Already, the World Health Organisation (WHO) and Saudi authorities are worried about the unknown origin of the ailment which has killed over 50 per cent of those infected in that country.
The disease, called Middle East Respiratory Syndrome (MERS), according to the WHO, is spread through body to body contact which experts believed could become an emergency situation during Umra and Hajj in which millions of pilgrims gather for religious duties in Mecca and Medina.
While the WHO has convened an emergency committee under the International Health Regulations (IHR) to advise on the current situation, the Cable News Network (CNN) has reported Saudi authorities directing pilgrims to wear masks while in crowded places to avoid contracting and spreading the disease.
“In a few months, the holy city of Mecca opens its doors to millions of Muslim pilgrims for the annual Hajj, with multitudes congregating at the same holy places at the same time. Others visit during the holy month of Ramadan, which started this week. It’s a perfect scenario for catching and spreading the relatively new Middle East
Respiratory Syndrome (MERS), which has befallen Saudi Arabia almost exclusivelyCNN quoted Saudi SPA news agency.
The ailment, caused by the coronavirus, wreaks havoc on the respiratory systems of those who contract it.
More than half of those known to have caught it have died, the Centers for Disease Control and Prevention said last week Friday.
Apart from pilgrims wearing masks, Saudi authorities have also asked old people, people with chronic diseases, as well as patients with weakened immune systems to postpone their pilgrimage.
“Pilgrims have also been asked to be extra careful regarding hand hygiene, to sneeze or cough into a paper tissue or the inside of their elbow, and to make sure they are up-to-date with all their vaccinations,” UK-based Medical News Today reported during the week while describing the measures as “ the strictest regulations for the pilgrimage in the country’s history.”
MERS-CoV, which causes SARS-like symptoms plus kidney failure, according to the WHO, has infected 90 people so far, of whom more than half died. Most of the infections and deaths occurred in Saudi Arabia.
There are two peak periods for pilgrimage visits to the holy sites of Saudi Arabia, one is towards the end of Ramadan, and the other is the October Hajj. Pilgrims journey to Mecca, and pray in the Al-Masjid Al-Haram (Grand Mosque) before the Kaaba. Some also travel to the Masjid Al-Nabawi (Mosque of the Prophet), in Medina.
One patient in Jordan according to Medical News Today had MERS-CoV infection but no symptoms, (he was not ill). This means there may be many more infected people out there than official figures suggest. They could potentially infect others,” the report said.
It added, however, that experts from Johns Hopkins University,United States, who visited Saudi Arabia wrote in NEJM (New England Journal of Medicine) that in healthcare settings, MERS-CoV infection spreads more easily.
“Another problem with MERS-CoV is that we know so little about it. We have no idea where it comes from, how many asymptomatic infected people there are, or exactly how human transmission occurs outside hospital settings,” experts said.
A team of 11 experts led by Dr. Kumran Khan of the University of Toronto, Canada, last week released a report on the disease with a warning that the whole world should brace up proactively to curb the likely dispersal of the disease from Saudi Arabia by millions of pilgrims after the two main events. The report is entitled: “Potential for the international spread of Middle East Respiratory Syndrome in association with mass gathering in Saudi Arabia.”
“MERS-CoV is an emerging pathogen with pandemic potential with its apparent epicentre in Saudi Arabia, where millions of pilgrims will imminently congregate for two international mass gatherings. Understanding global population movements out of the Middle East through the end of this year’s Hajj could help direct anticipatory
MERS-CoV surveillance and public health preparedness to mitigate its potential global health and economic impacts.
“As of July 12 2013, 81 cases of the Middle East Respiratory Syndrome (MERS) have been confirmed worldwide, with Saudi Arabia reporting approximately 80 per cent of cases. Among confirmed infections, MERS has a mortality rate exceeding 50 per cent, has a spectrum of illness that includes asymptomatic infection, mild illness and life-threatening severe disease, appears to cause more severe disease in individuals with underlying medical conditions, has demonstrated its potential for community and hospital based human-to-human transmission and has already dispersed to the United Kingdom, France, Germany, Tunisia and Italy. While the MERS coronavirus (MERS-CoV) is genetically similar to coronaviruses found in bats and is suspected to be of animal origin, no animal source has yet been identified.
