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| Tracking the next pandemic: Avian Flu Talk |
MERS before Hajj |
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Pixie 
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 Topic: MERS before HajjPosted: June 05 2013 at 7:15pm |
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Saudi Arabia Moves to Control MERS-CoV Before Mecca Hajj Pilgrimage Season
By Esther Tanquintic-Misa | June 6, 2013 11:43 AM EST Medical authorities in Saudi Arabia are racing against the clock to implement measures to control the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) into a feared, potential pandemic in light of the forthcoming annual Mecca Hajj pilgrimage season on October 13-18. Millions of Muslims around the world go to Makkah, Saudi Arabia, for their annual recurring pilgrimage or Hajj. Considered one of the five pillars of Islam, Muslims who are able-bodied and financially capable are required to make the Hajj pilgrimage at least once in their lifetime. The Hajj is the Muslim people's demonstration of solidarity as well as submission to Allah, their known god.
This year, Saudi Arabia expects around 2,000 Muslim pilgrims from Italy alone to go to Mecca, according to Foad Aodi, president of the association of foreign doctors in Italy (AMSI) and Comai, which represents the Arab world in Italy. Worldwide, at least 3 million ethnically diverse Muslims converge in Mecca every year to observe the Hajj pilgrimage. "The most worrying aspect is that we still haven't identified the means of contagion of the virus and we have serious fears about the next haj that will bring millions of Muslims from around the world to Mecca the most holy place in Islam in October," Mr Aodi said. Victims from the new SARS-like virus have reached 30 worldwide, where 24 of those deaths came from Saudi Arabia. Another 39 new cases have been confirmed while another 1,300 suspected cases are being monitored. However, Mr Aodi fears a potential spread could start as early as August, which marks the end of Eid-al-Fitr or the end of Ramadan, a holiday to mark the end of the Islamic month of Ramadan when Muslims fast during the hours of daylight. During this time, Muslims hold a feast including slaughtering an animal that is shared among the poorest families in the Arab world. The Mecca Hajj pilgrimage season would be a perfect breeding ground for the infectious and deadly MERS-CoV to further spread since the Muslim people will converge in tight spaces over a span of several weeks. And when they return home, they also bring with them any potential virus they contracted. Authorities recommend getting vaccinated against hepatitis A and B, typhoid, and the seasonal flu before traveling to Saudi Arabia. They also urged people to observe standard hygiene practices like washing hands, sneezing into a tissue or sleeve, and avoiding sick people. |
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Satori
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Posted: June 05 2013 at 7:55pm |
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if yer in the middle of that crowd I don't think sneezin' into a tissue is gonna do much good that's one giant petri dish |
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EdwinSm,
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Posted: June 06 2013 at 1:12am |
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It didn't spread last year -- I have less hope for it doing nothing this year, as MERS seems more entrenched in the area. I just hope it proves to be very limited in its H2H spreading.
I think India has festivals that generate more crowds than are seen during the Hajj, but the Hajj like the Olympic Games draws people from all over the world. |
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Pixie
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Posted: July 07 2013 at 8:23am |
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2.5 million pilgrims and 20 person medical team?
JEDDAH: AHMAD WAHAJ SIDDIQUI Sunday 7 July 2013 Last Update 7 July 2013 2:28 am The Makkah Municipality has all the necessary resources and services in place to ensure a healthy and safe environment for Umrah pilgrims during Ramadan. This was the assurance Makkah Mayor Osama Al-Bar gave in an interview with Arab News recently. He expects an estimated 2.5 million foreigners to visit Makkah and Madinah during Ramadan this year. Al-Bar said 8,500 workers including supervisors, drivers, sweepers and others would ensure the city is kept clean and free of diseases. A fleet of 350 garbage trucks and other equipment will be deployed around the clock. A total of 170 pressurized garbage containers and 45 regular containers have been placed around the Grand Mosque to deal with garbage causing foul odors. The municipality has appointed 13 teams to spray insecticides in pools of water across the city. Al-Bar said there are strict measures in place to ensure the six abattoirs across the city are clean. Each abattoir has a furnace to burn animal waste. Veterinarians at the slaughterhouses examine animals before and after slaughtering to ensure good meat is supplied to the market. Butchers are fined for failing to meet health standards, said Al-Bar. He said all roads and the 55 tunnels are monitored to ensure smooth flow of traffic. The lighting system is also regularly checked. He said six parking areas around the city have mosques, toilets and proper water supply. Two teams consisting of 10 people each with vehicles and ambulances are ready to handle medical emergencies. Al-Bar said it was an honor to serve visitors to the city, particularly during Ramadan. There are also offices available to deal speedily with any complaints, he said |
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CStackDrPH
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Posted: July 07 2013 at 12:52pm |
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Fascinating topic, made even more complicated by (a) the high case-fatility rate of MERS and (b) the fact that animal reservoirs remain unidentified.
