Survey: MERS advice for high-risk Hajj pilgrims often ignored

In the lead-up to Saudi Arabia’s Hajj observance, which begins on Oct 13, a survey of French pilgrims bound for Mecca found that, although many are aware of the country’s Middle East respiratory syndrome coronavirus (MERS-CoV) outbreaks, the threat isn't cancelling plans, even for people with health risks who have been advised to consider skipping the event this year.

The MERS outbreak is casting a tall public health shadow over the event, which is expected to draw more than 3 million visitors from all over the world. Amid the growing crowds, Saudi Arabia’s health ministry yesterday announced two new MERS-CoV cases, both adults who lived near Riyadh and died from their infections.

One patient is a 78-year-old who had several underlying health conditions, and the other is a 55-year-old who also had chronic health conditions, according to a health ministry announcement posted in Arabic. The report did not list genders or say if the individuals had any connections to other MERS patients.

The new fatalities raise the number of infections from the new virus to 138 and push the number of deaths to 60.

French researchers decided to survey patient knowledge of MERS-CoV after early data from a mandatory meningitis vaccination program for people preparing to make their Hajj pilgrimages revealed that 48% had at least one chronic condition.

Saudi Arabia's health ministry has recommended that pregnant women, older people, and those with underlying health conditions postpone making Hajj this year because of MERS. The team reported its findings today in the latest issue of Eurosurveillance.

They conducted a more in-depth survey on knowledge, attitudes, and practices surrounding MERS-CoV infections and prevention from Aug 26 through Sep 22 at an outpatient clinic in Marseilles.

A total of 360 adults ages 20 to 85 took the 15-question survey. A little more than half were men. Most of the people were North Africans who had lived in France for more than two decades and were preparing to make their first Hajj pilgrimage.

Of respondents, 64.7% knew about the Saudi MERS-CoV outbreak, and 35.3% were aware of Saudi Arabia's recommendation for high-risk people. However, none of the 179 at-risk respondents decided to cancel their trips, despite consultation with clinic staff.

Researchers wrote that the findings show that some pilgrims departing from southern France were unaware of the outbreak and Saudi Arabia's health recommendations, despite extensive media coverage and information that had been relayed to health providers and travel agencies from the French health ministry.

They noted that some of the at-risk people may have decided not to change their plans, because they had already arranged and paid for their trips. Also, their risk perception regarding the Hajj might be swayed by cultural and religious beliefs.

 "Identifying effective communication strategies for necessary preventive measures in the context of religious mass gatherings would be of high value for public health authorities [and] those providing healthcare and advice to individuals," the authors wrote.

In other MERS-CoV research developments today, a team from the University of Sydney that studied bat cells found a clue that might suggest that the animals have been battling the virus and have evolved the capacity to elude it. The team published its findings today in Virology Journal.

They found that bats have more changes to DPP4 protein on their cells compared with other mammals. The MERS-CoV virus uses the DPP4 receptor to gain entry to cells. The researchers suggested that the findings could indicate a "ong-term arms race between bats and MERS related CoVs."

In September, a research team from the United States and Saudi Arabia identified a fragment of a virus in a bat that resembles the MERS-CoV virus, but it isn't clear yet if it is from the same virus infecting people or is part of a closely related virus.

See also:

Oct 10 Eurosurveillance report

Oct 9 Saudi Arabia health ministry statement (in Arabic)

Oct 10 Virology Journal abstract

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