As several million Muslim faithful get set to make the annual pilgrimage to Mecca, among them thousands of Israelis and Palestinians, concern has grown over potential dissemination of the Middle East Respiratory Syndrome. Israeli health officials, however, said the infectious and untreatable disease poses little threat to the Israeli public.

Middle East Respiratory Syndrome, better known by the acronym MERS, is a new form of bug similar to SARS which has emerged in Saudi Arabia in recent years. It’s a form known as a coronavirus, named for its sun-like appearance under high-powered microscopes. Since MERS’s discovery in 2012, the lethal disease has spread to neighboring Gulf states and as far abroad as Europe and the US.

There is no vaccine.

Riyadh recently raised its total number of cases to nearly 700 since health officials there began tracking the disease. But MERS’s similarity to more common respiratory illnesses means many more cases may have gone undetected.

The World Health Organization reported at least 701 laboratory-confirmed cases of MERS worldwide, and at least 249 related deaths. The US Centers for Disease Control and Prevention (CDC), approximately 30% of people who contracted MERS died. Compared to SARS, however, MERS appears not to be as easily transmissible.

A highly-magnified negatively-stained transmission electron micrograph image of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). (photo credit: Centers for Disease Control/ Cynthia Goldsmith; Azaibi Tamin, Ph.D.)

A highly-magnified negatively-stained transmission electron micrograph image of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). (photo credit: Centers for Disease Control/ Cynthia Goldsmith; Azaibi Tamin, Ph.D.)

Despite the fact that confirmed cases have been recorded in neighboring Jordan and Lebanon, Israel has yet to see a confirmed case.

Prof. Itamar Grotto, director of public health services at Israel’s Health Ministry, told The Times of Israel there is little concern that pilgrims traveling to Saudi Arabia for Ramadan will contract the disease and spread it on their return home, considering the way the virus is thought to spread.

Roughly 20,000 Israelis and Palestinians will be making their way to Mecca for the hajj over Ramadan this year. Last year, nearly 1.5 million Muslims made their way to Mecca for the holy month’s rituals. Many of the rituals performed during the hajj involve close proximity with large numbers of people, as well as the slaughter of animals, which are potential carriers of the disease.

Abu Iman Abu Liyal, an organizer for Israeli Muslim pilgrims from Umm al-Fahm, said that roughly 14,500 Israeli Arabs will travel to Saudi Arabia in July. Including those who performed the umrah, or lesser pilgrimage during the rest of the year, he said, the total number of Israeli Muslims making the hajj in 2014 came to roughly 26,000.

Additionally, an average of about 4,500 Palestinians were issued travel permits to make the pilgrimage to Mecca for the hajj in the past three years, the IDF’s Civil Administration said. The IDF didn’t have figures for 2014 available, however.

While there have been a handful of suspected MERS cases in Israel from people who entered the country after visiting Saudi Arabia or Jordan in the past two years, lab tests found they were not infected with MERS. For now, the three Israeli labs responsible for conducting clinical examination of suspected MERS cases are not yet engaged in researching possible antidotes for the disease.

Grotto said that because most cases of MERS have come from close proximity to infected people in hospitals and contact with camels, “we don’t see a high risk of many cases” from returning hajjis.

“Of course we cannot rule out… [there being] one or two cases [of MERS] in Israel,” Grotto added with due caution.

As a precautionary measure, Grotto said that Israelis going on the hajj, who require vaccination against polio and meningitis before departing, are given a written advisory in Arabic to avoid contact with animals and emphasizing the importance of personal hygiene during the trip. The CDC likewise recommends everyday preventive measures against respiratory illness, including washing hands, avoiding physical contact with the sick, avoiding touching the eyes, nose and mouth with unwashed hands, and covering one’s nose and mouth with a tissue when coughing or sneezing.

Health researchers remain uncertain how the infectious disease is transmitted or how fast it is spreading, but signs point to camels as the primary vector. The WHO recommends avoiding contact with camels because infected animals, which may be asymptomatic, “may shed MERS-CoV through nasal and eye discharge, feces, and potentially in their milk and urine.”

More problematic for Muslims on the hajj, who must slaughter a sheep or camel as part of the ritual, “the virus may also be found in the organs and meat of an infected animal,” the WHO warns.

An Indian worker wears a mouth and nose mask as he touches a camel at his Saudi employer's farm on May 12, 2014, outside Riyadh. Camels have been cited as a possible vector for MERS. (photo credit: AFP/Fayez Nureldine)

An Indian worker wears a mouth and nose mask as he touches a camel at his Saudi employer’s farm on May 12, 2014, outside Riyadh. Camels have been cited as a possible vector for MERS. (photo credit: AFP/Fayez Nureldine)

MERS has an incubation period of anywhere between two days and two weeks. The disease tends to manifest itself with symptoms of an acute respiratory infection: fever, cough and shortness of breath. Some patients may exhibit diarrhea and vomiting. According to a CDC spokesperson, most of the fatalities from MERS had an underlying medical condition, and people with comorbidities “may be more likely to become infected with MERS, or have a severe case.” Other people had milder cold-like symptoms, or no symptoms, and recovered.

“There is no specific antiviral treatment recommended for MERS-CoV infection,” a CDC spokesperson said. “Individuals with MERS can seek medical care to help relieve symptoms. For severe cases, current treatment includes care to support vital organ functions.”

Grotto said that on their return to Israel, hajjis will be encouraged to report any MERS-like symptoms to their local healthcare provider and seek medical attention.

He was confident that Israel’s health care system was capable of handling multiple cases of MERS should Israeli citizens return from the hajj infected with it. Doctors at hospitals nationwide have been made aware of the situation and of protocols for reporting MERS cases to the Health Ministry, he said.

“We believe we would be able to both identify suspected cases if they will appear, and then we would diagnose them and then, of course, put them in isolation,” Grotto added.

Grotto said the Israeli Health Ministry was collaborating with the WHO and was receiving updates about MERS cases in other countries and in reporting possible cases in Israel. He said there was “some kind of collaboration” with the Palestinian Authority and Jordanian Health Ministry inasmuch as Israel exchanges information with the two governments concerning MERS cases.

Jordan tallied its sixth MERS death earlier in June when a 69-year-old man succumbed to the disease.