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Tuesday, July 23, 2019
UK PHE Risk Assessment & Travel Advice For MERS-CoV In Saudi Arabia
With the start of the Hajj just over two weeks away - and roughly two million pilgrims expected to make this year's journey - there is understandable concern over
the potential spread of infectious diseases at these crowded venues.
The most likely infectious disease outbreak scenarios involve mosquito borne illnesses (like Dengue & Chikungunya, Zika), tuberculosis, mumps, measles, chickenpox, norovirus andrespiratory viruses like seasonal influenza & Rhinovirus.
The Hajj, or pilgrimage to Mecca, Saudi Arabia,
is one of the world’s largest mass gatherings. In 2019, Hajj will take
place August 9–14. Because of the crowds, mass gatherings such as Hajj
are associated with unique health risks. Before you go, visit a travel
health specialist for advice, make sure you are up-to-date on all
routine and travel-related vaccines, and learn about other health and
safety issues that could affect you during your trip.
But Saudi Arabia - since 2012 - has also reported the vast majority of the world's MERS infections, and because of its often prolonged (up to 14 day) incubation period and non-specific early symptoms, travel related cases have allowed the virus to be exported to more than 2 dozen other countries.
It is not always possible to identify
patients with MERS-CoV early because like other respiratory infections,
the early symptoms of MERS-CoV are non-specific. Therefore, healthcare
workers should always apply standard precautions consistently with all
patients, regardless of their diagnosis.
'In today’s “global village”, there is probability of MERS-CoV epidemic at any time and in any place without prior notice. Thus, health systems in all countries should
implement better triage systems for potentially imported cases of
MERS-CoV to prevent large epidemics.'
While MERS could easily simmer in the Middle East for years without ever sparking a global crisis, we have seen a substantial uptick in cases this year, and all viruses evolve over time. One of the reasons why MERS-CoV made the CDC's 2019 short list of theThe 8 Zoonotic Diseases Of Most Concern In The United States.
Although an individual's risk of contracting MERS while visiting Saudi Arabia is very low, today UK's PHE issued travel advice for the upcoming Hajj today, along with a Risk Assessment.
The risk of infection to UK residents travelling to the Middle East remains very low and PHE, NaTHNaC and the World Health Organization do not currently advise any travel restrictions to the Kingdom of Saudi Arabia (KSA) in relation to MERS-CoV.
We urge pilgrims returning from Hajj and Umrah to look out for these symptoms:
fever
coughing
shortness of breath or difficulty breathing
If individuals experience these symptoms within 14 days of leaving the Middle East, they should call their GP immediately or NHS 111 and mention their travel history.
However, Saudi Arabia has reported over 150 cases across the country since January 2019, occurring mainly among KSA residents. There is growing evidence that camels can be a source of infection. MERS-CoV
can also spread person-to-person if there is close contact.
It is
important to practise good personal, hand and respiratory hygiene
including covering your mouth when coughing or sneezing, using tissue or
the upper sleeve, and washing your hands with soap and water regularly.
Dr Gavin Dabrera, lead for MERS-CoV at PHE said:
We strongly advise travellers to avoid contact with camels and
consumption of camel products in the Middle East and to practise good
hand hygiene.
Pilgrims returning from Hajj and Umrah with
symptoms including fever and cough or shortness of breath, within 14
days of leaving the Middle East, should call their GP immediately or NHS 111 and mention their travel history.
Dr Dipti Patel, director of NaTHNaC, said:
Ourinformation sheet for pilgrims
includes information on health regulations, vaccine requirements and
recommendations, and other general health advice for those planning to
travel for Hajj and Umrah. Pilgrims are strongly advised to follow our
specific guidance about staying safe and healthy when travelling.
As of 21st July 2019, 2,449 cases of Middle East Respiratory Syndrome (MERS-CoV) have been published by WHO, with at least 845 related deaths. The majority of MERS-CoV cases have been reported from the Arabian Peninsula, with one large outbreak outside this region involving 186 cases in the Republic of Korea (RoK) in 2015. Cases have been exported to other countries outside of the Middle East, including cases being identified in United Kingdom and South Korea in August and September 2018 respectively.
On 22 August 2018, Public Health England (PHE) reported a laboratory confirmed case of MERS-CoV infection in a resident of the Middle East who had travelled from Saudi Arabia. In response to this, public health measures were implemented including identification of exposed contacts and provision of health advice. This is the third imported MERS case reported by the UK; the last such case was reported in 2013 was associated with two infections in close contact.
Excluding the 2015 outbreak in RoK, the majority of reported cases of MERS-CoV have been from the Kingdom of Saudi Arabia (KSA).
2. MERS-CoV in Saudi Arabia
In KSA, cases of MERS-CoV occur throughout the year; there is currently no evidence of sustained community transmission; human-to-human transmission is most likely to occur in healthcare facilities and household clusters. Large outbreaks linked to healthcare facilities are a feature of MERS-CoV and have occurred both within the Middle East and RoK. This underlines the significance of healthcare facilities as a risk factor for amplifying infection, but also the importance of effective and rapid implementation of infection prevention and control practices for possible cases to limit the potential for onward transmission to other patients and staff.
Outside of hospital outbreaks and smaller household clusters, reported cases are sporadic and usually occur in individuals with a history of contact with camels or camel products such as consumption of raw camel milk. PHE will continue to monitor the situation in KSA.
3. Risk assessment
The most recently reported case from the UK highlights the continued risk of imported cases to the UK, reflecting the current epidemiology of MERS-CoV infection in the Middle East. It is therefore imperative that health professionals remain vigilant for clinical presentations compatible with Middle East Respiratory Syndrome. Early identification and rapid implementation of appropriate infection control measures for possible cases and reporting of these to local health protection teams is crucial.
The risk of infection with MERS-CoV to UK residents in the UK remains very low.
The risk of infection with MERS-CoV to UK residents travelling to the Middle East is very low but may be higher in those with exposure to specific risk factors within the region, such as camels (or camel products) or the local health care system.
Although the risk of MERS-CoV in individuals who meet the case definition for a possible case in the UK following travel to/from the Middle East is low, testing for MERS-CoV is warranted together with rapid implementation of appropriate infection control measures while awaiting results of testing.
The probability that a cluster of severe acute respiratory infection cases in the UK, with unexplained aetiology and requiring intensive care admission, is due to MERS-CoV, remains very low but warrants investigation and testing. A history of travel to the Middle East would increase the likelihood of MERS-CoV.
(SNIP)
Further information and guidance on MERS-CoV is available online.
