International Health Regulations Emergency Committee Research Articles

Current directions, conceptions and viewpoints on 2019-nCoV (Review).

On December 31, 2019, the first case of a novel coronavirus infection was reported in Wuhan, China. The ongoing outbreak of the 2019 novel coronavirus (2019-nCoV) has caused immense global concern. According to the recommendations of the International Health Regulations Emergency Committee and the facts and cases that 215 other countries have also reported to date, the World Health Organization Director-General announced that the outbreak of 2019-nCoV constitutes a public health emergency of international concern and a severe threat to the human health worldwide. To date, the prevalence of the virus has continued in waves and is increasing globally. The present review briefly introduces the epidemiology of 2019-nCoV, as well as viral structural characteristics, and receptors and cells that may act after entering the body, laboratory examinations, imaging and pathological features, clinical manifestations, complications, treatment and management.

Role of biological Data Mining and Machine Learning Techniques in Detecting and Diagnosing the Novel Coronavirus (COVID-19): A Systematic Review.

Coronaviruses (CoVs) are a large family of viruses that are common in many animal species, including camels, cattle, cats and bats. Animal CoVs, such as Middle East respiratory syndrome-CoV, severe acute respiratory syndrome (SARS)-CoV, and the new virus named SARS-CoV-2, rarely infect and spread among humans. On January 30, 2020, the International Health Regulations Emergency Committee of the World Health Organisation declared the outbreak of the resulting disease from this new CoV called ‘COVID-19’, as a ‘public health emergency of international concern’. This global pandemic has affected almost the whole planet and caused the death of more than 315,131 patients as of the date of this article. In this context, publishers, journals and researchers are urged to research different domains and stop the spread of this deadly virus. The increasing interest in developing artificial intelligence (AI) applications has addressed several medical problems. However, such applications remain insufficient given the high potential threat posed by this virus to global public health. This systematic review addresses automated AI applications based on data mining and machine learning (ML) algorithms for detecting and diagnosing COVID-19. We aimed to obtain an overview of this critical virus, address the limitations of utilising data mining and ML algorithms, and provide the health sector with the benefits of this technique. We used five databases, namely, IEEE Xplore, Web of Science, PubMed, ScienceDirect and Scopus and performed three sequences of search queries between 2010 and 2020. Accurate exclusion criteria and selection strategy were applied to screen the obtained 1305 articles. Only eight articles were fully evaluated and included in this review, and this number only emphasised the insufficiency of research in this important area. After analysing all included studies, the results were distributed following the year of publication and the commonly used data mining and ML algorithms. The results found in all papers were discussed to find the gaps in all reviewed papers. Characteristics, such as motivations, challenges, limitations, recommendations, case studies, and features and classes used, were analysed in detail. This study reviewed the state-of-the-art techniques for CoV prediction algorithms based on data mining and ML assessment. The reliability and acceptability of extracted information and datasets from implemented technologies in the literature were considered. Findings showed that researchers must proceed with insights they gain, focus on identifying solutions for CoV problems, and introduce new improvements. The growing emphasis on data mining and ML techniques in medical fields can provide the right environment for change and improvement.

Novel Coronavirus COVID-19: Current Evidence and Evolving Strategies.

Novel Coronavirus COVID-19: Current Evidence and Evolving Strategies.

WHO International Health Regulations Emergency Committee for the COVID-19 outbreak.

To discuss whether the coronavirus disease 2019 (COVID-19) outbreak constitutes a Public Health Emergency of International Concern (PHEIC), World Health Organization (WHO) organized the 15-member International Health Regulations Emergency Committee (EC). On January 22-23 and January 30, 2020, EC convened and discussed whether the situation in China and other countries would constitute PHEIC and issued recommendations for WHO, China and the international community. Based on the recommendations of EC, WHO declared the COVID-19 outbreak a PHEIC. One of the purposes of the declaration of PHEIC was to alarm countries with weak public health infrastructures to prepare promptly for emerging infectious diseases (EID) and provide WHO with a framework for proactively supporting those countries. On February 3, 2020, WHO proposed the 2019 COVID-19 Strategic Preparedness and Response Plan, which includes accelerating research and development (R&D) processes as one of three major strategies. On February 11-12, 2020, WHO held the Global Research and Innovation Forum: Towards a Research Roadmap for COVID-19. The fact that a COVID-19 R&D forum was the first meeting convened after the PHEIC declaration testifies to the importance of R&D in response to EID. Korea has demonstrated a remarkable capacity in its laboratory response by conducting high-throughput COVID-19 testing and utilizing innovative drive-through samplings. These measures for early detection and screening of cases should be followed by full efforts to produce research-based evidence by thoroughly analyzing epidemiological, clinical and immunological data, which will facilitate the development of vaccines and therapeutics for COVID-19. It is expected that Korea plays a global partner for COVID-19 research by actively participating in immediate and mid/long-term priorities jointly led by WHO and global partners.

