Some groups organizing hajj pilgrimages to Mecca are increasingly worried about the outbreak of a deadly new virus in the Middle East.
The Association of British Hujjaj (Pilgrims) is one. The Birmingham-based group, which offers guidance to hajj participants, is warning prospective travelers to take special precautions ahead of the October event:
"We would like to warn those people who have low body immune systems that they should not attend this year's hajj. And for the rest of the people, we would strongly recommend that they [check their health with] their doctor before their departure," says Khalid Pervez, general secretary of the organization.
"We also recommend to people that while they are in Saudi Arabia they follow hygiene guidelines. They should not share utensils, and they must not cough while they are amongst the crowd."
The warnings are part of a wave of worry over the mounting number of deaths from the Middle East respiratory syndrome coronavirus (MERS-CoV). The virus, which emerged in the region late last year, has so far infected more than 60 people
, killing 38 of them.
That's a far higher death rate than SARS, the related severe acute respiratory syndrome that broke out 10 years ago in Southeast Asia. SARS, which killed more than 775 people in a global epidemic in 2003, was fatal to only 10 percent of those infected.
But while alarm over MERS-CoV -- which can cause victims to suffocate -- is high, health experts say that for now only normal health precautions appear to be necessary.
"My advice for the hajj at the present time is that there need not be any special consideration beyond what I would recommend for large gatherings, and that is that personal hygiene should be as good as possible," says Ian Jones, a professor of virology at the University of Reading in Britain.
"You should take care of food hygiene, of course, and you should generally avoid situations which seem to be suspicious in terms of the cleanliness of the establishment. So, don't put yourself at obvious risk. But that would apply to a number of communicable diseases, not only this one."
Not Like SARS, So Far
Health experts are encouraged by the fact that there have been a relatively small number of cases reported to date, most of them in Saudi Arabia. That suggests that the virus spreads to humans much more slowly than SARS did 10 years ago.
John Oxford, a professor of virology at Queen Mary College in London, notes that the first cases of MERS infection were discovered before the last hajj, in October 2012. But there was no explosion of infections among participants.
"So that does suggest that [the virus] had an opportunity [to spread), if you look at it like that, but this virus didn't take it," Oxford says. "And that does suggest, to my way of thinking, that this virus has not quite got the edge, not quite got the punch, that other viruses might have, and we can be thankful for that."
Still, health officials are cautious, because most questions about the virus have yet to be answered. That includes where it comes from, how it passes to humans, and how easily it is passed between people.
Investigators suspect that the hosts of the MERS-CoV virus are Middle Eastern bats, which -- like many animal species -- carry viruses that are not harmful to themselves but can endanger people. How the virus moves from bats to humans is not known, but possible routes could be eating contaminated food products or handling intermediary animals such as goats and camels that have been bitten by bats and fallen sick.
'Poor' Direct Transmission
Jones, the virology professor, says very few of the reported cases show the virus being transmitted from one person to another. "There are two cases so far where transmission has been reported but both of those cases have been in hospitalized patients who were in very close proximity," he notes.
"So, I think we can take from this that actually the transmission of this virus naturally [between people] is extremely poor," he continues. "After all, these patients would have contacted many, many people on the streets, on flights, had contacts in families and so on prior to being hospitalized and yet, as far as we know, nobody has become infected through that casual contact."
The two cases of transmission were in hospitals in Britain and France. It is not yet known whether the transmission was due to being in a shared space or using contaminated equipment.
Both the infections in Britain and France, as well as one in Germany, were carried back from the Middle East by travelers. Saudi Arabia is the presumed epicenter of the outbreak, and the virus has been found in Jordan, Qatar, Tunisia, and the United Arab Emirates.
A Jordanian man who was working at a hotel in Florence, Italy, is tied to the most recent confirmed cases, in which the man's toddler niece and a female co-worker have also been hospitalized.
The World Health Organization sent a team to Saudi Arabia this month to make a risk assessment ahead of the hajj and suggest ways to minimize the danger. The UN agency is not currently recommending any restrictions on travel to the kingdom or screening of passengers at airports.
The hajj, which annually brings more than 2 million people to Mecca from around the world, is due this year to take place between October 13 and 18.