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MERS Cases Increasing in Saudi Arabia, And The Hajj Is Coming

When last we checked in on the elusive disease MERS—Middle East Respiratory Syndrome, caused by a virus related to the cause of the worldwide SARS epidemic in 2003—it had been brewing in the Gulf states for three years, but was triggering international alarm because of an outbreak in Korea.

That was in June. There has not been a case of MERS in Korea since July. But rather suddenly, the virus has picked up activity in the country where it got started, the Kingdom of Saudi Arabia. And that’s a concern, because in a month, Saudi Arabia will host millions of temporary visitors from all over the world, making the obligatory pilgrimage known as the hajj.

Earlier in the MERS outbreak, there was international criticism (some of it written by me) that the Kingdom’s government was being parsimonious with information about where the infection was going. As a result, the Saudi Ministry of Health now makes near-daily online reports of any MERS cases. Beginning in June, things had been quiet, with no new cases reported, or at most, one per week. And then, in mid-July, the numbers began to tick up again: two cases on July 13, one on July 16, one on July 21, two on July 22, 2 on July 23, and so on. There has been at least one case every day since Aug. 3, usually more—altogether, 76 new confirmed cases this month.

Screengrab from the KSA Ministry of Health site showing MERS cases over the past 2 weeks.
Screengrab from the KSA Ministry of Health site showing MERS cases over the past 2 weeks.

The new run of cases is centered in one city and one hospital: King Abdulaziz Medical City, in Riyadh, the capital. This is important because, in the original MERS cases, and also in the recent Korean outbreak, hospitals were the nexus of infection, the place where the virus was exchanged between sick people, healthy companions and family members, and healthcare workers. Dr. Keiji Fukuda, an assistant director general of the WHO, said of the Korean outbreak in June: “In some instances there was close and prolonged contact between people who had infection and people who did not have infection, so for example other patients, visitors, healthcare workers in emergency rooms, so under crowded conditions and for prolonged periods of time.”

According to Agence France Presse earlier this week, the hospital has closed its emergency department, hoping to prevent cycling of the illness from infected to uninfected people. But, according to the daily records on the Ministry site, most of the people becoming infected are not hospital personnel. The Ministry doesn’t specify where it thinks people got infected, other that to indicate Yes or No in a category headed “Contact with suspected or confirmed cases in the community or hospitals,” as in this tally from Monday:

Screengrab from the KSA Ministry of Health website; original posted Aug. 17, 2015.
Screengrab from the KSA Ministry of Health website; original posted Aug. 17, 2015.

Whether the source of the infection is the community or the hospital, neither is good news. If the hospital: Saudi Arabia has been experiencing MERS cases since mid-2012; by now, it ought to understand how healthcare transmission can be prevented. (For history, here’s my original post, with an explanation of the troubling echoes of the SARS epidemic.) If the community: The hajj brings an estimated 2 million people to the Kingdom, mixing in very close quarters. The government pours enormous resources into maintaining pilgrims’ health, screening travelers and setting up temporary hospitals near the holy sites, but the hajj nevertheless represents prime conditions for the spread of a respiratory disease.

The fretting about possible MERS transmission during the hajj is not new: It has been a concern every year since the disease was first identified. For the first three of those years, the world has been fortunate, and we can hope that will be true this year as well. But there is still no specific treatment for MERS and no rapid test, and a potential vaccine is in the earliest stages of research. For those of us outside Saudi Arabia, there isn’t much to do except keep watching the numbers, and hope.

5 thoughts on “MERS Cases Increasing in Saudi Arabia, And The Hajj Is Coming

  1. “For those of us outside Saudi Arabia, there isn’t much to do except keep watching the numbers, and hope” is not quite true. There is so much to do now. Now is the time.

    I have elaborated more in my article: http://www.ncbi.nlm.nih.gov/pubmed/25811387

    Joseph I. Middle east respiratory syndrome corona virus (MERS CoV): The next steps J Public Health Policy. 2015 Mar 26. doi: 10.1057/jphp.2015.9.

    MM: Thank you for sharing the link to your piece!

  2. Interesting article and I hope the virus does not spread. Why don’t you say most if not all Hajj related flights fly direct to Jeddah – not stopping in Riyadh. Why is that? Where are the editors to check such facts and statements? Surely the article needs correcting as the implication of your piece is that Hajjies will travel to Riyadh, fall ill and be treated t this hospital and spread disease around the world killing everyone…

    MM: Thanks for pointing out that most pilgrims coming from outside the Kingdom arrive in Jeddah not Riyadh. One concern would be that people from Riyadh could unknowingly carry the virus as they travel within the Kingdom to perform the hajj. One of the lessons of SARS was that starting a chain of infection doesn’t take much; in 2003, a single resident of the infected area on the mainland traveled to Hong Kong, and passed the disease to 12 people who then brought it to their home countries. MERS appears to be less communicable than SARS, but it’s a piece of history to consider in thinking about how unpredictably travel can spread diseases.

  3. Increase awareness of persons through media who are going for hajj and educate them in preventive measures,expedite the process of of any possible vaccine,possibly drop old people from hajj this year as they can easily succumb.

  4. Novavax, a company based in Maryland also has a promising vaccine. Because of the public health priority given to MERS, within weeks of getting the virus’ sequence, they successfully produced a vaccine candidate designed to provide protection against MERS. This vaccine candidate, which was made using our recombinant nanoparticle vaccine technology, is based on the major surface spike protein, which they had earlier identified as the antigen of choice their our work with a SARS vaccine candidate. In April 2014, in collaboration with the University of Maryland, School of Medicine, they published results that showed their investigational vaccine candidates against both MERS and SARS blocked infection in laboratory studies. Although the development of a MERS vaccine candidate currently remains a preclinical program, they believe that their MERS vaccine candidate offers a viable option to interested global public health authorities. It is time for public health authorities to act as this disease can quickly get out of control as recently witnessed is S. Korea.

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