The thing that almost makes it easier about Hajj is that you know when people are going and when they are coming back. But if you have migrant workers coming and going the whole time, then it requires constant vigilance,"
One of the common denominators of controlling the spread of disease during highly pathogenic outbreaks such as smallpox, Ebola, H5N1, SARS-CoV and more recently MERS-CoV is the application of isolation and quarantine. In some instances such as the 1972 outbreak of smallpox in Yugoslavia, it is necessary to ban public gatherings. In modern democratic society, banning public events and issuing quarantine orders is often considered in conflict with civil rights. How does a country like Saudi Arabia handle disease containment particularly during the Hajj? The Hajj pilgrimage to Mecca, Saudi Arabia, is among the largest mass gatherings in the world. In 2013, the Saudi regime and other international health institutes such as the World Health Organization based in Geneve and the Centers for Disease Control and Prevention in Atlanta issued health advice to those travelling to attend the Hajj. Saudi Arabia's approach was sound. "Because they bring large numbers of people from all around the world, mass gatherings such as Hajj and Umrah can increase the risk for infectious diseases. Outbreaks of meningococcal disease used to be a problem so the Saudi Ministry of Health required all pilgrims to receive the meningococcal vaccine and neither Hajj or Umrah visas can be issued without proof of vaccination." See: http://www.cdc.gov/Features/hajjandumrah/index.html
In a study undertaken by Ziad Memish of Riyadh University and colleagues, it appears MERS-CoV emerged between July 2007 and June 2012, with perhaps as many as 7 separate zoonotic transmissions. Among animal reservoirs, CoV has a large genetic diversity yet the samples from patients suggest a similar genome, and therefore common source, though the data are limited. It has been determined through molecular clock analysis, that viruses from the EMC/2012 and England/Qatar/2012 date to early 2011 suggesting that these cases are descended from a single zoonotic event. It would appear that MERS-CoV has been circulating in the human population for greater than one year without detection and suggests independent transmission from an unknown source (11)(12). See: http://en.wikipedia.org/wiki/Middle_East_respiratory_syndrome_coronavirus
While it is important to note the case differences between SARS-CoV and MERS-CoV as an emerging zoonosis, a recent spike in cases has alarmed some within the epidemiology community. Eurosurveillance (a European peer-reviewed scientific journal devoted to the epidemiology, surveillance, prevention and control of communicable diseases, with a focus on such topics that are of relevance to Europe), notes on their site, "As of 23 April 2014, 345 people have been reported infected, and of those 107 have died(2). Most cases occurred in Saudi Arabia (SA) and to a lesser extent in the United Arab Emirates(UAE), still further 11 countries in Europe, Asia and North Africa have reported cases linked to the Arabian peninsula. Few clusters and cases were noted in the second half of 2012, and the epidemic has been stable at low levels in 2013 with about 15 cases notified monthly (Figure). This has changed dramatically over the past weeks when we faced an unprecedented increase in cases and community transmission as well as transmission in hospital settings. April 2014 reported cases were higher than the past two years combined. See:http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20783
Protocols developed by China to prevent the spread of SARS-CoV offer in depth knowledge for containing outbreaks of emerging disease. In a CNN report on MERS today, in an interview with Professor Malik Peiris, Director of Hong Kong University School of Public health, notes "SARS not only took everyone by surprise, it marked the re-emergence of infectious diseases as a major concern. He says that in the wake of SARS, not only were resources--like isolation wards in hospitals--reallocated to combat infectious diseases like SARS, but as a result Hong Kong has now become a center for infectious disease epidemiology and virology. "The HKU group have contributed very signficantly to that event and to understanding what's going on there. We have been working on MERS since almost the time it emerged. We have a greater awareness of the emergence of coronaviruses--not only in Hong Kong but internationally." See: http://edition.cnn.com/2014/05/01/health/mers-virus-sars-lessons/index.html?hpt=hp_c2
Clearly, Saudi Arabia has extensive expertise in disease control and surveillance and one is tempted to say that their approach is almost a case study in containment done right for dense population events. As of May 2, 2014, Saudi Arabia's Health Minister has appointed a ten member council of infectious disease medical advisers.
Note: I will be following up with an article on Novovax vaccine candidate for MERS on my Bio-Industry Analyst blog:https://www.blogger.com/blogger.g?blogID=3473753755600614135#overview/src=dashboard