For the second month in a row (see last month's WHO EMRO MERS-CoV Summary - May, 2019) the WHO's monthly MERS Outbreak Summary - which is normally published around the 10th of the month - is running late. Last month it appeared on the 18th, while this month it is running even later, and has yet to show.
Delays and interruptions in MERS reporting from KSA have been fairly common - last summer they went more than 2 months without an update (see The Saudi MOH Breaks Their Silence On MERS-CoV) - and only rarely do we get an explanation.While reported MERS activity has slowed, we do have a 4th case reported (yesterday) for Epi Week 29, making it the busiest month since early June.
Once again it is a primary case (M,58), with unknown exposure, this time in the southern city of Najran.
We are now less than 3 weeks from the start of the Hajj, when roughly 2 million religious pilgrims from all over the world will make the journey to the holy cities of Mecca and Medina.
Six years ago, in MERS, Mass Gatherings & Public Health, we looked at some of the immense challenges that Saudi Arabia faces each year with the Hajj.
Emergence of medicine for mass gatherings: lessons from the Hajj
Prof Ziad A Memish MD , Gwen M Stephens MD, Prof Robert Steffen MD , Qanta A Ahmed MD
Within the immediate vicinity of the Hajj, there are 141 primary health-care centres and 24 hospitals with a total capacity of 4964 beds including 547 beds for critical care. The latest emergency management medical systems were installed in 136 health-care centres and staffed with 17 609 specialised personnel. More than 15 000 doctors and nurses provide services, all at no charge.In 2015's EID Journal: ARI’s In Travelers Returning From The Middle East, researchers found respiratory infections are the most commonly reported illness among religious pilgrims. This study also found that:
`Pneumonia is the leading cause of hospitalization at Hajj, accounting for approximately 20% of diagnoses on admission.’This sort of `viral noise' can make it difficult to identify and isolate those infected with MERS (see BMC Inf. Dis.: Clinical Management Of Suspected MERS-CoV Cases).
While we've been lucky in the past, with no large MERS outbreaks linked to the Hajj or Ramadan, the possibility of seeing one or more infected pilgrims returning home while silently carrying the virus remains a yearly concern.