pavli A, 2016 [33] | 2009–2013 | TS | 5283 | 6 | NR |
Metanat M, 2015 [34] | 2012 | OPS | 422 | 6 | NR |
Yezli S, 2022 [35] | 2019 | OPS | 616 | 3 | A: 2; B: 1 |
Tezer H, 2020 [36] | 2018 | OPS | 229 | 10 | B: 1 |
Tafuri S, 2012 [37] | NR | NPS | 201 | 13 | W-135: 4; Y: 3; Autoagglutinable: 6 |
Memish ZA, 2017 [38] | 2014 | NPS | 628 | 7 | NR |
Dull PM, 2005 [39] | 2001 | OPS | 215 | 25 | W-135: 10; B: 5; W: 18; Y: 1; NG: 15 |
El-Bashir HE, 2004 [40] | 2000–2001 | TS | 174 | 11 | 29E: 1; W-135: 1; B: 3; NG: 6 |
Wilder-Smith A, 2003 [41] | 2001 | TS | 373 | 61 | W-135: 56 |
Wilder-Smith A, 2003 (2) [45] | 2002 | OPS | 153 | 2 | W-135: 2 |
Wilder-Smith A, 2003 (3) [42] | 2001 | TS | 160 | 2 | Autoagglutinable: 1; NG: 1 |
Yousuf M, 2000 [27] | 1992–1993 | CSF | 15 | 13 | W-135: 2; A: 7; B: 1; C: 3 |
Karima TM, 2003 [43] | 2000 | CSF | 105 | 65 | W-135: 19; A: 44; B: 1; NG: 1 |
Lingappa JR, 2003 [44] | 2000 | Blood and CSF | 264 | 253 | W-135: 93; A: 60 |
Alborzi A, 2008 [51] | 2003 | TS | 674 | 31 | W-135: 1; A: 1; B: 2; C: 1; Y: 2; Z: 1; Z’: 2; NG: 21 |
Nicolas P, 2005 [46] | 2000–2001 | TS | 3558 | 95 | W-135: 31; B: 12; Y: 5; NG: 47 |
Nicolas P. 2005 (Oman) * | 2000–2001 | TS | 1157 | 18 | W-135: 9; B: 4; NG: 5 |
Nicolas P. 2005 (Sudan) * | 2000–2001 | TS | 250 | 5 | W-135: 5 |
Balkhy HH, 2003 [28] | 2001 | TS | 131 | 1 | W-135: 1; NG: 5 |
Wilder-Smith A, 2002 [47] | 2001 | NPS | 171 | 29 | W-135: 26 |
Aguilera, 2002 [48] | 2000 | BI and/or CSs | 38,849 | 12 | NR |
Moore PS, 1988 [49] | 1987 | TS | 550 | 52 | A: 36; NG: 16 |
Jones DM, 1990 [50] | 1987 | TS | 170 | 13 | A: 1; NG: 11 |
Author, Year | Study Design | Selection (5 Score) | Comparability (2 Score) | Outcome (3 Score) | Total (10 Score) |
---|---|---|---|---|---|
Balkhy HH, 2004 [29] | Cross-sectional | 5 | 1 | 3 | 9 |
Yezli S, 2023 [30] | Prospective | 5 | 2 | 3 | 10 |
Alasmari A, 2021 [31] | Cross-sectional | 5 | 1 | 2 | 8 |
Fazio C, 2019 [32] | Retrospective | 5 | 1 | 3 | 9 |
Pavli A, 2016 [33] | Cross-sectional | 5 | 2 | 2 | 9 |
Metanat M, 2015 [34] | Cross-sectional | 5 | 2 | 3 | 10 |
Yezli S, 2022 [35] | Cross-sectional | 5 | 2 | 3 | 10 |
Tezer H, 2020 [36] | Prospective | 5 | 1 | 3 | 9 |
Tafuri S, 2012 [37] | Cross-sectional | 5 | 1 | 2 | 8 |
Memish ZA, 2017 [38] | Prospective | 5 | 2 | 3 | 10 |
Dull PM, 2005 [39] | Retrospective | 5 | 2 | 2 | 9 |
El-Bashir HE, 2004 [40] | Ambispective | 5 | 2 | 2 | 9 |
Wilder-Smith A, 2003 [41] | Prospective | 5 | 2 | 3 | 10 |
Wilder-Smith A, 2003 (2) [45] | Prospective | 4 | 2 | 3 | 9 |
Wilder-Smith A, 2003 (3) [42] | Prospective | 5 | 2 | 3 | 10 |
