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PLoS Curr Outbreaks. Potential for the International Spread of Middle East Respiratory Syndrome in Association with Mass Gatherings in Saudi Arabia
[Source: PLoS Current Outbreaks, full page: (LINK). Abstract, edited.]
Potential for the International Spread of Middle East Respiratory Syndrome in Association with Mass Gatherings in Saudi Arabia
July 17, 2013 ? Research
Citation: Khan K, Sears J, Hu VW, Brownstein JS, Hay S, Kossowsky D, Eckhardt R, Chim T, Berry I, Bogoch I, Cetron M. Potential for the International Spread of Middle East Respiratory Syndrome in Association with Mass Gatherings in Saudi Arabia. PLOS Currents Outbreaks. 2013 Jul 17 [last modified: 2013 Jul 17]. Edition 1. doi: 10.1371/currents.outbreaks.a7b70897ac2fa4f79b59f90d24c860b 8.
Authors: Kamran Khan Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Jennifer Sears Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Vivian Wei Hu Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. John S Brownstein Children?s Hospital Boston, Harvard Medical School, Boston, USA. Simon Hay Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, UK. David Kossowsky Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Rose Eckhardt Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Tina Chim Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Isha Berry Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Isaac Bogoch Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Canada; University Health Network, Divisions of Internal Medicine and Infectious Diseases, Toronto, Canada. Martin Cetron Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, USA; Departments of Medicine and Epidemiology, Emory University School of Medicine and Rollins School of Public Health, Atlanta, USA.
Abstract
Background:
A novel coronavirus (MERS-CoV) causing severe, life-threatening respiratory disease has emerged in the Middle East at a time when two international mass gatherings in Saudi Arabia are imminent. While MERS-CoV has already spread to and within other countries, these mass gatherings could further amplify and/or accelerate its international dissemination, especially since the origins and geographic source of the virus remain poorly understood.
Methods:
We analyzed 2012 worldwide flight itinerary data and historic Hajj pilgrim data to predict population movements out of Saudi Arabia and the broader Middle East to help cities and countries assess their potential for MERS-CoV importation. We compared the magnitude of travel to countries with their World Bank economic status and per capita healthcare expenditures as surrogate markers of their capacity for timely detection of imported MERS-CoV and their ability to mount an effective public health response.
Results:
16.8 million travelers flew on commercial flights out of Saudi Arabia, Jordan, Qatar, and the United Arab Emirates between June and November 2012, of which 51.6% were destined for India (16.3%), Egypt (10.4%), Pakistan (7.8%), the United Kingdom (4.3%), Kuwait (3.6%), Bangladesh (3.1%), Iran (3.1%) and Bahrain (2.9%). Among the 1.74 million foreign pilgrims who performed the Hajj last year, an estimated 65.1% originated from low and lower-middle income countries.
Conclusion:
MERS-CoV is an emerging pathogen with pandemic potential with its apparent epicenter in Saudi Arabia, where millions of pilgrims will imminently congregate for two international mass gatherings. Understanding global population movements out of the Middle East through the end of this year?s Hajj could help direct anticipatory MERS-CoV surveillance and public health preparedness to mitigate its potential global health and economic impacts.
Funding Statement
This study was funded by the Canadian Institutes of Health Research. The funding source did not have any involvement in the writing of this article or in the decision to submit it for publication. The corresponding author, Dr. Kamran Khan, had full access to all data in the study and had final responsibility for the decision to submit for publication.
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Potential for the International Spread of Middle East Respiratory Syndrome in Association with Mass Gatherings in Saudi Arabia
July 17, 2013 ? Research
Citation: Khan K, Sears J, Hu VW, Brownstein JS, Hay S, Kossowsky D, Eckhardt R, Chim T, Berry I, Bogoch I, Cetron M. Potential for the International Spread of Middle East Respiratory Syndrome in Association with Mass Gatherings in Saudi Arabia. PLOS Currents Outbreaks. 2013 Jul 17 [last modified: 2013 Jul 17]. Edition 1. doi: 10.1371/currents.outbreaks.a7b70897ac2fa4f79b59f90d24c860b 8.
Authors: Kamran Khan Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Jennifer Sears Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Vivian Wei Hu Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. John S Brownstein Children?s Hospital Boston, Harvard Medical School, Boston, USA. Simon Hay Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, UK. David Kossowsky Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Rose Eckhardt Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Tina Chim Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Isha Berry Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Isaac Bogoch Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Canada; University Health Network, Divisions of Internal Medicine and Infectious Diseases, Toronto, Canada. Martin Cetron Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, USA; Departments of Medicine and Epidemiology, Emory University School of Medicine and Rollins School of Public Health, Atlanta, USA.
Abstract
Background:
A novel coronavirus (MERS-CoV) causing severe, life-threatening respiratory disease has emerged in the Middle East at a time when two international mass gatherings in Saudi Arabia are imminent. While MERS-CoV has already spread to and within other countries, these mass gatherings could further amplify and/or accelerate its international dissemination, especially since the origins and geographic source of the virus remain poorly understood.
Methods:
We analyzed 2012 worldwide flight itinerary data and historic Hajj pilgrim data to predict population movements out of Saudi Arabia and the broader Middle East to help cities and countries assess their potential for MERS-CoV importation. We compared the magnitude of travel to countries with their World Bank economic status and per capita healthcare expenditures as surrogate markers of their capacity for timely detection of imported MERS-CoV and their ability to mount an effective public health response.
Results:
16.8 million travelers flew on commercial flights out of Saudi Arabia, Jordan, Qatar, and the United Arab Emirates between June and November 2012, of which 51.6% were destined for India (16.3%), Egypt (10.4%), Pakistan (7.8%), the United Kingdom (4.3%), Kuwait (3.6%), Bangladesh (3.1%), Iran (3.1%) and Bahrain (2.9%). Among the 1.74 million foreign pilgrims who performed the Hajj last year, an estimated 65.1% originated from low and lower-middle income countries.
Conclusion:
MERS-CoV is an emerging pathogen with pandemic potential with its apparent epicenter in Saudi Arabia, where millions of pilgrims will imminently congregate for two international mass gatherings. Understanding global population movements out of the Middle East through the end of this year?s Hajj could help direct anticipatory MERS-CoV surveillance and public health preparedness to mitigate its potential global health and economic impacts.
Funding Statement
This study was funded by the Canadian Institutes of Health Research. The funding source did not have any involvement in the writing of this article or in the decision to submit it for publication. The corresponding author, Dr. Kamran Khan, had full access to all data in the study and had final responsibility for the decision to submit for publication.
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