Santé publique France et le CNR des méningocoques souhaitent vous informer de la survenue de cas d’infections invasives à méningocoque (IIM) consécutifs au retour du pèlerinage Umrah à la Mecque en avril et mai 2024.
Douze cas d’IIM ont été rapportés dans plusieurs pays (France (4), Royaume-Uni (3), Etats-Unis (5)) dont 10 chez des personnes revenues du pèlerinage Umrah à la Mecque et 2 dans l’entourage direct d’une personne de retour du pèlerinage (cf. message du 20 mai 2024 du Health Alert Network des CDC). Parmi les 11 cas pour lesquels le sérogroupe a été déterminé, 10 cas étaient liés au sérogroupe W et 1 cas lié au sérogroupe C. Le statut vaccinal pour la vaccination ACWY était documenté pour 8 personnes ayant fait le pèlerinage et ces personnes n’étaient pas vaccinées.
Trois souches présentaient des marqueurs de résistance à la ciprofloxacine. En France, cette résistance a été confirmée pour 1 cas tandis que les souches des 3 autres cas étaient sensibles aux antibiotiques recommandés pour le traitement des cas ou l’antibioprophylaxie des contacts.
Selon les analyses par séquençage du génome entier réalisées par le CNR des Méningocoques et Haemophilus influenzae en collaboration avec le CNR anglais, les souches de sérogroupe W sont dérivées de la lignée dite « Anglo-French Hajj » du complexe clonal 11 mais elle diffère de la souche originale responsable d’IIM liés à la Mecque au début des années 2000, cette souche ayant circulé dans plusieurs pays du monde et ayant évolué sur le plan génétique [1,2]
Les investigations épidémiologiques et microbiologiques laissent suspecter plusieurs foyers de transmission de méningocoques à la Mecque en avril et mai 2024. Le risque d’IIM est connu dans le contexte de grand rassemblement avec un brassage important de population venant de différents pays, et dans des conditions de promiscuité favorisant la transmission des méningocoques.
Nous attirons votre vigilance dans le contexte des retours de pèlerinage de la Umrah, qui sera suivi par le pèlerinage du Hajj (dates prévisionnelles : 14-19 juin 2024).
Nous rappelons l’importance de :
- Signaler sans délai aux ARS tout cas d’infection invasive à méningocoque et rechercher lors de l’investigation la notion de retour de voyage à la Mecque chez le patient ou son entourage proche ;
- Réaliser un antibiogramme en urgence et informer immédiatement l’ARS et le CNR en cas de suspicion de résistance pour que, le cas échéant, le choix de l’antibioprophylaxie des contacts soit adapté ;
- Veiller, en lien avec les laboratoires de bactériologie, à l’envoi des souches et prélèvements biologiques au CNR des Méningocoques et Haemophilus influenzae. La culture est essentielle pour permettre le séquençage du génome entier et ainsi évaluer si les cas sont rattachés au même cluster, et déterminer les profils de sensibilité et de résistance aux antibiotiques des souches ;
- – Rappeler auprès de vos patients les obligations de vaccination vis-à-vis des méningocoques ACWY en cas de projet de pèlerinage à la Mecque, y compris en dehors du Hajj. Cette vaccination doit être attestée par le Certificat International de Vaccination comme rappelé dans les recommandations sanitaires 2023 pour les voyageurs établies par le Haut Conseil de la Santé Publique. [3]
Références
- Taha MK, Achtman M, Alonso JM, et al. Serogroup W135 meningococcal disease in Hajj pilgrims. Lancet 2000; 356: 2159.
- Lucidarme J, Hill DMC, Bratcher HB, Gray SJ, du Plessis M, Tsang RSW, et al. Genomic resolution of an aggressive, wide-spread, diverse and expanding meningococcal serogroup B, C and W lineage. J Infect 2015;71(5):544e52.
- Haut Conseil de la Santé Publique. Recommandations sanitaires 2023 pour les voyageurs. Disponible à l’adresse : https://www.hcsp.fr/explore.cgi/avisrapportsdomaine?clefr=1314
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