COVID‐19: Lessons from SARS and MERS

COVID‐19: Lessons from SARS and MERS

Overlapping and discrete aspects of the pathology and pathogenesis of the emerging human pathogenic coronaviruses SARS-CoV, MERS-CoV, and 2019-nCoV.

First reported from Wuhan, The People's Republic of China, on 31 December 2019, the ongoing outbreak of a novel coronavirus (2019‐nCoV) causes great global concerns. Based on the advice of the International Health Regulations Emergency Committee and the fact that to date 24 other countries also reported cases, the WHO Director‐General declared that the outbreak of 2019‐nCoV constitutes a Public Health Emergency of International Concern on 30 January 2020. Together with the other two highly pathogenic coronaviruses, the severe acute respiratory syndrome coronavirus (SARS‐CoV) and Middle East respiratory syndrome coronavirus (MERS‐CoV), 2019‐nCov and other yet to be identified coronaviruses pose a global threat to public health. In this mini‐review, we provide a brief introduction to the pathology and pathogenesis of SARS‐CoV and MERS‐CoV and extrapolate this knowledge to the newly identified 2019‐nCoV.

Covid-19: Critical Lessons for the Survival of Mankind from the Present and Future Pneumonic Viral Infections

Covid-19, the short for Coronavirus Disease (occurring in) 2019, hit the world with a bang, beginning from Wuhan, the capital of Hubei province in China. Tracing the history, the first case (P-zero) was detected on December 8, 2019 (now recognized to be a woman of 57 years, who sold shrimps in the Huanan market admitted in the Wuhan Union Hospital on December 10 and diagnosed on December 31 with Covid-19) before several workers from the Huanan seafood market started to fall sick with fever and respiratory symptoms of shortness of breath, sneezing and cough, and some with dyspnea and signs of pneumonitis.[1] [2] Three weeks later on December 31, Wuhan Health Authorities announced a series of 21 cases of suspected pneumonia of unknown origin, all linked to seafood market, and notified to the World Health Organization (WHO) country office in China.[2] [3] The disease appeared to be highly infectious, causing considerable anxiety among physicians. Within a month, 41 patients were getting treatment for this unique infection in the Wuhan Union Hospital, where one of them died in the meantime (but the P-zero is still surviving). Due to fast-spreading transmission events, Covid-19 cases were widespread not only across mainland China but also beyond Chinese borders by January 21, 2020, as a result of symptomatic/asymptomatic international or national travelers returning to their native countries or other states of China, respectively. On January 30, 2020, the International Health Regulations Emergency Committee (IHREC) of WHO declared the disease epidemic as Public Health Emergency of International Concern (PHEIC), because as of January 27, more than 2000 cases had been diagnosed in several other countries, besides China and Hongkong: Thailand, Japan, South Korea, Singapore, Vietnam, Taiwan, Nepal, Macao, Australia, France, Canada, and US. Most of these patients were living in, visited Wuhan, or were their contacts.[1] [2] [3] Human-to-human transmission was confirmed.[4]

COVID-19: Lessons learned

Modern society has not forgotten yet epidemics that killed millions in the last millennium and the COVID-19 pandemic caused by the SARS CoV-2 has recently emerged. With the onset of the Wuhan epidemic in the Chinese province of Hubei, the initially called new corona virus due to the similarity of 80 % to the 2002 SARS virus was renamed to SARS CoV-2. The virus was originally isolated from bronchoalveolar aspirate specimens. Viral RNK was detected in 6 of 41 blood samples with clinical signs of infection. A senior Chinese expert told to the media that the median incubation period was 7 days, ranging from 2 -1 2. The International Health Regulations Emergency Committee for Epidemics gives a preliminary estimate basic reproduction number R0 of 1.4 - 2.5. COVID-19 is mainly transmitted by close contact with the infected by drops due to sneezing and coughing. Fever, cough, myalgia and fatigue are the predominant initial signs and symptoms. The clinical picture is non-specific. Exacerbation occurs suddenly, as bilateral interstitial pneumonia that requires admission to intensive care. Initial lethality in hospitalised cases was 15 %, but these estimates had to be taken with reserve as the situation evolved. According to recent data, the global fatality rate is 3.7 %, the lethality rate in China is 3.9 % and in Italy 6.8 %. According to data from the Chinese Centre for Disease Control and Prevention, of 44,672 confirmed cases 1,023 people died, therefore lethality was 2.3 %. In the absence of specific prevention and control measures, mankind is limited to general prevention measures.