This is a good read: When the Black Death exploded in Arabia in the 14th century, killing an estimated third of the population, it spread across the Islamic world via infected religious pilgrims. Today, the Middle East is threatened with a new plague, one eponymously if not ominously named the Middle East respiratory syndrome (MERS-CoV, or MERS for short).
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CRS, DrPH
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Satori
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Posted: July 07 2013 at 3:32pm |
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CStack that article is not a "good read" it is an EXCELLENT read incredibly informative thanks for posting |
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Rors
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Posted: July 07 2013 at 5:20pm |
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Great article and it does shed the light on the multitude of factors that might contribute to the spread of the disease. But just to point out that while Turkey and Jordan both have refugee camps, Lebanon does not (except for some "gatherings" that remain small in size). Refugees in Lebanon are spread all over the country that has now 20 to 25% of its population made of refugees. The fact that people are not crammed in a camp might help ease transmission, but it also makes it that much harder to monitor, detect and treat cases if any before they get the chance to infect others. Another good point in the article is mentioning that not only do we have refugees moving around, but also humanitarian workers that are converging from all over the world in large numbers since this is one of the highest profiles emergencies at the moment, and the turn over of those is really fast. Add to that many of them are shuffling between Lebanon, Jordan and Turkey back and forth with travels home/vacations in-between. Although we still don't have any cases despite the frequent travel between Lebanon and KSA, it does put me on edge knowing that many people will be going for hajj in the coming weeks and coming back which shoots the risk of the spread of MERS out of the roof. The country is barely able to cope with the syrian emergency as is and is definitely not preparing for any outbreak of MERS (i dont believe it's even on the radar so much everyone is busy with Syria). Coupling it with a public health emergency will be nothing short of catastrophic, with repercussions even far beyond the borders. Luckily, we're not there yet and the virus does seem to need to further mutate before going haywire which is good. but having hundreds of thousands of people in the same place at the same time in KSA presents as many chances for it to mutate as to spread. |
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CStackDrPH
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Posted: July 07 2013 at 8:42pm |
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Thank you, I aim to please!  As a seasoned infectious disease epidemiologist and virologist, I feel it is my duty to disseminate information as I receive it, with my own read on the subjects. I think that MERS during the Hajj is a real danger.... ...so, apparently, do our friends at the World Health Organization, who have just set up an emergency guidance panel for MERS! I have to think they are looking forward to the Umrah and Hajj migrations. Also, please don't buy into the malarky that "MERS is not as contagious as SARS." It's a coronavirus, related to the common cold. We know virtually nothing about this bug yet, including its natural reservoir (presumed to be bats), mode of spread to human hosts (possibly by bat-feces contamination of dates?) and other facts. MERS has a higher case-fatality rate than SARS, and that one caused global panic. RIP, Dr. Carlo Urbani, a true hero in the history of public health!! |
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CRS, DrPH
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rickster58
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Posted: July 07 2013 at 9:24pm |
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Fantastic lesson in history, which unfortunately may repeat itself. Dr Stack do you know why they are finding it so difficult to find what animal is the natural reservoir? Given the technology now available and methodology in tracking and data collection we now have post SARS and Swine Flu it seems like we still know very little about MERS, except that it is potentially more deadly.
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Guests
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Posted: July 07 2013 at 10:17pm |
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I keep saying that there are too many people on earth and Mother Nature is going to get rid of a bunch of us. Plague was because people did not know rats carried the fleas that gave people plague and no cure for 1918 Spanish Flu. MERS is here because Mother Nature has had a good fight from man on the Flu Virus so she has gone a different way a way we have yet to be able to fight off, Corona Virus.
The article is great and give us forewarning let's hope people listen. |
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Kyle
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Posted: July 07 2013 at 11:41pm |
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I'm going on a trip out of the country to Mexico in the upcoming weeks. How worried Should I be?
