In Europe, the risk of infection is usually very low, but the many travelers who have visited Qatar for the World Cup worry the health authorities of the old continent. In particular, the British Health Security Agency (HSA) has alerted doctors across the United Kingdom that football fans returning from Qatar could be carriers of the so-called Middle East respiratory syndrome, in jargon MERS. Australia has also issued a specific warning aimed at anyone traveling from the Middle East: “MERS is a rare but serious respiratory disease that can affect travelers to Middle Eastern countries,” reads a statement posted online. Mers is spread through close contact with camels carrying the virus or an infected person, or by consuming raw camel meat or unpasteurized camel milk. There is currently no vaccine available and the so-called camel flu can lead to a serious illness which initially manifests itself with typical flu symptoms which can worsen with breathing difficulties and diarrhoea.
Like Covid, MERS is caused by a coronavirus but the similarities with Sars-Cov-2 are less than its differences: MERS does not spread easily and only 2,500 cases of MERS have been identified since 2012 as the virus replicates in the lower respiratory tract. However it is far more deadly than Covid and has so far killed 35% of patients causing severe respiratory failure requiring mechanical ventilation and intensive care unit admission. First reported as a new human pathogen from Saudi Arabia in 2012, it is the deadliest of the three zoonotic coronaviruses (i.e. MERS-CoV, SARS-CoV and SARS-CoV-2) that have caused human outbreaks: of 2600 people reported with laboratory-confirmed Middle East respiratory syndrome (MERS), I know of 894 deaths (fatality rate of 34%). While most of the infections have occurred in the Middle East, eight countries in Europe have also reported confirmed infections, all with travel links to the Arabian Peninsula. One notable case was the large 2015 MERS-CoV outbreak in South Korea, where a South Korean individual visited four countries in the Middle East and fell ill after returning to Seoul. While waiting in an overcrowded hospital emergency room, the infection spread to others, and the resulting MERS-CoV super-spread events resulted in 184 infections with 36 deaths. While this major outbreak outside the Middle East should have been a wake-up call to global public health authorities, attention to MERS-CoV has been diverted over time by the Ebola, Zika and COVID-19 virus outbreaks.
In the well-known scientific publication The Lancet, the Saudi doctor Esam Azhar signs an article in which he warns about the dangerous coincidence of sporting events and festivals that are taking place during the soccer World Cup championship in Qatar complete with a beauty contest for camels at the Camel Mazayen Club. “These have attracted hundreds of thousands of people from the Middle East and around the world and many are attending both events, interacting closely with each other and with the camels, creating ideal conditions for transmission of zoonotic pathogens associated with camels”. These pathogens include MERS-CoV as we have seen potentially lethal.
In May 2022, Qatari authorities reported two individuals with MERS to WHO, one of whom died. Both had primary MERS-CoV infections, contact with camels, and had consumed raw camel milk.
To reduce the risk of spreading MERS-CoV, WHO and the Qatari authorities have broadcast an extensive health message to travelers in Qatar. This message includes avoiding direct contact with camels and avoiding consuming raw camel milk or camel meat. However, these messages are easily overlooked in the festive and competitive atmosphere. Furthermore, contact between imported and local dromedaries participating in the parade, camel owners and participants in both events is inevitable, as is the consumption of foods popular in Qatar, which includes camel curds.
The risk that visitors to Qatar will return to their home countries infected with MERS-CoV therefore remains real. Returning travelers should be advised to seek immediate medical attention if they feel unwell and should inform their doctor of their recent trip to Qatar.