Every year, millions of domestic and foreign Muslim pilgrims congregate in Saudi Arabia to perform Umrah and Hajj. Umrah, which is a “lesser” pilgrimage, may be performed at any time of the year but is considered particularly auspicious during the month of Ramadan. This year’s version holds from July 9th to August 7th when it will draw an estimated one million pilgrims. By comparison, the Hajj is a five-day pilgrimage that is required of all physically and financially able Muslims at least once in their lifetime. This year (October 13th to 18th), the Hajj is expected to draw over three million pilgrims from within Saudi Arabia and around the world. In 2012, 55 per cent of Hajj pilgrims (1.74 million) were of foreign origin,” the report said, drawing attention to “ the potential for these imminent mass gatherings to amplify MERS-CoV cases and contribute to its international spread.”
“It could help the international community to identify countries that have strong travel connections to Saudi Arabia and the Middle East but which have limited capacity to detect MERS-CoV in a timely manner, and if necessary, mobilise an effective public health response to imported cases including the implementation of rigorous infection control practices. Adopting a proactive and anticipatory approach to the international spread of MERS-CoV may help to mitigate its global health and economic consequences.
“An estimated 8.7 per cent of foreign Hajj pilgrims in 2012 originated from countries that were low income, 56.4 per cent lower-middle income, 27.3 per cent upper-middle income, and 7.6 per cent high income. 60.7 per cent of foreign pilgrims originated from just eight countries – Indonesia (12.4 per cent), India (10.1 per cent), Pakistan (9.9 per cent), Turkey (7.8 per cent), Iran (6.5 per cent), Nigeria (5.7 per cent), Egypt (5.5per cent) and Bangladesh (2.9per cent).
“At the time of writing, imported MERS-CoV has been confirmed in Germany, the United Kingdom, France, Italy, and Tunisia, with the latter four countries reporting domestic transmission. With millions of foreign pilgrims set to congregate in Mecca and Medina between Ramadan and Hajj, pilgrims could acquire and subsequently return to their home countries with MERS-CoV, either through direct exposure to the virus of yet unidentified source or through contact with domestic pilgrims who may be infected. Our findings also indicate that two-thirds of all Hajj pilgrims will be returning to low or lower-middle income countries where medical and public health capacity will be limited, and presumably where the risk of domestic transmission of imported MERS-CoV will be elevated.
“Public health interventions to prevent or attenuate the international spread of an emerging infectious disease and its subsequent domestic consequences may be directed at three frontiers: the source area(s), travellers departing the source area(s), and geographies worldwide receiving travelers from the source area(s). In the case of MERS-CoV, rigorous efforts in Saudi Arabia and the Middle East are ongoing to identify the presumed animal origins of this novel human coronavirus. While there is presently no evidence to indicate that animal livestock are a direct or intermediate source of MERS-CoV, reasonably excluding this possibility will be important since millions of animals, including goats, sheep, cattle and camels will be sacrificed during Ramadan and at the end of Hajj (i.e. Eid-al Adha or Festival of Sacrifice). Products of these animal sacrifices will then be consumed by pilgrims and distributed to the poor.
Many Middle Eastern countries are home to large foreign-born populations including migrant workers (e.g. an estimated 28.7 per cent of Saudi Arabia’s population is comprised of foreign nationals), which may be at risk for MERS-CoV acquisition and subsequent spread to their home countries. These populations may be at heightened risk due to inadequate healthcare access in their host country (e.g. lack of health insurance, language barriers) and may be ‘undercounted’ from traditional government disease surveillance systems,” the report concluded.
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