Reorganization of Active Surveillance of Acute Flaccid Paralysis (AFP) in Emilia-Romagna, Italy: a two-step Public Health intervention.

Background and aim of the work:The International Health Regulations Emergency Committee declared in 2014 that poliovirus circulation is a public health emergency of international concern. In 2017 and 2018 Italy was classified at intermediate risk of poliovirus reintroduction based on suboptimal poliovirus surveillance. Acute flaccid paralysis active surveillance is the gold standard in the polio eradication process. The aims of this study were to investigate the causes of reduced acute flaccid paralysis case reporting in Emilia-Romagna in the last few years (step 1) and to study a public health intervention to restore an adequate level of acute flaccid paralysis surveillance in that region (step 2).Methods:In the first step a context analysis was performed by analysing the 2015-2017 Hospital Discharge Registers in Emilia-Romagna with the ICD-9-CM differential diagnosis codes for acute flaccid paralysis. Data from context analysis was then used to plan a new regional collaborative network of acute flaccid paralysis active surveillance.Results:The active surveillance network was, at the end of the study, composed by 49 doctors from both hospital administrations and clinical wards from 4 University Hospitals and 7 Local Health Authorities throughout the Region. In 15 months, 7 acute flaccid paralysis cases have been reported; 85,7% received a full clinical and virological investigation and 83,3% completed the 60 day’s follow-up. The mean response to each e-mail was 48,5% (SD 7,5%).Conclusions:In 2019, the Emilia-Romagna’s active surveillance system reached the sensitivity, completeness of case investigation and follow-up required to achieve the minimum levels for certification standard surveillance.

Modeling the costs and benefits of temporary recommendations for poliovirus exporting countries to vaccinate international travelers

Recognizing that infectious agents readily cross international borders, the International Health Regulations Emergency Committee issues Temporary Recommendations (TRs) that include vaccination of travelers from countries affected by public health emergencies, including serotype 1 wild polioviruses (WPV1s). This analysis estimates the costs and benefits of TRs implemented by countries with reported WPV1 during 2014–2016 while accounting for numerous uncertainties. We estimate the TR costs based on programmatic data and prior economic analyses and TR benefits by simulating potential WPV1 outbreaks in the absence of the TRs using the rate and extent of WPV1 importation outbreaks per reported WPV1 case during 2004–2013 and the number of reported WPV1 cases that occurred in countries with active TRs. The benefits of TRs outweigh the costs in 77% of model iterations, resulting in expected incremental net economic benefits of $210 million. Inclusion of indirect costs increases the costs by 13%, the expected savings from prevented outbreaks by 4%, and the expected incremental net benefits by 3%. Despite the considerable costs of implementing TRs, this study provides health and economic justification for these investments in the context of managing a disease in advanced stages of its global eradication.

Eradicating polio in Pakistan: an analysis of the challenges and solutions to this security and health issue.

Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988 the global incidence of poliomyelitis has fallen by nearly 99 %. From a situation where wild type poliovirus was endemic in 125 countries across five continents, transmission is now limited to regions of just three countries – Pakistan, Afghanistan and Nigeria. A sharp increase in Pakistan’s poliomyelitis cases in 2014 prompted the International Health Regulations Emergency Committee to declare the situation a ‘public health emergency of international concern’. Global polio eradication hinges on Pakistan’s ability to address the religious, political and socioeconomic barriers to immunisation; including discrepancies in vaccine coverage, a poor health infrastructure, and conflict in polio-endemic regions of the country. This analysis provides an overview of the GPEI, focusing on the historical and contemporary challenges facing Pakistan’s polio eradication programme and the impact of conflict and insecurity, and sheds light on strategies to combat vaccine hesitancy, engage local communities and build on recent progress towards polio eradication in Pakistan.

