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SHORT COMMUNICATION
Year : 2016  |  Volume : 9  |  Issue : 5  |  Page : 635-636  

Middle East respiratory syndrome and Hajj


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Kanchipuram, Tamil Nadu, India

Date of Web Publication13-Oct-2016

Correspondence Address:
Saurabh RamBihariLal Shrivastava
3rd Floor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur, Guduvanchery Main Road, Sembakkam Post, Kanchipuram - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.192161

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  Abstract 


Since the emergence of Middle East respiratory syndrome in Saudi Arabia in 2012, it has been acknowledged as a major global public health threat. The Kingdom of Saudi Arabia (KSA) serves as one of the biggest hosts for millions of pilgrims. However, owing to the potential of the virus to spread internationally, overcrowding, and tough physical conditions for the pilgrims, it is quite a tricky situation for the travelers planning to visit Saudi Arabia. Experts have recommended that the current situation in KSA does not meet the criteria to be acknowledged as a public health emergency of international concern. Indirectly, it means that currently there is no public health justification to suggest that travel or trade should be restricted to Saudi Arabia. To conclude, travel to Saudi Arabia by the pilgrims for Hajj has been declared safe and no restrictions have been imposed. Nevertheless, it is the responsibility of policy makers, health professionals, and pilgrims themselves to prevent any major outbreak by adhering to the recommendations proposed by the International Health Regulations.

Keywords: Hajj, International Health Regulations, Middle East respiratory syndrome, Saudi Arabia


How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Middle East respiratory syndrome and Hajj. Med J DY Patil Univ 2016;9:635-6

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Middle East respiratory syndrome and Hajj. Med J DY Patil Univ [serial online] 2016 [cited 2024 Mar 29];9:635-6. Available from: https://journals.lww.com/mjdy/pages/default.aspx/text.asp?2016/9/5/635/192161




  Introduction Top


Since the emergence of Middle East respiratory syndrome (MERS) in Saudi Arabia in 2012, it has been acknowledged as a major global public health threat.[1] This is mainly because of its high magnitude (close to 1500 confirmed cases of MERS), global distribution (cases being reported across 26 different nations), and high case-fatality rate (36%).[1]

Middle East respiratory syndrome in Saudi Arabia

Out of the total global burden of MERS, Saudi Arabia alone accounts for the maximum number of confirmed cases.[1] Further, strains of MERS virus isolated in Saudi Arabia region have been isolated in various nations (viz., 2015 MERS outbreak in the Republic of Korea, China, etc.).[1],[2] The Kingdom of Saudi Arabia (KSA) serves as one of the biggest hosts for almost 2 million pilgrims for annual Hajj and 6 million pilgrims around the year for Umrah.[3]

However, owing to the potential of the virus to spread internationally, overcrowding, tough physical conditions for the pilgrims, and Saudi Arabia being the largest source of infection to other nations, it is quite a tricky situation for the travelers planning to visit Saudi Arabia either for Hajj or Umrah.[1],[2],[3]

Potential risk of outbreak

Infact, a major outbreak of MERS can precipitate anytime, especially in nations with a significant number of Muslim people.[2],[3] Furthermore, issues pertaining to the mechanism of transmission of infection from animals to human, estimation of the risk to the pilgrims, extent of transmission of the disease by the pilgrims to their contacts after returning to their native country, inadequate implementation of the infection control measures, preparedness of the health system to deal with a potential outbreak, and poor awareness about the infection among the general population, have been identified.[1],[3],[4],[5] In addition, concerns of shortage in resource capacities (including diagnostic and therapeutic services), noncompliance with the standard recommendations regarding notification of asymptomatic yet positive cases, inequitable distribution of medical resources, lacunae in the triage system, unavailability of a vaccine or specific treatment approach, quality of the epidemiological and virological surveillance, and ineffective involvement of the concerned stakeholders, have not been addressed universally.[1],[3],[4],[5]

Suggested measures

To deal effectively with the above issues and to suggest recommendations with regard to travel of pilgrims to Saudi Arabia for Hajj, the members of the Emergency Committee have released specific guidelines.[6] It has been concluded that the current situation in KSA does not meet the criteria to be acknowledged as a public health emergency of international concern.[6] Indirectly, it means that currently there is no public health justification to suggest that travel or trade should be restricted to Saudi Arabia, and there is no need for conducting screening at points of entry.[6],[7] This is predominantly due to the extensive efforts and the progress observed in different aspects in the region.[6] However, the epidemiological scenario in the country needs to be cautiously followed as outbreak in either hospital or community can precipitate following exposure to the persons with undiagnosed infection.[6]

However, the committee has proposed a set of recommendations such as prioritizing the issue of MERS infection among the policy makers; strengthening of the health care establishments (viz., diagnostics, implementation of infection prevention and control measures, sensitization of the health workers, etc); and facilitating collaboration among different sectors such as animal/agriculture/health has been envisaged.[1], 2, [5],[6],[7] In addition, other measures such as sharing of information of public health importance in a prompt manner; mobilizing resources effectively to deal with a potential outbreak; creating awareness about MERS and its symptoms among the pilgrims travelling to the affected region; improving the surveillance mechanism; and fasttracking the process of development of vaccine through international support, to strengthen the public health approach against the disease, not only in Saudi Arabia but also across the world has been advocated.[1], 2, [5],[6],[7]


  Conclusion Top


Travel to Saudi Arabia by the pilgrims to Hajj has been declared safe and no restrictions have been imposed. Nevertheless, it is the responsibility of policy makers, health professionals, and pilgrims themselves to prevent any major outbreak by adhering to the recommendations proposed by the International Health Regulations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. Middle East Respiratory Syndrome Coronavirus (MERS-CoV): Fact Sheet No. 401; 2015. Available from: http://ww.who.int/mediacentre/factsheets/mers-cov/en/. [Last accessed on 2015 Dec 05].  Back to cited text no. 1
    
2.
World Health Organization. Middle East Respiratory Syndrome Coronavirus (MERS-CoV): Republic of Korea; 2015. Available from: http://www.who.int/csr/don/03-july-2015-mers-korea/en/. [Last accessed on 2015 Dec 05].  Back to cited text no. 2
    
3.
Soliman T, Cook AR, Coker RJ. Pilgrims and MERS-CoV: What's the risk? Emerg Themes Epidemiol 2015;12:3.  Back to cited text no. 3
[PUBMED]    
4.
Memish ZA, Zumla A, Al-Tawfiq JA. How great is the risk of Middle East respiratory syndrome coronavirus to the global population? Expert Rev Anti Infect Ther 2013;11:979-81.  Back to cited text no. 4
[PUBMED]    
5.
Tashani M, Alfelali M, Barasheed O, Fatema FN, Alqahtani A, Rashid H, et al. Australian Hajj pilgrims' knowledge about MERS-CoV and other respiratory infections. Virol Sin 2014;29:318-20.  Back to cited text no. 5
[PUBMED]    
6.
World Health Organization. WHO statement on the Tenth Meeting of the IHR Emergency Committee Regarding MERS; 2015. Available from: http://www.who.int/mediacentre/news/statements/2015/ihr-emergency-committee-mers/en/. [Last accessed on 2015 Dec 08].  Back to cited text no. 6
    
7.
Al-Tawfiq JA, Zumla A, Memish ZA. Travel implications of emerging coronaviruses: SARS and MERS-CoV. Travel Med Infect Dis 2014;12:422-8.  Back to cited text no. 7
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