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CStackDrPH
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Posted: July 08 2013 at 9:22am |
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Worried about influenza or MERS? Not much. Those agents are still evolving and developing, and there have not been any reports of H7N9, MERS etc. in Latin America. Worried about Hep A, E. Coli etc.? Much more so. I work throughout Mexico & never get sick. Do the following: a) avoid all water, INCLUDING ice, unless you absolutely know its source. Tap water in Mexico is laden with amoebas that cause dysentery and many other enteric pathogens. Hint: the beer is fine! b) avoid raw vegetables unless they are peeled. See (a) c) bring along some alcohol hand disinfectant and use this religiously AFTER you use the bathroom & after you are outside! There are a lot of viral agents, esp. norovirus, and we get these by touching sink handles, door knobs etc. d) avoid street vendor food. You might catch an enteric pathogen like roundworm or pork tapeworm (from the contaminated hands of the vendors). I recommend that you obtain the Hepatitis A vaccine immediately, as it takes two doses spaced weeks apart for maximum effectiveness. Even the first dose confers very good immunity. Bring some emergency food. I recommend beef jerky, power bars (I like Abbott Lab's "Zone" bars for travel as they don't melt), dried fruit/nuts etc. That way you can eat if you are stuck with a broken bus, or in an airport terminal. Follow US State Department alerts. The border towns (Juarez, Acapulco etc.) are notoriously rough right now because of ongoing narcotic gang warfare. Interior cities like Guanajuato are very nice and fantastic tourist destinations. ¡Hasta la vista y vaya con Dios! |
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CRS, DrPH
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Pixie
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Posted: July 10 2013 at 9:18am |
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Deadly Saudi MERS-CoV Global Pandemic Bio-tech Stocks Profit Potential
Companies / BioTech Jun 17, 2013 - 02:39 AM GMT By: Money_Morning Greg Madison writes: One of the really beneficial things about science is its power to transcend borders and ideologies. Scientists in countries that may be totally hostile to one another have the chance of collaborating on difficult problems in a spirit of openness. This ability to collaborate and exchange information across borders is particularly important when a new disease with global pandemic potential emerges, as it has in the Middle East with the respiratory system coronavirus (MERS-CoV). This "novel coronavirus" was identified in September of 2012 in the Saudi Red Sea port of Jeddah. The disease was found in a deceased 60-year old man who died of acute pneumonia and kidney failure. Little else is known of this unfortunate individual. A Scary Bug MERS-CoV is a scary bug. There have been 51 reported cases radiating outward from the Arabian Peninsula, from Saudi Arabia, Jordan, Qatar, the United Arab Emirates, and Tunisia, out to Germany, France, and Italy. The death toll presently stands at 30, giving an informal "mortality rate" of more than 50%. The overwhelming majority of those deaths have occurred in Saudi Arabia. Which is why the deafening silence coming from Saudi Arabia's Ministry of Health is troubling - if not downright scary. World Health Organization scientists seeking to tackle the problem desperately need any data the Saudis can provide But Scientific American has reported that the Saudi health ministry has done little except announce new cases and report deaths from MERS-CoV. Even basic patient information like age, sex, pre-existing conditions, co-morbidity, and any other factors are left out of the Saudi reports Early indications are that MERS-CoV does not spread easily from person to person... yet. When viruses are concerned, evolutionary leaps and bounds happen in the (relative) blink of an eye. This has the WHO worried. Millions May Be Headed For The Epicenter And there is good reason for worry. Global air travel is a huge problem when dealing with any pandemic, for obvious reasons. The free flow of people means the free flow of disease, but only rarely do people fly directly into the epicenter of a pandemic. Yet, we're less than one month away from the Muslim holy month of Ramadan. Ramadan coincides with a huge influx of religious tourists to Saudi Arabia, as millions of pilgrims arrive from all over the world to take part in the Umrah and Hajj rituals practiced by observant Muslims. These pilgrimages are among the largest single movements of humanity, and they happen every year. During the pilgrimage, the great throngs of human beings are visible by satellite. During these rituals, pilgrims from every continent,from more than 150 countries, live, eat, and worship for weeks in communal, necessarily primitive conditions in the desert outside the holy city of Mecca. This year, these pilgrims could be walking into a very dangerous situation indeed. During any "routine" pilgrimage season, if anything like this could be called routine, the Saudi government faces enormous logistical challenges in accommodating the millions of tourists. Mix in a potentially lethal pandemic to the equation, and a timeless, sacred ritual turns ugly very quickly. The disease need not strike pilgrims first. In addition to being the gateway to Mecca, Jeddah is an ancient Red Sea port. Ships come and go, day after day after day, as they have for centuries. Cosmopolitan Jeddah ties the Arabian Peninsula to East Africa, the Indian subcontinent, and China beyond. Billions of people have indirect exposure to anything that happens in that city. Most Saudi oil is exported from three major ports on either the Red