A crucial time for public health preparedness: Zika virus and the 2016 Olympics, Umrah, and Hajj

The 138th session of WHO's Executive Board on Jan 25, 2016, noted both the end of the 2014 Ebola crisis and the beginning of a global public health threat, the outbreak of Zika virus infection in the Americas.1 On Jan 15, 2016, the US Centers for Disease Control and Prevention advised pregnant women to refrain from travelling to countries affected by Zika, given a possible association between Zika virus infection with microcephaly and other neurological disorders.2 On Feb 1, 2016, WHO's International Health Regulations Emergency Committee declared the possible association between Zika virus infection and clusters of microcephaly and other neurological disorders as a Public Health Emergency of International Concern.

Recommended Strategies to Move Closer Toward the Global Eradication of Polio: International Health Regulations.

DEAR EDITOR, Polio was once considered a fearsome disease with a tendency to strike suddenly and paralyze millions of children for their entire lifetime.[1] However, in response to the Global Polio Eradication Initiative, assistance from the World Health Organization, and support from various stakeholders (viz., policy makers, health personnel, nongovernmental organizations, etc.), the number of polio cases have been reduced by more than 99% when compared with 1998 estimates.[2] However, there is a definitive potential risk of spread of polio from these nations to other nations that have less than adequate vaccination.[1,2,3] Unlike most other infectious diseases, polio can be completely eradicated as none of the three strains of wild poliovirus can survive outside the human body for longer durations and will die, if they cannot infect a susceptible individual.[4] Further, type 2 wild poliovirus has already been eradicated in the year 1999 while very few cases attributed to type 3 wild poliovirus have been reported in the recent years.[1,4] In fact, other than Nigeria (in which last wild polio case was detected 1 year back), only two countries—Pakistan and Afghanistan—are remaining where polio transmission has never been interrupted.[2,3] Most of these improvements and reduction in the incidence of polio cases on the global platform has been observed following the declaration of polio as a Public Health Emergency of International Concern.[1,2] Even though in 2015, less than a third of the number of cases have been reported in Pakistan (in contrast to the number of cases in the similar interval in 2014) with no exportation of wild poliovirus cases since October 2014 and a significant decline in the number of unimmunized children, still Pakistan alone accounts for almost 85% of all global wild poliovirus cases in the current year.[2] On the contrary, Afghanistan has reported international spread of wild poliovirus even in 2015 (viz., two cases to Quetta and Sindh regions of Pakistan).[2] This is mainly because of the weak public health systems, noncompliance with the International Health Regulations (IHR) recommendations for the international air travelers (viz., measures not implemented uniformly for all ages, no tracking of the vaccination status of travellers, no exit screening or restriction on unvaccinated travellers, etc.), sharing of a common zone of poliovirus transmission between the two nations, suspension of mass vaccination campaigns in the Kandahar region, and poor sanitation facilities.[1,2] In an attempt to expedite the process of global eradication of polio and to address the existing deficient mechanisms, a wide range of recommendations has been proposed by the IHR emergency committee.[2] These recommendations have been broadly divided into three major categories, namely states currently exporting wild poliovirus (Pakistan and Afghanistan); states infected with wild poliovirus, but not currently exporting (Nigeria and Somalia); and states no longer infected by wild poliovirus, but which remain vulnerable to international spread (Ethiopia, Syria, etc.).[2] For the first two categories of nations, it has been advocated that these should declare interruption of poliovirus transmission as a national public health emergency; administer to all residents or long-term visitors (more than 4 weeks), a dose of oral poliovirus vaccine (OPV) or inactivated poliovirus vaccine (IPV) between 4 weeks and 1 year prior to international travel; ensure receiving of OPV/IPV to even urgent travelers; provision of an international certificate of vaccination or prophylaxis to the travelers; restrict departure of travelers who lack the necessary documents at the point of departure; improve level of coordination at various levels to strengthen cross-border efforts; sustain these measures until at least 6 months have passed without new exportations; and provide monthly (currently exporting) or once in a year (not currently exporting) report to IHR about the implementation of recommendations.[2,5] However, the nations that are no longer infected by wild poliovirus but are still vulnerable to international spread should strengthen their routine vaccination and surveillance mechanism, especially among the mobile and vulnerable populations; enhance the level of cooperation and cross-border coordination to enable prompt detection of wild poliovirus and vaccination of high-risk population groups; and provide a comprehensive report every year regarding prevention and control measures.[2,6] In addition, implementation of cost-effective measures to neutralize the existing insecurity and inaccessibility to the healthcare services, especially in the conflict-affected nations can also prevent a major outbreak of wild poliovirus.[4,5,6] To conclude, a critical end stage has been achieved by the world for global polio eradication and any form of ignorance can either reverse or even prevent the world from achieving this goal. Thus, it is high time that both affected nations and even other nations continue to work according to the laid recommendations so that polio eradication can be achieved.

Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola

© 2015 Elsevier Ltd. The west African Ebola epidemic that began in 2013 exposed deep inadequacies in the national and international institutions responsible for protecting the public from the far-reaching human, social, economic, and political consequences of infectious disease outbreaks. The Ebola epidemic raised a crucial question: what reforms are needed to mend the fragile global system for outbreak prevention and response, rebuild confidence, and prevent future disasters? To address this question, the Harvard Global Health Institute and the London School of Hygiene & Tropical Medicine jointly launched the Independent Panel on the Global Response to Ebola. Panel members from academia, think tanks, and civil society have collectively reviewed the worldwide response to the Ebola outbreak. After difficult and lengthy deliberation, we concluded that major reforms are both warranted and feasible. The Panel's conclusions off er a roadmap of ten interrelated recommendations across four thematic areas: 1 Preventing major disease outbreaks All countries need a minimum level of core capacity to detect, report, and respond rapidly to outbreaks. The shortage of such capacities in Guinea, Liberia, and Sierra Leone enabled Ebola to develop into a national, and worldwide, crisis. Recommendation 1: The global community must agree on a clear strategy to ensure that governments invest domestically in building such capacities and mobilise adequate external support to supplement eff orts in poorer countries. This plan must be supported by a transparent central system for tracking and monitoring the results of these resource flows. Additionally, all governments must agree to regular, independent, external assessment of their core capacities. Recommendation 2: WHO should promote early reporting of outbreaks by commending countries that rapidly and publicly share information, while publishing lists of countries that delay reporting. Funders should create economic incentives for early reporting by committing to disburse emergency funds rapidly to assist countries when outbreaks strike and compensating for economic losses that might result. Additionally, WHO must confront governments that implement trade and travel restrictions without scientific justification, while developing industry-wide cooperation frameworks to ensure private firms such as airlines and shipping companies continue to provide crucial services during emergencies. 2 Responding to major disease outbreaks When preventive measures do not succeed, outbreaks can cross borders and surpass national capacities. Ebola exposed WHO as unable to meet its responsibility for responding to such situations and alerting the global community. Recommendation 3: A dedicated centre for outbreak response with strong technical capacity, a protected budget, and clear lines of accountability should be created at WHO, governed by a separate Board. Recommendation 4: A transparent and politically protected WHO Standing Emergency Committee should be delegated with the responsibility for declaring public health emergencies. Recommendation 5: An independent UN Accountability Commission should be created to do systemwide assessments of worldwide responses to major disease outbreaks. 3 Research: production and sharing of data, knowledge, and technology Rapid knowledge production and dissemination are essential for outbreak prevention and response, but reliable systems for sharing epidemiological, genomic, and clinical data were not established during the Ebola outbreak. Recommendation 6: Governments, the scientific research community, industry, and non-governmental organisations must begin to develop a framework of norms and rules operating both during and between outbreaks to enable and accelerate research, govern the conduct of research, and ensure access to the benefits of research. Recommendation 7: Additionally, research funders should establish a worldwide research and development financing facility for outbreak-relevant drugs, vaccines, diagnostics, and non-pharmaceutical supplies (such as personal protective equipment) when commercial incentives are not appropriate.

Influenza A and B Viruses but Not MERS-CoV in Hajj Pilgrims, Austria, 2014.

