Hajj pilgrims urged to be alert against MERS in Mecca

Jakarta, NU online
The Indonesian government insists it is taking both preventive and anticipatory steps to deal with the threat of a pilgrim-borne outbreak of a viral infection from Saudi Arabia that has already claimed 45 lives this year.<>

Emil Agustiono, an epidemiologist and the secretary of the Health Ministry’s National Zoonosis Committee, told the Jakarta Globe that Indonesians slated to go to Mecca for the hajj this October “should not reconsider going.”

Instead, the pilgrims “should consider better health, better conditions.”

“The most important thing is prevention. Wear face masks, stay at the residence [for pilgrims] and try and limit outdoor activities,” he was quoted by the Jakarta Globe as saying.

Emil said the ministry’s stance on the threat posed by the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), which has killed 38 people in Saudi Arabia, was focused more on preventative measures than restricting activities.

He said this included training doctors in Indonesia to recognize the illness in the event that any of the returning pilgrims exhibited symptoms.

“We need to [build up] more capacity in local health centers and at local hospitals,” Emil said.

Doctors in private clinics who may not be as well versed in handling MERS-CoV cases compared to doctors in government hospitals will undergo special training sessions conducted by local districts, he said.

Educational information about the virus is also being disseminated at health centers nationwide.

Entry points such as airports, sea ports and border towns are also being carefully monitored by health authorities, and the ministry is urging people in these areas to “be alert.”

Emil said he was worried about the capacity of local hospitals to recognize the complex virus with symptoms that can easily be mistaken for cases of typhoid, seasonal flu or dengue fever — viruses that health staff are more used to treating.

“The capacity at the local level is very variable. For remote health centers, it’s not easy to get health personnel to detect the symptoms of MERS because the symptoms aren’t as easy as we think,” he said.

He noted that MERS-CoV initially started with the same symptoms as the flu. But unlike the flu, MERS-CoV attacks the respiratory system, making it increasingly difficult to breathe.

Emil stressed that the “fast-moving” nature of MERS-CoV was an important reason why those with flu-like symptoms should seek immediate treatment rather than wait for symptoms to clear.

He explained how small the window of opportunity was for treating even better understood flu viruses.

“Sometimes people come at the late stage [of H5N1 or H7H9] and it will be [a] problem to treat them. The antivirus for H5N1 and H7H9 works well only 48 hours after contamination. [For] people coming in the late stage [for those viruses] the doctor can’t treat them well,” he said.

“All people with symptoms of the flu should be brought to the ICU. It’s a dire situation.”

MERS-CoV also has the potential to cause renal failure. Similarities to SARS, the worldwide pandemic that broke out and was eventually contained in 2003, are limited. Both viruses are classified as coronaviruses, which have characteristic crown-like projections on their surface, and cause flu-like symptoms.

While it was later discovered that SARS spread quickly through person-to-person contact and traced back to China’s Guangdong province, very little is known about MERS-CoV.

Scientists and doctors do not know its origin or how it spreads, which are critical for containing and eventually treating MERS-CoV.

Some scientists theorize that it could be a zoonotic disease, one spread from animals to humans, that originated in bats.

The World Health Organization has set up an emergency committee, for only the second time in its history, to address the threat of an epidemic as millions of people from across the globe gather in Mecca later this year for the hajj, placing themselves at potential risk of contracting MERS-CoV and taking it back to their home countries.

Indonesia, which has the largest hajj contingent of any country, amounting to some 168,000 pilgrims this year, is represented on the committee by Tjandra Yoga Aditama, the Health Ministry’s director general for disease control and environmental health.

In an email to the Globe, Tjandra said measures being taken domestically to contain a possible outbreak included notifying port and airport health officials to be on high alert, coordinating with the Foreign Ministry and the migrant worker protection board to look for symptoms among Indonesians returning from the Middle East, and preparing thermal scanners at ports and airports to screen people with fevers — one of the symptoms of the illness.

Anggito Abimanyu, the Religious Affairs Ministry’s director general for the hajj, confirmed that there would be no restrictions on those going on the pilgrimage, despite a recommendation by Saudi health authorities for at-risk pilgrims — the elderly, chronically ill, pregnant women and children — to avoid this year’s hajj.

“From all I know it is a recommendation,” he said.

“We are not obliged to follow it. Everyone on the list will go on hajj this year.”

He added that his office would coordinate with the Health Ministry to promote preventative measures amid the health scare. The recommendations include staying hydrated, clean and wearing masks.

“They can also get an influenza shot, but it is not mandatory,” Anggito said.

Graham Tallis, the team leader for communicable diseases at the WHO’s Indonesia office, said in an email to the Globe that while MERS-CoV did cause severe respiratory problems, it did not appear to be as deadly as SARS or the H5N1 avian flu virus were.

Still, he warned that pilgrims faced a greater risk of infection, especially the elderly.

“The danger with pilgrims is due to mass gathering, where the infection could transmit easily,” Tallis said.

“[This coronavirus] does not appear to transmit easily between people whereas the SARS virus was much more transmissible,” he added.

Editing by Sudarto Murtaufiq