As MERS-CoV emerged in 2012 prior to Hajj, an update to the Hajj requirements was published in Eurosurveillance . The recommendations included explicit measures to reduce the risk of transmission of viral respiratory infections including MERS-CoV infection. These recommendations include the practice of proper hand hygiene, protective behaviors and cough etiquette .
The 2012 Hajj season which took place from 10 to 31 October 2012, was uneventful without any MERS-CoV cases being reported. During that season, four million pilgrims from 187 countries performed the annual Hajj. None should 300 pilgrims with respiratory symptoms was tested positive for MERS-CoV infections . In addition, the testing of 154 French pilgrims returning from the 2012 annual Hajj showed that 83.4% had respiratory symptoms . None of the pilgrims were positive for MERS-CoV by real-time PCR .
This year, 2013, the annual Hajj is taking place in October 1–20, and thus with the increased number of cases of MERS-CoV, there was a concern of the potential risk of the transmission of MERS-CoV. The KSA released the 2013 Hajj requirement .
The Saudi Ministry of Health recommends that people aged over 65 years and those with chronic diseases (e.g., heart disease, kidney disease, respiratory disease and diabetes) and pilgrims with immune deficiency (congenital and acquired), malignant and terminal illnesses, pregnant women and children aged under 12 years planning to come for Hajj and Umrah this year, to postpone the performance of the Hajj and Umrah .
The Saudi Ministry of Health also recommends that all pilgrims should comply with common public health recommendations to prevent the spread of respiratory infectious disease, such as hand hygiene, use of disposable tissues when coughing or sneezing, avoid direct contact with the persons who is coughing, sneezing or vomiting .
The second meeting of the WHO Emergency Committee convened by the Director-General under the International Health Regulations (2005)  was held on Wednesday, 17 July 2013. The unanimous decision of the Committee was that, with the information now available, and using a risk-assessment approach, the conditions for a Public Health Emergency of International Concern have not at presently been met . Two mass gatherings events attracting over 15 million pilgrims have occurred in Saudi Arabia over the past 12 months, the annual Hajj in October 2012  and the recently completed July 2013 Ramadaan Umrah season. No MERS-CoV cases have been reported from these events.
These observations support the findings in a recent modeling paper published in Lancet that examined the risk of MERS-CoV on mass gathering [23,24]. Breban and colleagues estimated MERS-CoV R0 to be 0.69 compared to the R0 for pre-pandemic severe acute respiratory syndrome-coronavirus of 0.80  concluding that MERS-CoV in its current status quo is unlikely to cause a pandemic . Watchful surveillance and vigilance will continue despite the minimal risk of global spread.