To the Editor: The World Health Organization recommends that persons who return from pilgrimages to the Middle East with acute severe respiratory infections be tested to determine the cause of infection; the aim is to identify infections with the Middle East respiratory syndrome coronavirus (MERS-CoV), which have been occurring in Saudi Arabia since 2012. Each year, >2.5 million persons from >180 countries, including 240,000 pilgrims from Europe, participate in Hajj, the Muslim pilgrimage to Mecca, Saudi Arabia. The gathering of mass numbers of persons during the Hajj increases the risk for the spread of respiratory infections among participants, and this risk has raised global concern that travelers returning from this pilgrimage could contribute to the international spread of MERS-CoV. During the 2012 and 2013 Hajj and Umrah (a minor pilgrimage) pilgrimages, no MERS cases in pilgrims were reported (1,2). However, in 2014, cases of MERS-CoV infection were confirmed in 2 returning pilgrims in the Netherlands (3). The International Health Regulations Emergency Committee advised all countries to improve awareness about MERS-CoV among pilgrims and to conduct surveillance for MERS-CoV among pilgrims during and after Hajj (4). According to data from the International Air Transport Association, Austria received an estimated 68,000 air travelers from Saudi Arabia, Jordan, Qatar, and the United Arab Emirates during June–November 2012 (a period encompassing 1 month before Ramadan and 1 month after the Hajj) (5); of these travelers, 1,000 were pilgrims performing the Hajj. Relatively constant travel volumes to Austria on commercial flights out of these countries during 2010–July 2014 have been confirmed by an analysis of air traffic statistics for Austria (A. Herndler, M. Rudolf, pers. comm.). We report on the investigation of illness among Austrian residents just after their return home from the 2014 Hajj pilgrimage, which ended in early October. As of October 27, 2014, a total of 7 Hajj pilgrims from Austria had sought medical care in different Austrian hospitals/medical centers just after returning from Saudi Arabia. The patients had fever and/or respiratory symptoms. A summary of the patients’ characteristics is presented in the Table. Of the 7 patients, 4 had cough, 1 had dyspnea, and 4 had fever. Patients 1, 2, and 7 had an acute febrile illness and clinical and/or radiologic evidence of pulmonary parenchymal disease. Patient 1 had sought medical care in Saudi Arabia, and patient 2 had been hospitalized for 10 days in Saudi Arabia. Table Characteristics of pilgrims who returned from the Hajj with acute respiratory illness and detectable virus in respiratory specimens, Austria, 2014* For the diagnosis of viral infection, a serum sample and a sputum, throat swab, or bronchoalveolar lavage sample were collected and sent to the Department of Virology, Medical University of Vienna, Austria, for analysis. All samples were tested for MERS-CoV by using reverse transcription PCR targeting regions upstream of the envelope gene (6). Respiratory and serum samples from all 7 patients were negative for MERS-CoV. The respiratory samples were also tested for influenza A and B viruses and for rhinoviruses, as previously described (7–9). Of the 7 patients, 3 were positive for influenza B virus, 2 for influenza A(H3N2) virus, and 2 for rhinoviruses (Table). Subsequent phylogenetic analysis showed that the influenza A(H3N2) strains belonged to the A/Hong Kong/146/2013-like viruses and the influenza B strains belonged to the B/Phuket/3073/2013-like viruses of the Yamagata lineage, both of which are subtype H3N2 and B strains included in the 2014–15 seasonal influenza vaccine for the Northern Hemisphere. Our results showed that MERS-CoV was not detected in any of these patients, and our findings support those from reports investigating illness among 2013 Hajj pilgrims (2). Our data indicate that all patients had a respiratory virus infection, and 5 of the 7 patients were infected with influenza virus. Six of the patients had not received seasonal influenza vaccine before traveling; for the seventh patient, influenza vaccine uptake data were not available. In 2014 in Austria, the incidence of influenza-like illnesses was below the epidemic threshold during weeks 40–43: no cases of influenza were reported by the National Influenza Surveillance network, Austria (http://www.influenza.at). Therefore, it is likely that these 7 patients became infected while at the Hajj, as reported for patients during previous Hajj seasons (10), or while traveling through international airports. Our preliminary data indicate that influenza virus infection was the cause of severe respiratory illness in 5 of 7 Austrian pilgrims returning from the 2014 Hajj. Because influenza is a serious and potentially life-threatening illness, seasonal influenza vaccination is recommended for Hajj pilgrims. Accurate and rapid testing for MERS-CoV and other respiratory viruses, including influenza, is essential for identifying persons who may be contagious and for timely and effective antiviral drug treatment and, thus, should be considered for pilgrims with severe respiratory illness.

Infection control and MERS-CoV in health-care workers

The recent exponential rise in the number of reported cases of Middle East respiratory syndrome coronavirus (MERS-CoV) is of major global concern. The Fifth Meeting of the International Health Regulations Emergency Committee concerning MERS-CoV was convened on May 13, 2014, by WHO's Director-General and concluded that, although the seriousness of the situation had increased, there was no evidence of sustained human-to-human transmission and that conditions for a Public Health Emergency of International Concern have not yet been met.

Lack of MERS Coronavirus but Prevalence of Influenza Virus in French Pilgrims after 2013 Hajj

Lack of MERS Coronavirus but Prevalence of Influenza Virus in French Pilgrims after 2013 Hajj