Yousuf M, 2000 [27] | Prospective | 5 | 1 | 3 | 9 |
Karima TM, 2003 [43] | Prospective | 5 | 0 | 3 | 8 |
Lingappa JR, 2003 [44] | Retrospective | 5 | 1 | 3 | 9 |
Alborzi A, 2008 [51] | Prospective | 5 | 2 | 2 | 9 |
Nicolas P, 2005 [46] | Prospective | 5 | 1 | 2 | 8 |
Nicolas P. 2005 (Oman) * | Prospective | 5 | 1 | 3 | 9 |
Nicolas P. 2005 (Sudan) * | Prospective | 5 | 1 | 3 | 9 |
Balkhy HH, 2003 [28] | Prospective | 5 | 2 | 3 | 10 |
Wilder-Smith A, 2002 [47] | Cross-sectional | 4 | 1 | 3 | 8 |
Aguilera, 2002 [48] | Prospective | 5 | 0 | 3 | 8 |
Variable | Meta-Regression Coefficient | Standard Error | p-Value | 95%CI |
---|---|---|---|---|
Study duration/time | −0.503 | 0.755 | 0.512 | −2.071 to 1.063 |
Test sample | 0.241 | 0.326 | 0.469 | −0.436 to 0.917 |
Study design | 0.332 | 0.741 | 0.658 | 1.205 to 1.870 |
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Samannodi, M.; Alwafi, H.; Muglan, J.; Tawakul, A.; Algahtani, R.M.; Almoallim, H.M.; Alghamdi, I.A.; Obaid, M.S.; Alkhotani, A.M.A.; Alhazmi, A.S.H.; et al. Prevalence and Risk of Meningococcal Disease or Carriage During Mass Gatherings and Associated Travel: Systematic Review and Meta-Analysis. Trop. Med. Infect. Dis. 2025, 10, 207. https://doi.org/10.3390/tropicalmed10080207
Samannodi M, Alwafi H, Muglan J, Tawakul A, Algahtani RM, Almoallim HM, Alghamdi IA, Obaid MS, Alkhotani AMA, Alhazmi ASH, et al. Prevalence and Risk of Meningococcal Disease or Carriage During Mass Gatherings and Associated Travel: Systematic Review and Meta-Analysis. Tropical Medicine and Infectious Disease. 2025; 10(8):207. https://doi.org/10.3390/tropicalmed10080207
Chicago/Turabian StyleSamannodi, Mohammed, Hassan Alwafi, Jihad Muglan, Abdullah Tawakul, Rami M. Algahtani, Hani M. Almoallim, Ismail Ahmad Alghamdi, Majed Sameer Obaid, Amar Mohammad A. Alkhotani, Aous Sami Hayat Alhazmi, and et al. 2025. "Prevalence and Risk of Meningococcal Disease or Carriage During Mass Gatherings and Associated Travel: Systematic Review and Meta-Analysis" Tropical Medicine and Infectious Disease 10, no. 8: 207. https://doi.org/10.3390/tropicalmed10080207
APA StyleSamannodi, M., Alwafi, H., Muglan, J., Tawakul, A., Algahtani, R. M., Almoallim, H. M., Alghamdi, I. A., Obaid, M. S., Alkhotani, A. M. A., Alhazmi, A. S. H., Adly, H. M., Khan, A. A., Alamri, F. A., & Garout, M. A. (2025). Prevalence and Risk of Meningococcal Disease or Carriage During Mass Gatherings and Associated Travel: Systematic Review and Meta-Analysis. Tropical Medicine and Infectious Disease, 10(8), 207. https://doi.org/10.3390/tropicalmed10080207