Sea or the Persian Gulf; Ras Tanura, Ras al-Ju'aymah, and Yanbu. Tankers leave these facilities for destinations all over the world. Any one of those tankers could potentially carry MERS-CoV to the outside world. More Questions Than Answers To be clear, there is absolutely nothing special about Saudi Arabia or its people that makes it more or less prone to be the origin of this virus. It's just a diabolical luck of the draw, and there's every chance that it was a case of a person coming into contact with an infected animal, a case of zoonosis - something that happens all over the world as the human population expands and wild habitats shrink. There are far more dangerous things than hungry bears and angry spiders out in the wilds. It would be irresponsible to say that MERS-CoV will definitely become a global health crisis. The WHO just doesn't have enough information to make that determination. MERS-CoV's communicability rate, whether or not it can spread through sustained contact, even its method of infection, are all huge gray areas. The WHO is very concerned about it, while other scientists just aren't. This split decision is thanks in part to the unwillingness of the Saudi health ministry to open up about the facts. What we're left with is a limited body of evidence, some precedent, some (very) educated guesswork, and potentially deadly unanswered questions. That's not a great way for scientists to fight a disease, especially one with the ghastly potential of MERS-CoV. A situation where people flow freely while information is withheld is a nightmare scenario for disease fighting. Back To The Future If anything, scientists may have to go back to the future, and take a hard look at at the SARS-CoV outbreak which occurred in the early part of the last decade. SARS-CoV was a coronavirus, like this new emerging threat, and it did spread widely across the planet, though it caused (relatively) few deaths. Coronaviruses infect both humans and animals, and in many cases, humans only get sick once the virus - endemic in such and such an animal population - makes the jump to an unlucky human. The most well-known of the coronaviruses is the common cold, something that most of us have experienced at one time or another. The SARS outbreak brought renewed research into coronaviruses. The disease caught the world with its collective pants down. It was a global threat, and there was no therapy in place besides evaluating each patient and moving on from there.
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Pixie
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Posted: July 10 2013 at 5:26pm |
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This photo is surreal. Density and spiraling movement.
 Muslim pilgrims circle the Kaaba and pray at the Grand Mosque during the annual hajj pilgrimage in the holy city of Mecca. File photo. Image by: AMR ABDALLAH DALSH / REUTERS |
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Satori
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Posted: July 10 2013 at 5:33pm |
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if something is going to happen the hajj is THE place http://www.cidrap.umn.edu/news-perspective/2013/07/news-scan-jul-10-2013 Study: Viral respiratory infections common in Hajj pilgrims |
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LOPPER
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Posted: July 10 2013 at 6:36pm |
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CStackDrPH
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Posted: July 10 2013 at 9:33pm |
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That is an excellent question, Rickster! Since I'm not on the ground in Saudi Arabia, I can guess that investigators are being hampered by cultural sensitivities (the Kingdom puts very tight travel limits on non-Muslims), shortages of workers in the Saudi Ministry of Health, and an overall confusing situation. This guidance by the WHO is only a few weeks old, notice that they emphasize identification of the animal species that is the ecological reservoir for the MERS coronavirus: This excellent paper provides more details, I'll repost this to a MERS thread: Identification of the reservoir species and exposure data The importance of identifying animal reservoir(s) and understanding human exposure to reservoir species (e.g. direct contact, contact via contaminated food) is well recognised. Once the reservoir has been identi fied, any exposure of MERS-CoV human cases to that reservoir should be documented in epidemiological investigations. Currently, the uncertainty regarding reservoirs and modes of transmission mean that only five of 50 cases can reliably be classified as ‘human- to-human’ transmission, with the source of infection unclear for the remainder. ===== So, the professionals are basically saying "Hell if we know!!" The natural ecosystem of the Middle East isn't that complex in terms of mammals....we are all guessing bats, since they are a known reservoir of the Coronavirus. I've seen cats, camels etc. all suggested as animal reservoirs in this region, so I'll let you know when I know! Remember, SARS was found in Civet Cats that Catonese Chinese folks liked to eat!! Epidemiology is never a dull field. (addendum) I looked around for a few minutes, this is a fantastic article on the natural ecology of the corona viruses!! Very impressive! http://novel-infectious-diseases.blogspot.com/2013/06/potential-animal-reservoirs-of-novel.html |
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arirish
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Posted: July 11 2013 at 9:56am |
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I read that there is alot of hoof and mouth disease in KSA and most countries won't allow the animal samples in to be tested!
