Thursday, September 24, 2015

Eurosurveillance: Knowledge, Attitudes & Practices Regarding MERS For Hajj Pilgrims From Turkey, 2015


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As we discussed last May in CDC Traveler’s Advice: Umrah, The Hajj and MERS, with roughly 2 million devout in Saudi Arabia this week taking part in the Hajj, there are inevitably concerns over the transmission of quite a number of diseases, of which MERS is only one.


A study we looked at in 2012 – before MERS emerged - in  Clinical Infectious Diseases (co-authored by Ziad Memish) called - Unmasking Masks in Makkah: Preventing Influenza at Hajj  found:.


Each year more than 2 million people from all over the world attend the Hajj pilgrimage to Saudi Arabia. At least 60% of them develop respiratory symptoms there or during outward or homebound transit [1, 2] During recent interpandemic years, approximately 1 in 10 pilgrims with respiratory symptoms in Makkah have had influenza detected by polymerase chain reaction tests of respiratory samples [3, 4]. Pneumonia is the leading cause of hospitalization at Hajj, accounting for approximately 20% of diagnoses on admission [5].


Other infectious disease threats of concern include tuberculosis, meningitis, mumps, measles, chickenpox along with a plethora of other health risks including food poisoning, insect bites (dengue & malaria), accidents & heat stroke.


But it is the emergence of MERS three years ago, and memories of the spread of another novel coronavirus – SARS – ten years before, that has many infectious disease specialists particularly concerned.  


While not nearly as likely to be a factor during this year’s Hajj as many of these other disease threats, it has the potential of producing a significant impact – locally, and potentially internationally -  should it emerge among the Hajjis.


While playing down the MERS threat to religious pilgrims, the Saudi MOH does promote a variety of Health Tips to Be Followed During Hajj – which strongly encourages hand hygiene and the wearing of face masks to prevent `respiratory diseases’:

1. Hygiene and General Cleanliness Tips (EXCERPT):

  • Maintaining personal hygiene, bathing regularly, and washing hands well by using water and soap, or other disinfectants used for handwashing, especially after coughing and sneezing.
  • Using handkerchiefs when coughing or sneezing by covering the nose and mouth, and then eliminating them in the trash. In case there are no handkerchiefs at hand, use the upper arms rather than hands.
  • Using a face-mask, especially in crowded places, and changing it every now and then.
  • In case there are no handkerchiefs at hand, use the upper arms, rather than hands, for covering the nose and mouth when coughing or sneezing.
  • Wash your hands well, using water and soap, or the hand-sterilizing gel, especially after bathing, after coughing and sneezing, before eating, and when coming back to your residence.


Apparently, despite the media coverage on MERS and health guidance being offered by Saudi, and local public health agencies around the globe, the word isn’t getting through to a lot of pilgrims.  At least according to a sampling of pilgrims in Turkey headed for this year’s Hajj.


Eurosurveillance, Volume 20, Issue 38, 24 September 2015
Rapid communication

Knowledge, attitudes and practices concerning Middle East respiratory syndrome among Umrah and Hajj pilgrims in Samsun, Turkey, 2015

MK Sahin 1 , S Aker 1 , E Kaynar Tuncel 2

+ Received:14 September 2015; Accepted:23 September 2015

We performed a questionnaire study to determine knowledge, attitudes and practices concerning Middle East respiratory syndrome (MERS) among people intending to participate in the Hajj or Umrah Muslim pilgrimages. Of the 381 respondents aged between 17 and 85 years, 55% had never heard of MERS, while only one in three knew that it is a respiratory disease. Approximately half were insufficiently informed about protective measures. Prospective pilgrims do not seem prepared to take such precautions.

We performed a survey among people intending to visit the Arabian Peninsula for the Hajj or Umrah pilgrimages and aimed to determine their awareness about Middle East respiratory syndrome (MERS).

Hajj in 2015 will take place from 21 to 25 September. Umrah is a similar pilgrimage that can be undertaken at any time of the year but is likely to be more crowded during the month of Ramadan (18 June to 17 July 2015). In 2015, 55,540 people from Turkey secured the right to perform the Hajj [1]. Because of the ability of infectious diseases to spread rapidly at mass gatherings, the Saudi Ministry of Health (MoH) advises people 65 years and older, pregnant women and children under 12 years and individuals with weak immune systems or chronic diseases to postpone travelling as long as there is the risk of MERS in the area [2]. People wishing to perform the Hajj or Umrah are advised to follow general hygiene measures such as regular hand washing, using disposable materials and using masks [2-4]. Knowledge and application of basic hygiene principles and measures in such an environment is therefore vitally important.



While 76% of participants (288 people) said they did not intend to take protective measures against MERS-CoV infections during the Hajj or Umrah, 21% (78 people) said they would wear a mask, 14% (54 people) that they would take care in regard to hand washing and 0.5% (two people) that they would use hand disinfectants. People with university degrees were significantly more likely to take protective measures than others (chi-square test: 8.093; p=0.005).

(Continue . . . .)


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