MERS-CoV Stats - Credit WHO
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In less than two weeks Saudi Arabia will hold the first unrestricted Hajj since the emergence of COVID in 2019, with upwards of 2 million devout expected to make the pilgrimage over the last week of June (see Mass Gatherings, The Upcoming Hajj & MERS-CoV).
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).
Traditionally, among the biggest public health concerns are mosquito borne illnesses (like Dengue, Chikungunya, Zika & Yellow Fever), food poisoning, and respiratory viruses like tuberculosis, mumps, measles, chickenpox, norovirus, seasonal influenza, adenoviruses, RSV, and CAP (Community Acquired Pneumonia).
But in 2013 a new threat was added; MERS-CoV, an emerging coronavirus which was discovered to transmit from camels to humans, primarily on the Arabian peninsula.
Over the next 7 years more than 2,500 cases (and > 900 deaths) would be reported - primarily in Saudi Arabia - although both are believed to be significant under-counts (see EID Journal: Estimation of Severe MERS Cases in the Middle East, 2012–2016).
EID Journal: Sensitivity and Specificity Of MERS-CoV Antibody Testing
AJIC: Intermittent Positive Testing For MERS-CoV
JIDC: Atypical Presentation Of MERS-CoV In A Lebanese Patient
Reports of MERS-CoV cases 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.
Late last month, the WHO held an EPI-WIN webinar (now available on Youtube) on MERS-CoV called:
All of which brings us to the following statement from the UK's Health Security Agency (UKHSA) on respiratory precautions that Hajj travelers should consider during their journey. I'll have a postscript after the break.
Hajj pilgrims urged to prioritise respiratory hygiene measures
UKHSA is reminding Hajj and Umrah pilgrims to prioritise Middle East Respiratory Syndrome (MERS-CoV) safety measures when travelling to the Middle East.
From:UK Health Security AgencyPublished13 June 2023Last updated13 June 2023 — See all updates
The UK Health Security Agency (UKHSA) and the National Travel Health Network and Centre (NaTHNaC) are reminding Hajj and Umrah pilgrims to be aware of the risks of MERS-CoV and other general hygiene safety measures when travelling to the Middle East.
Large gatherings such as Hajj and Umrah are associated with unique health risks and travellers should practise good general health measures, such as regular hand washing with soap and water, to reduce the spread of infections. NaTHNaC provides travel health advice for pilgrims attending Hajj.
MERS-CoV is a respiratory virus which causes fever, coughing and shortness of breath. It is primarily spread from animals, particularly camels, to humans, but can also spread from person to person.
The likelihood of infection with MERS-CoV among UK residents travelling to the Middle East is very low and no travel restrictions to the Kingdom of Saudi Arabia (KSA) are currently advised in relation to MERS-CoV. However, to minimise the risk of contracting MERS-CoV or any other respiratory infections including COVID-19, all travellers – particularly those with long-term medical conditions – should practise good general health measures, such as regular hand washing with soap and water, especially after visiting farms, barns or market areas in the Middle East.
- UKHSA advises all pilgrims to:wash hands with soap and water or an alcohol-based hand sanitiser, especially after coughing and sneezing, after using toilets, before and after handling food and before consuming food, and after touching animals;
- use disposable tissues when coughing or sneezing and dispose of used tissues in a wastebasket
- consider wearing a face mask in crowded places
- avoid close contact with people who appear ill and avoid sharing their personal belongings
- avoid contact with camels in farms, markets or barns, including animal waste, for example faeces and urine
- avoid drinking raw milk or eating raw or undercooked meat or animal products that have not been thoroughly cooked
Dr Richard Puleston, lead for MERS-CoV at UKHSA, said:
Travellers are strongly urged to refrain from contact with camels and consuming camel products while in the KSA or the Middle East, and to prioritise maintaining proper hand and respiratory hygiene to reduce the risk of infections spreading.
For individuals returning from Hajj and Umrah, if you experience symptoms such as fever, cough, or shortness of breath within 14 days of leaving the KSA or the Middle East, please contact your GP or NHS 111 without delay and inform them about your recent travel history.
Dr Dipti Patel, director of NaTHNaC, said:
Our comprehensive information sheet for pilgrims provides valuable details regarding health regulations, vaccine requirements, recommendations, and general health advice for those embarking on Hajj and Umrah journeys.
Please follow our specific guidance to ensure your safety and wellbeing throughout your travels.
UK Health Security Agency press office
Nobel House
17 Smith Square
London
SW1P 3JR
Emailukhsa-pressoffice@ukhsa.gov.uk
While the risks of contracting MERS-CoV are considered very low, ten years ago (see EID Journal: Respiratory Viruses & Bacteria Among Pilgrims During The 2013 Hajj) we looked at a study that examined a small group of French pilgrims (n=129) both before and after attending the Hajj, and compared nasal swabs. They found:
. . . that performing the Hajj pilgrimage is associated with an increased occurrence of respiratory symptoms in most pilgrims; 8 of 10 pilgrims showed nasal or throat acquisition of respiratory pathogens.
You put 2 million people - drawn in from nearly every country in the world - into a confined space for a week, and you pretty much guarantee the spread of a wide variety of respiratory viruses. With COVID-19 still evolving and spreading around the globe, the Hajj provides the virus with fresh opportunities to meet and greet - and potentially recombine with - its vast array of cousins.
Add in the non-trivial risks from influenza, and other respiratory viruses, and the advice to wear a mask in large crowds is well taken.
Nature: CoV Recombination Potential & The Need For the Development of Pan-CoV Vaccines
Co-infection of MERS-CoV and SARS-CoV-2 in the same host: A silent threat by Buket Baddal
The Recombination Potential between SARS-CoV-2 and MERS-CoV from Cross-Species Spill-over Infections by Abdulrahim A Sajini, Almohanad A Alkayyal & Fathi A Mubaraki
One of the hallmarks of the past 18 months has been the field day that non-COVID viruses have had sparking epidemics around the world; Influenza, RSV, Adenoviruses, Enteroviruses, Dengue, Strep A, Mpox, etc.
The lesson from COVID is that masks can dramatically reduce the spread of a wide variety of respiratory illnesses.
