WHO Issues travel Advicw on &quot;Killer Virus&quot; For Pilgrimages to Saudi Arabia

WHO Issues travel Advicw on "Killer Virus" For Pilgrimages to Saudi Arabia

Posted on: Thu 01-08-2013

WORRIED about possible outbreak of the Middle East respiratory syndrome coronavirus (MERS-CoV) during pilgrimages to Kingdom of Saudi Arabia, the World Health Organisation (WHO) has issued guidance to national authorities of countries from which pilgrims will be travelling in the coming months for Umra and Hajj for the prevention, detection and management of imported cases of the virus. However, a report published July 25 in The Lancet Infectious Diseases suggested that MERS would not prove as dangerous as Severely Acute Respiratory Syndrome (SARS).

The WHO in a statement, however, said" "At this time, the risk to an individual pilgrim of contracting MERS-CoV is considered very low." MERS-Cov, first reported in 2012, has affected nine countries to date. WHO is coordinating the global response to this emerging virus according to the International Health Regulations (IHR 2005). According to the WHO report, it is important for countries to use all practical and effective means possible to communicate information on a range of issues before, during and after Umra and Hajj to all key groups, induding the following: travellers to Umra and Hajj, particularly vulnerable groups within this population; public health officials; health care staff responsible for the care of ill pilgrims; public transportation and tourism industries; and the general public. MERS emerged last year in Saudi Arabia and nearly all cases of infection have been reported there, or in people who were infected with the virus there before traveling to other countries.

According to the report, between Sept. I, 2012, and June 15, 2013, there were 47 con- firmed cases (46 adults, one child) of MERS infections in Saudi Arabia and 90 MERS cases worldwide.

The investigators said an analysis of dinical records, laboratory results and other data revealed that older people, men and patients with chronic health problems are more likely to succumb to the disease.

Like those infected with SARS, people with MERS have a wide range of symptoms. Most patients admitted to the hospital had fever (98 perent), chills (87 percent), ough (83 percent),shortness

of breath (72 percent) and muscle {Jain (32 percent). One-fourth of patients also had gas- ointestinal symptoms, such vomiting and diarrhea. Unlike SARS, however, nearly all of the cases of MERS occurred in people with chronic health conditions,Study leader Ziaad Memish, the deputy minister for public health from the Kingdom of Saudi Arabia, said in a journaly news release: "Despite sharing some clinical similarities with SARS (example, fever, cough and incubation period), there are also some important differences, such as the rapid progression to respiratoryfailure, up to five days earlier than "In contrast to SARS - which was much more infectious, especially in health-care settings, and affected the healthier and the younger age group

_ MERS appears to be more deadly, with 60 percent of patients with co-existing chronic illnesses dying, com- pared with the one percent to two percent toll of SARS."

"Although this high mortality rate with MERS is probably spurious due to the fact that t we are only picking up severe ~ - cases and missing a signifi- i cant number of milder or I asymptomatic cases, so far there is little to indicate that I MERS will follow a similar path to SARS,:,Memish added. Study co-author Ali Zumla, from University College London in the United Kingdom, said that "the recent identification of milder or asymptomatic cases of MERS ~ in health-care workers, children and family members of contacts of MERS cases indicates that we are only reporting the tip of the iceberg of severe cases and there is a I spectrum of milder clinical disease which requires urgent definition." "Ultimately, the key will be to identify the source of MERS infection, predisposing factors for susceptibility to infection and the predictive factors for poor outcome," Zumla said in the news release. "Meanwhile, infection control measures within hospitals seem to work." In an editorial accompanying the report, Christian Drosten, of the University of Bonn Medical Center in Germany, said there is an '" urgent need to develop accu- rate diagnostic tests to help focus efforts to control MERS and to minimize the risk of it spreading from infected patients to other people. The WHO said countries should advise pilgrims that pre-existing major medical

conditions (example chronic diseases such as diabetes, chronic lung disease, immunodeficiency) can increase the likelihood of illness, including MERS-CoV infection, during travel; thus, pilgrims should consult a health care provider before travelling to review the risk and assess whether mak- ing the pilgrimage is advisable.

According to the WHO, countries should make information known to departing pilgrims and 'travel organizations on general travel health precautions, which will lower the risk of infection in general, including illnesses such as influenza and traveller's diarrhoea. The apex health body said specific emphasis should be placed on: washing hands often with soap and water.

When hands are not visibly dirty, a hand rub can be used; adhering to good food-safety practices, such as avoiding undercooked meat or food prepared under unsanitary conditions, and properly washing fruits and vegetables before eating them; maintain- ing. good personal hygiene; oIding unnecessary contact with farm, domestic, and wild animals.

The WHO said health advi- sories should be made avail- able to all departing travellers to Urnra or Hajj by working with the travel and tourism sectors and placing such materials at strategic

locations (example travel agent offices or points of departure in airports). It reads: "Different kinds of communication, such as health alerts on board planes and ships, and banners, pamphletsand radio announce-ments at international points of entry, can also be used to reach travellers. "1ravel advisortes should include current information on MERS-CoV andgiIidance on

how to avoid illness while trave statement rrorect rnar

current WHO guidelines, or their national equivalents, on surveillance, infection prevention and control measures and clinical management of MERS-CoV should be distrib- uted to health care practitioners and health care facilities. According to the WHO, countries should ensure that there are adequate laboratory services for testing for MERS-CoV and that information on laboratory services and clinical referral mechanisms is known to health care providers and facilities. The WHO also noted advised that medical staff accompanyit ing pilgrims should be up to date on MERS-CoV informa tion and guidance, including how to recognize early signs and symptoms of infection, who is considered to be in a high-risk group, and what to do when a suspected case is identified, as well as on simple health measures to reduce transmission. The WHO said travellers who develop a significant acute respiratory illness with fever and cough (severe enough to interfere with usual daily activitieS) should be advised to: minimize their contact I with others to keep from infecting them; cover their -mouth and nose with a tissue when coughing or sneezing and discard the tissue in the trash after use and wash hands afterwards, or, if this is not possible, to cough or sneeze into upper sleeves of their clothing, but not their hands; report to the medical uaff accompanying the group or to the local health services. The statement reads: 'Returning pilgrims should advised that if they develop significant acute respiratory illness with fever and cough (severe enough to interfere with usual daily activities) during the two weeks after their return, they should seek medical attention and Imme- lately notify their local

health authority. "Persons who have had close contact with a pilgrim or traveller with a significant acute respiratory illness with fever and cough (severe enough to interfere with usual daily activities) and who themselves develop such an ilness should be advised to report to local health authori- ies to be monitored for MERS-

Cov."

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