In what appears to be the first US case of Middle East Respiratory Syndrome (MERS), a man has been quarantined in Munster, Indiana with MERS. The disease has reportedly infected over 370 people in Saudi Arabia, with a 30% fatality rate.

According to the Chicago Tribune article, “The man, who has not been identified, was diagnosed with the virus after traveling to Riyadh, Saudi Arabia, and exhibiting symptoms on his return to the United States. He flew from London to O’Hare International Airport on April 24, then took a bus to Indiana.” Given the millions of Pilgrims making the journey to Mecca and traveling back to their home countries, in this case through London to Chicago by air and then his final destination by bus, we are surprised that there have been so few cases of the communicable disease reported.

Our first coverage of MERS was in July of last year, and it included a detailed study by Dr. Kamran Khan, showing the possibilities of MERS to spread through air travel.  The 2014 Hajj will last from October 3-7 according to the CDC Site “More than 2 million Muslims from >183 countries make Hajj each year (2.5 million in 2009), >11,000 of whom travel from the United States. Most international pilgrims fly into Jeddah and take a bus to Mecca. After arriving in Mecca, pilgrims go immediately to the Grand Mosque, which contains the Ka’aba, the most sacred site in Islam, and perform a tawaf, circling the Ka’aba 7 times counterclockwise.

Because of the vast number of people (each floor of the 3-level mosque has a capacity of 750,000), a single tawaf can take hours. In addition to tawaf, pilgrims performs a’i, walking or running 7 times between the hills of Safa and Marwah. Once in open air, this route is now enclosed by the Grand Mosque and can be traversed via air-conditioned tunnels, with separate sections for walkers, runners, and disabled pilgrims.” Also reported in a news blog, the Saudi government is advising that there is no risk of pandemic in spite of rapidly growing cases with a 30% mortality rate.