The Knowledge–Practice Gap in Pharmacists’ Management of Suspected Meningococcal Disease During Mass Gatherings: Evidence from Surveys and Simulated Patient Visits

Background: Meningococcal disease remains a public health concern during mass gatherings such as Hajj and Umrah, where crowding, close contact, and travel may increase transmission risk. Although pharmacists play a role in prevention and early referral, existing studies have relied on self-reported assessments, which may not reflect actual practice. Aim: To assess pharmacists’ knowledge, attitudes, and self-reported practices regarding the recognition, referral, and preventive management of suspected meningococcal disease during mass gatherings, and to compare reported practices with community pharmacists’ behavior observed during simulated patient encounters at the group level. Methods: A cross-sectional study was conducted from February to June 2026 in Makkah, Jeddah, Madinah, and Taif. A total of 380 community and hospital pharmacists completed a questionnaire assessing knowledge, attitudes, and self-reported practices regarding post-exposure meningococcal prevention. In parallel, 305 simulated patient visits assessed practice among community pharmacists using a standardized scenario. Spearman correlation, multivariable linear regression with robust standard errors, and chi-squared or Fisher’s exact tests (with Holm adjustment for regional comparisons) were used for analysis. Results: Pharmacists demonstrated good knowledge (median score, 5.0/6), attitudes (median, 13.0/15), and favorable self-reported practices (median, 15.5/20). However, only 5.2% of simulated patient encounters resulted in recognition of meningococcal disease, 7.5% included enquiry about close contact, and 6.2% included preventive counselling. Immediate referral was observed in 30.5% of encounters, while 88.9% involved symptomatic medication provision. Knowledge, attitudes, and self-reported practices were positively correlated with one another (Spearman’s rho = 0.32–0.54). Conclusions: A substantial group-level gap was observed between favorable self-reported practices and lower performance in a separate, unlinked sample of community pharmacists. Practical, case-based education, standardized referral pathways, and simulation-based training may help improve pharmacists’ ability to recognize and manage meningococcal disease during mass gatherings.