WHO Provides Advice on MERS-CoV for Pilgrimages

The World Health Organization (WHO) provides the following interim travel advice on MERS-CoV for pilgrimages to the Kingdom of Saudi Arabia for Umra and Hajj.

An outbreak of the Middle East respiratory syndrome coronavirus (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). The following points provide guidance to national authorities of countries from which pilgrims will be traveling in the coming months for Umra and Hajj for the prevention, detection and management of imported cases of MERS-CoV. At this time, the WHO says risk to an individual pilgrim of contracting MERS-CoV is considered very low.

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, including the following: travelers to Umra and Hajj, particularly vulnerable groups within this population; public health officials; healthcare staff responsible for the care of ill pilgrims; public transportation and tourism industries; and the general public.

Countries should advise pilgrims that pre-existing major medical conditions (e.g., 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 traveling to review the risk and assess whether making the pilgrimage is advisable.

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 travelers diarrhea. 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; maintaining good personal hygiene;
avoiding unnecessary contact with farm, domestic, and wild animals.

Health advisories should be made available to all departing travellers to Umra or Hajj by working with the travel and tourism sectors and placing such materials at strategic locations (e.g., travel agent offices or points of departure in airports).
different kinds of communication, such as health alerts on board planes and ships, and banners, pamphlets and radio announcements at international points of entry, can also be used to reach travelers. Travel advisories should include current information on MERS-CoV and guidance on how to avoid illness while traveling.

Current WHO guidelines, or their national equivalents, on surveillance, infection prevention and control measures and clinical management of MERS-CoV should be distributed to healthcare practitioners and healthcare facilities.

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 healthcare providers and facilities.

Medical staff accompanying pilgrims should be up to date on MERS-CoV information 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.
 
Travelers 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 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 staff accompanying the group or to the local health services.
 
Returning pilgrims should be advised that if they develop a 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 immediately notify their local health authority.

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

Practitioners and facilities should be alerted to the possibility of MERS-CoV infection in returning pilgrims with acute respiratory illness, especially those with fever and cough and pulmonary parenchymal disease (e.g., pneumonia or the acute respiratory distress syndrome). If clinical presentation suggests the diagnosis of MERS-CoV, laboratory testing, in accordance with WHOs case definition should be done and infection prevention and control measures implemented. Clinicians should also be alerted to the possibility of atypical presentations in patients who are immunocompromised.
 
WHO does not recommend the application of any travel or trade restrictions or entry screening.

WHO encourages countries to raise awareness of this travel advice to reduce the risk of MERS-CoV infection among pilgrims and those associated with their travel, including transport operators and ground staff, and about self-reporting of illness by travelers.

Source: WHO