Helen Branswell on health

September 22, 2013 4:18 pm
Updated: November 8, 2013 4:12 pm

Pilgrims. Progress?


The Hajj is fast approaching. The migration has already started but in the next couple of weeks, upwards of three million Muslims will converge on Mecca, the holiest site of their faith, to perform the pilgrimage each able-bodied Muslim is expected to do at least once in his or her lifetime. Roughly two million of those pilgrims will come from outside Saudi Arabia to take part in the religious observation, which will take place this year in the second full week of October.

That event has enormous disease spreading potential, a fact the Saudi government knows well and for which it prepares seriously. With years of experience, the Kingdom of Saudi Arabia (KSA) is considered a global leader on mass gatherings medicine.

Experts watching MERS have been nervous about the Hajj, but last week in an interview with The Wall Street Journal, the Kingdom’s point man for MERS, Dr. Ziad Memish, said he takes heart from the fact no MERS infections were spotted in foreign pilgrims who took part in the earlier Umrah pilgrimage, over Ramadan in July and early August.

“For the Ministry of Health, the Umrah is a test run for the Hajj,” Memish, the deputy health minister, told the WSJ. “It gives us an indication of how ready our public health system is to deal with the Hajj.”

But Dr. Tony Mounts of the World Health Organization sees something else in the fact that Umrah pilgrims appeared not to contract MERS while in Saudi Arabia. For Mounts, it’s a clue.

The global health agency’s technical lead on MERS, Mounts has been studying the pattern of infections looking for signs that could shed light on how people are contracting the coronavirus, which is a cousin of SARS. The source of the virus is still a mystery.

In the early days of MERS, most infections were seen in men, often older men. That’s not because the virus has a gender preference. Something men, older men in particular, did was putting them in the way of the virus. (Lately the gender and age imbalance of cases has been evening out.) Was it attending camel races or drinking raw camel milk? Or something else entirely?

Disease detectives didn’t crack the mystery of how people are contracting MERS with the older men clue, but Mounts thinks something could be learned about the source of the virus from puzzling out why pilgrims haven’t been infected.

“I suspect that means whatever non-human exposure that happens and results in the sporadic cases is maybe something that’s not happening during the pilgrimage.”

Mounts thinks its a good sign MERS hasn’t been cropping up in returned Umrah pilgrims, but that doesn’t mean he’s not worried about the Hajj. Though not a required stop on the pilgrimage, many who take part go to Medina while they are in KSA to visit the Prophet’s Mosque, the second holiest site in the Islamic faith. And there has been a cluster of MERS cases in Medina of late, cases where the virus has spread person to person.

“We’ve got these connected cases in Medina and that I think does raise concerns about the pilgrims still. Because of human to human transmission is occurring in the area where the pilgrimage is happening, we have to be wary. And we have to be vigilant about the possibility.”

© 2013 Helen Branswell

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