Sunday, May 21, 2023

Mass Gatherings, The Upcoming Hajj & MERS-CoV



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All able bodied Muslims are required to make at least one major pilgrimage to Mecca during their life, but over the past 3 years pandemic restrictions have prevented nearly 10 million from doing so. 

The faithful may also make `lesser pilgrimages’, called omra (or Umrah), at other times of the year. These minor pilgrimages don’t absolve the faithful of making the hajj journey unless they take place during Ramadan.

Next month (June 26th -Jul 1st) Saudi Arabia will hold the first unrestricted Hajj since 2019, with more than 2 million religious pilgrims from around the world expected to attend. 

As we've discussed often, the Hajj - like many other mass gathering events - has the potential to amplify and disperse emerging and existing infectious diseases on a global scale (see J, Epi & Global Health: Al-Tawfiq & Memish On Hajj Health Concerns).

In addition to COVID, the biggest health concerns include mosquito borne illnesses (like Dengue, Chikungunya, Zika & Yellow Fever), tuberculosis, mumps, measles, chickenpox, norovirus and respiratory viruses like seasonal influenza & Rhinovirus - and since 2013 - MERS-CoV. 

While billed as the first `unrestricted' Hajj since the start of COVID, there are still minimum vaccine requirements, and pilgrims must provide a negative COVID PCR test conducted no more than 72 hours before arrival in the Kingdom.  

Reports on the other coronavirus of concern - MERS-CoV - have plummeted since 2019, although the virus remains endemic in camels, and there are doubts over the thoroughness of surveillance and reporting by many Middle Eastern countries. 

In last November's Update: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) – Saudi Arabia, the World Health Organization diplomatically cautioned:

The number of MERS-CoV cases reported to WHO has substantially declined since the beginning of the ongoing COVID-19 pandemic. This is likely the result of epidemiological surveillance activities for COVID-19 being prioritized, resulting in reduced testing and detection of MERS-CoV cases.
 
Detecting MERS-CoV cases can be challenging, even when countries are actively looking for cases. A task has which has admittedly become even more difficult due to the COVID pandemic. 

 
While probably a long-shot, there is even speculation (see Nature: CoV Recombination Potential & The Need For the Development of Pan-CoV Vaccines) that MERS-CoV and COVID might someday recombine into a new viral threat.

But even prior to COVID's emergence in 2019, MERS-CoV was viewed as having pandemic potential of its own (see 2017's A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia), meaning it doesn't necessarily need a viral co-conspirator to start its own world tour.

There are other, far-more-likely, health risks associated with the Hajj (see CDC Yellow Book), including heat-related illness, animal and insect bites, bloodborne pathogens, skin infections, enteric Infections, and respiratory infections.

This typically leads to a month or so of careful global Post-Hajj surveillance, as pilgrims return to their home countries.  In 2019, the UK's HSA issued the following advice to travelers:

Now that the COVID emergency has been declared ended, we can expect to see the resumption of mass gatherings, including the Olympics, summer festivals, state fairs, and large sporting events.  

All venues we watched carefully before the pandemic, and all deserving of our attention now. 

While MERS-CoV has been largely forgotten by the general public, it remains a credible threat.  Next week (13:00–14:00 CEST (Geneva time), 24 May 2023) the WHO will hold an EPI-WIN webinar called:

MERS-CoV, a circulating coronavirus with epidemic and pandemic potential - Pandemic preparedness, prevention and response with a One Health approach


Middle East respiratory syndrome (MERS) is caused by a coronavirus, with a case fatality rate of 36% in humans. Dromedary camels are the reservoir host from which the virus sporadically spills over to humans. Onwards human-to-human transmission has been observed in health care and, to a lesser extent, community settings.

Since its first detection in the Kingdom of Saudi Arabia in mid-2012, MERS-CoV has been reported from 27 countries in the Middle East, North Africa, Europe, the United States of America, and Asia, with 2604 laboratory-confirmed cases and 936 associated deaths to date.

MERS-CoV is on the WHO list of pathogens with epidemic potential, prioritized for research and development in emergency contexts. The zoonotic origin of MERS-CoV means that a One Health approach is key to tackling the virus.
 
This webinar will ask: why does global work on MERS-CoV prevention, surveillance and control remain important for pandemic preparedness and prevention? What has been learnt from MERS and what gaps still remain?

Speakers:
  • Dr Maria Van Kerkhove, Technical Lead, COVID-19 Response, WHO Health Emergencies programme, WHO
  • Dr Sophie von Dobschuetz, Technical Lead MERS-CoV and novel Coronaviruses, WHO
  • Dr Malik Peiris, Professor of Virology, School of Public Health, University of Hong Kong
  • Dr Emad Almohammadi, Chief Officer of Communicable Diseases in the Saudi Public Health Authority

Panelists for Q&A:
  • Emma Gardner, Veterinary Epidemiologist and MERS-CoV Coordinator at the Food and Agriculture Organization (FAO)
  • Hala Abou El Naja, Epidemiologist and MERS-CoV Focal Point at the WHO Regional Office for the Eastern Mediterranean (EMRO)

Interested parties will want to follow the LINK to register.   Recordings of these Epi-Win webinars are posted on the WHO EPI-WIN Youtube Channel.

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