Via Bulletin of the Atomic Scientists, an informative Q&A: WHO's Maurizio Barbeschi talks about MERS and mass events. Excerpt:
With the number of MERS-CoV cases increasing, the Bulletin spoke with Maurizio Barbeschi, a scientist at the World Health Organization, about the virus and the risks posed by mass gatherings. Barbeschi leads the organization’s Preparedness, Mass Gatherings and Deliberate Events group, which provides strategic guidance on dealing with high-visibility and high-consequence events. He is a contributor to “Mass gatherings medicine: international cooperation and progress,” a new report published in The Lancet.
Barbeschi answered the Bulletin’s questions with support from his team at WHO, including Medical Officer David Brett-Major and Technical Officers Nicolas Isla and Sascha Meijers.
Saudi Arabia will draw millions of pilgrims this year, during Ramadan in July and the Hajj in October. How can such mass gatherings affect the spread of viruses like the one that causes MERS?
Mass gatherings can be wonderful events, but also may give any potential infection the opportunity to spread. People are close to one another, often in confined spaces, over a prolonged period of time. Sometimes they change their eating, drinking and hygiene habits. And mass gatherings attract many international participants who could potentially export an infection to their home countries.
To date, only limited, non-sustained human-to-human transmission of MERS-CoV has been observed. Performing the Umrah—pilgrimage to Mecca at any time—or the Hajj—pilgrimage to Mecca at an annual fixed time on the Islamic calendar—does not appear to have been a significant risk factor for infection since MERS-CoV was first detected in 2012. However, given the significant increase in recent infections, each mass gathering’s health risks should be viewed in light of the evolving outbreak.
Can you give past examples of mass gatherings that contributed to the spread of viruses?
A number of scientific studies conducted during and after the 2008 World Youth Day in Sydney, Australia, found that participants from overseas introduced influenza during a non-seasonal period.
During the celebrations, 223,000 pilgrims from 170 countries attended the mass religious gathering over a five-day period. Some events were attended by an estimated 400,000 persons. An influenza outbreak occurred among participants and likely resulted in increased influenza in Australia with some imported strains. Crowded accommodation conditions and low immunization rates were likely factors.
There was also an influenza outbreak that occurred during the Salt Lake City Winter Olympics in 2002, with more than one third of infections appearing in athletes. Three clusters in particular were identified—among law enforcement personnel living in close proximity to one another, among 12 national team members who trained together and were staying at a common location, and among eight athletes participating in one sport with common training venues.
And, there was a 2010 outbreak of measles found to have originated in Taizé, France. The area is home to the Taizé Community, an ecumenical monastic order and one of the most important sites of Christian pilgrimage. Each summer the community attracts up to 5,000 pilgrims. In September and October of 2010, primary measles cases were found in 13 people in Germany, all of whom had attended meetings in Taizé.
What have you learned from these past events?
First, that continuous risk assessment should be the backbone of any public health planning for a mass gathering.
Second, that while mass gatherings may pose significant challenges, they also present an opportunity to have a positive long-term impact in the form of enhanced public health services, improved hospital and emergency services, a healthier living environment, and enhanced health awareness.
Planning for a mass gathering generally involves the whole government. Therefore, it is of paramount importance that health has a seat at that planning table and that there is interoperability between sectors and their plans and risk assessments.
Finally, participants should be provided with travel and health advice on recommended vaccinations and precautions to be taken before the event. WHO routinely generates and publishes such advice on its International Travel and Health website. Individual country public health agencies also generate related advice.