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MERS Hajj Medina Mecca Jeddah Madrid Journey
Recombinomics Commentary 19:30
November 7, 2013

 Her symptoms began Oct 15 with cough and fever, and she was seen at a hospital emergency department of a Mecca hospital on Oct 28 and 29, where health workers diagnosed her as having pneumonia, based on chest x-ray findings.

According to the ECDC, the patient was sick during the flight and needed oxygen treatment while she was aboard.

The health ministry said she was in Medina from Oct 2 through Oct 10 and in Mecca from Oct 11 through Nov 1.

The above comments confirmed media reports which noted a disease onset date of October 15 for the above case (61F) as well as a Kingdom of Saudi Arabia (KSA) diagnosis of pneumonia.  The peak of Hajj activity was between Oct 13-18, corresponding with the patient’s travel to Mecca.

The disease onset date of Oct 15 suggests she was infected in Medina, where KSA reported confirmed cases at the end of Ramadan, which was also linked to a Qatari who traveled from Medina to Qatar and developed symptoms on the day of his arrival, which was subsequently linked to onward transmission in Qatar.  Although WHO noted that the Qatari did not perform Umrah or visit the Grand Mosque, his MERS infection became symptomatic after his attendance at a Medina clinic.

Thus, the presence of MERS in Medina after Ramadan raised concerns that Hajj pilgrims would be at risk and even though KSA cited the absence of any confirmed cases in Hajj or Ramadan pilgrims. MERS is widespread in KSA, including the Ramadan large cluster in Medina.

The recent MERS case was traveling and attending the Hajj in KSA while symptomatic and flew from Jeddah (see map)  to Madrid after she was diagnosed with pneumonia in Mecca.

This extensive travel strongly suggest the number of MERS infections in Hajj pilgrims is high, KSA detection / reporting failures notwithstanding.

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