Original Research Article
A Scenario-Based Evaluation of the Middle East Respiratory Syndrome Coronavirus and the Hajj
Article first published online: 14 JUL 2014
© 2014 Society for Risk Analysis
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Volume 34, Issue 8, pages 1391–1400, August 2014
How to Cite
Gardner, L. M., Rey, D., Heywood, A. E., Toms, R., Wood, J., Travis Waller, S. and Raina MacIntyre, C. (2014), A Scenario-Based Evaluation of the Middle East Respiratory Syndrome Coronavirus and the Hajj. Risk Analysis, 34: 1391–1400. doi: 10.1111/risa.12253
- Issue published online: 29 AUG 2014
- Article first published online: 14 JUL 2014
- mass gatherings;
Between April 2012 and June 2014, 820 laboratory-confirmed cases of the Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported in the Arabian Peninsula, Europe, North Africa, Southeast Asia, the Middle East, and the United States. The observed epidemiology is different to SARS, which showed a classic epidemic curve and was over in eight months. The much longer persistence of MERS-CoV in the population, with a lower reproductive number, some evidence of human-to-human transmission but an otherwise sporadic pattern, is difficult to explain. Using available epidemiological data, we implemented mathematical models to explore the transmission dynamics of MERS-CoV in the context of mass gatherings such as the Hajj pilgrimage, and found a discrepancy between the observed and expected epidemiology. The fact that no epidemic occurred in returning Hajj pilgrims in either 2012 or 2013 contradicts the long persistence of the virus in human populations. The explanations for this discrepancy include an ongoing, repeated nonhuman/sporadic source, a large proportion of undetected or unreported human-to-human cases, or a combination of the two. Furthermore, MERS-CoV is occurring in a region that is a major global transport hub and hosts significant mass gatherings, making it imperative to understand the source and means of the yet unexplained and puzzling ongoing persistence of the virus in the human population.