Meningococcal ACWY vaccine — DTM&H MCQ

Correct answer: A — Meningococcal ACWY vaccination

Explanation lettering: C = shown as A · D = shown as B · E = shown as C · B = shown as D · A = shown as E

Meningococcal ACWY vaccination (C) is correct because the Kingdom of Saudi Arabia mandates proof of quadrivalent ACWY vaccination for all pilgrims attending Hajj, given the well documented risk of meningococcal outbreaks amplified by extreme overcrowding and international mixing during the pilgrimage. This is both an entry requirement and a genuine public health measure, since large clusters of invasive meningococcal disease (serogroups A, C, W and Y) have previously occurred among pilgrims and spread to their contacts on return home. Vaccination must be given at least 10 days before arrival, using either the conjugate vaccine (valid 5 years) or, historically, the polysaccharide vaccine (valid 3 years), with the certificate carried as proof. No other vaccine on the list is specifically mandated for Hajj entry or targets the crowd associated meningococcal risk described in the stem. Why the other options are wrong: A. BCG vaccination: protects against tuberculosis, which is not the crowd associated risk described, and BCG is not an entry requirement for Saudi Arabia. B. Japanese encephalitis vaccine: relevant for rural, mosquito-exposed travel in parts of Asia with rice paddies and pig farming, an exposure pattern irrelevant to the urban mass gathering setting of Hajj. D. Oral cholera vaccine: considered only for travellers with limited access to safe food and water or working in high risk settings; it is not a Saudi entry requirement and does not address meningococcal transmission. E. Tick-borne encephalitis vaccine: indicated for tick exposure in forested parts of Europe and Asia, an exposure route absent from the Hajj scenario. Key point: Quadrivalent ACWY meningococcal vaccination, given at least 10 days before travel, is a mandatory Saudi entry requirement for Hajj and Umrah because of high meningococcal transmission risk in mass gatherings.

Reference: NaTHNaC TravelHealthPro, Hajj and Umra factsheet, https://travelhealthpro.org.uk/factsheet/19/hajj-and-umra