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CStackDrPH
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Posted: July 12 2013 at 1:07am |
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Here's a really good article that discusses the hunt for MERS in animal species in KSA! Indeed, hoof & mouth virus is terribly contagious....infected herds can shed enough virus that the wind can carry it large distances, infecting animals on distant farms. I can understand why livestock samples from the region are refused. |
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Pixie
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Posted: July 13 2013 at 9:52am |
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Clin Infect Dis. 2013 Jul 9. [Epub ahead of print]
Circulation of respiratory viruses among pilgrims during the 2012 Hajj pilgrimage. Benkouiten S, Charrel R, Belhouchat K, Drali T, Salez N, Nougairede A, Zandotti C, Memish ZA, Al Masri M, Gaillard C, Parola P, Brouqui P, Gautret P. Source Aix Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Unité Mixte de Recherche (UMR) 63, Centre National de la Recherche Scientifique (CNRS) 7278, Institut de Recherche pour le Développement (IRD) 198, Institut National de la Santé Et de la Recherche Médicale (INSERM) 1095, 13005, Marseille, France. Abstract Background. The Hajj is the oldest and largest annual mass gathering in the world and may increase the risk of spreading respiratory viruses. Methods. We performed a prospective survey among a cohort of pilgrims departing from Marseille, France, to Mecca in the Kingdom of Saudi Arabia (KSA) for the 2012 Hajj season. Nasal swabs were collected from participants and tested for 11 respiratory viruses by real-time RT-PCR (rRT-PCR). Results. Of 165 participants sampled before departing to the KSA, eight (4.8%) were positive for at least one virus (five rhinovirus, one influenza C, one adenovirus, and one enterovirus). Seventy symptomatic pilgrims underwent additional nasal swabs during their pilgrimage in the KSA, of which 27 (38.6%) were positive for at least one virus (19 rhinovirus, six influenza A, one influenza C, one respiratory syncytial virus B, one metapneumovirus, one adenovirus, and one enterovirus). This was significantly higher than the 4.8% who were positive before departing for the KSA (P<.001). Of 154 pilgrims sampled before leaving the KSA, 17 (11%) were positive for at least one virus (13 rhinovirus, three adenovirus, two influenza B, and one enterovirus), which was also significantly higher than the percentage of positive pilgrims (4.8%), before departing for the KSA (P=.040). Conclusions. This study suggests a rapid acquisition of respiratory viruses among pilgrims during their stay in the KSA, most notably rhinovirus, and highlights the potential of spreading these infections in the pilgrims' home countries upon their return. PMID: 23839997 [PubMed - as supplied by publisher]
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jacksdad
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Posted: July 13 2013 at 5:26pm |
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Yet another good find, Pixie
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"Buy it cheap. Stack it deep"
"Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary. |
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CStackDrPH
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Posted: July 13 2013 at 6:42pm |
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Yes, that is conceivable. However, once released from the lab, viruses tend to mutate quickly and would likely acquire additional properties that the creators did not anticipate, causing pandemonium. Such research is controlled by international accords on bioweapons. However, viruses are being studied for medical applications as well. Please see this article about viruses constructed to target malignant cells. This is a very promising development! |
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CRS, DrPH
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Suzi
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Posted: July 13 2013 at 6:51pm |
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Read a book on this topic. Slatewiper by Lewis Perdue.
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Elver
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Posted: July 13 2013 at 8:50pm |
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I love my Nook! I just downloaded this and started reading it.
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CStackDrPH
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Posted: July 15 2013 at 9:25pm |
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You are welcome. I'm not sure what you are asking....is it conceivable that some group or power would specifically engineer a virus to attack some genetic sub-set of humanity (racial gene etc.)? They could try, but viruses don't work that way. They are rather specific for what they do = invade host cells, hijack the genetic replication equipment (DNA or RNA), make multiple copies, and then explode out of the cell to infect more cells. They obviously have some affinities (which is why fish viruses don't attack humans), but to try to engineer something to attack males vs. females, or blue eyes vs. brown eyes would be beyond present day science and doubtful. If you want to read about a group that did much to engineer killer organisms, read about the USSR's "Biopreparat" military group that developed tons (yes, tons) of freeze-dried smallpox virus to be loaded onto ICBM MIRVs for deployment against US cities. Much of this material is missing, which is why we in the public health field are on such high alert for ILI (influenza-like illness), a harbinger of a bioterror agent attack. Here, enjoy: http://cns.miis.edu/npr/pdfs/alibek63.pdf
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CRS, DrPH
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CStackDrPH wrote: