In contrast to SARS, where the disease was introduced into predominantly high-income countries through air travel, more than half of all air travelers departing Saudi Arabia, Jordan, Qatar and UAE have final destinations in low or lower-middle income countries. Two-thirds of all hajj pilgrims originate from low or lower-middle income countries.
Of particular note is the degree of connectivity between the Middle East and South Asia. Collectively, India, Pakistan, Bangladesh, Afghanistan and Nepal represent the final destinations of nearly one-third of all international air travelers departing Saudi Arabia, Jordan, Qatar and the UAE, and the origins of roughly one in four foreign hajj pilgrims worldwide.
"Given that these countries have limited resources, they may have difficulty quickly identifying imported MERS cases, implementing rigorous infection control precautions and responding effectively to newly introduced cases," Dr. Khan said.
Dr. Khan's previous research suggests that if screening of air travelers for MERS is considered, it would be far more efficient and less disruptive to the world's air traffic to screen travelers as they leave source areas in the Middle East rather than screen the same travelers as they arrive at other airports around the world. However, all countries receiving pilgrims and other travelers from known MERS areas should mobilize their infectious disease surveillance and public health resources in ways that are commensurate with their potential for MERS introduction, he said.
Educating and preparing front-line health care providers to consider the possibility of MERS in patients is also critical, he said, since that is a necessary first step to implement effective infection control practices that could minimize the risk of spread to others. In the SARS epidemic, delays in considering the diagnosis led to delays in implementing appropriate infection control measures, which i
|Contact: Leslie Shepherd|
St. Michael's Hospital