101
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Eberhardt KA, Vinnemeier CD, Dehnerdt J, Rolling T, Steffen R, Cramer JP. Travelers to the FIFA world cup 2014 in Brazil: Health risks related to mass gatherings/sports events and implications for the Summer Olympic Games in Rio de Janeiro in 2016. Travel Med Infect Dis 2016; 14:212-20. [PMID: 27238909 DOI: 10.1016/j.tmaid.2016.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health threats during mass gatherings, such as the FIFA world cup 2014 differ from traditional health risks. The influence of event type, demographics of attendees and environmental conditions are still not fully understood. METHODS An observational, prospective case-control survey conducted at the Frankfurt international airport in Germany on 544 travelers to the FIFA world cup 2014 and 432 regular travelers to Brazil departing after the end of the world cup. RESULTS Travelers to the FIFA world cup 2014 were predominantly male whereas the gender distribution in the control group was more balanced. The majority in both groups obtained insect bites and sunburns as environmental risk factors. Every third traveler suffered from diarrheal complaints in both groups, whereas the proportion of travelers with flu-like symptoms was higher in the case group. Travelers to the FIFA world cup 2014 indicated alcohol intake and sexual contacts outside of a relationship more frequently than travelers in the control group. CONCLUSIONS The additional health risks of travelers to sporting events as the FIFA world cup 2014 should be addressed in addition to traditional health threats in pre-travel counseling for the Summer Olympic Games 2016 in Brazil.
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Affiliation(s)
| | - Christof David Vinnemeier
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Section Tropical Medicine, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Dehnerdt
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Thierry Rolling
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Section Tropical Medicine, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Steffen
- University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travelers' Health, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | - Jakob Peter Cramer
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
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102
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Zyoud SH. Dengue research: a bibliometric analysis of worldwide and Arab publications during 1872-2015. Virol J 2016; 13:78. [PMID: 27154247 PMCID: PMC4859974 DOI: 10.1186/s12985-016-0534-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/03/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Dengue is an important emerging and re-emerging arboviral infection globally as a rapidly growing and widespread public health problem, with transmission occurring in more than 128 countries in Asia, Americas, southeast Africa, western Pacific, and eastern Mediterranean regions. Therefore, the aim of this study was to characterize and quantify the scientific output of dengue research in Arab countries relative to that worldwide by using a bibliometric analysis. METHODS The standardized search approach based on the use of the the keyword "dengue" in the title, abstract, and keyword field was used to get research output related to dengue at a global level. All data related to dengue were collected from the past to December 31, 2015. RESULTS A total of 19,581 dengue-related documents identified in the Scopus database. The results show that the study of dengue exhibits an overall upward trend from 1872 to 2015 with peak publications in 2014. The leading countries in dengue research were the USA (4,709; 24.05 %), India (1,942; 9.92 %), Brazil (1,530; 7.81 %), Thailand (1,260; 6.43 %), the UK (1,129; 5.77 %), and France (1,087; 5.55 %). Only 226 (1.16 % of the overall global research effort in the dengue field) articles were published from the Arab region. The total number of citations for all publications was 352,710, with an average of 18.0 citations per publication. Furthermore, the h-index for all extracted data related to dengue research was 186. Kingdom of Saudi Arabia (KSA) was the most productive country in Arab region with 102 documents representing 45.1 %. Furthermore, the h-index for all extracted data related to dengue research was 27. The USA was Arab's most main cooperative partner (46, 20.4 %), followed by India (36, 15.9 %). CONCLUSIONS The amount of literature related to dengue research has considerably increased over the last decade. This bibliometric analysis has demonstrated the leading role that the USA, India, Brazil, Thailand, the UK, and France play in dengue research. The Arab world produced fewer publications related to dengue with lower quality than other world countries.
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Affiliation(s)
- Sa'ed H Zyoud
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
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103
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da Cunha DT, Saccol ALDF, Tondo EC, de Oliveira ABA, Ginani VC, Araújo CV, Lima TAS, de Castro AKF, Stedefeldt E. Inspection Score and Grading System for Food Services in Brazil: The Results of a Food Safety Strategy to Reduce the Risk of Foodborne Diseases during the 2014 FIFA World Cup. Front Microbiol 2016; 7:614. [PMID: 27199943 PMCID: PMC4847479 DOI: 10.3389/fmicb.2016.00614] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/13/2016] [Indexed: 11/13/2022] Open
Abstract
In 2014, Brazil hosted one of the most popular sport competitions in the world, the FIFA World Cup. Concerned about the intense migration of tourists, the Brazilian government decided to deploy a food safety strategy based on inspection scores and a grading system applied to food services. The present study aimed to evaluate the results of the food safety strategy deployed during the 2014 FIFA World Cup in Brazil. To assess food safety, an evaluation instrument was applied twice in 1927 food service establishments from 26 cities before the start of the competition. This instrument generated a food safety score for each establishment that ranged from 0.0 (no flaws observed) to 2565.95, with four possible grades: A (0.0-13.2); B (13.3-502.6); C (502.7-1152.2); and pending (more than 1152.3). Each food service received a stamp with the grade of the second evaluation. After the end of the World Cup, a study was conducted with different groups of the public to evaluate the acceptance of the strategy. To this end, 221 consumers, 998 food service owners or managers, 150 health surveillance auditors, and 27 health surveillance coordinators were enrolled. These participants completed a survey with positive and negative responses about the inspection score system through a 5-point Likert scale. A reduction in violation scores from 393.1 to 224.4 (p < 0.001) was observed between the first and second evaluation cycles. Of the food services evaluated, 38.7% received the A stamp, 41.4% the B stamp, and 13.9% the C stamp. All positive responses on "system reliability" presented a mean of 4.0 or more, indicating that the public believed this strategy is reliable for communicating risks and promoting food safety. The strategy showed positive results regarding food safety and public acceptance. The deployed strategy promoted improvements in the food safety of food services. The implementation of a permanent policy may be well accepted by the public and may greatly contribute to a reduction in foodborne diseases (FBDs).
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Affiliation(s)
- Diogo T da Cunha
- Faculdade de Ciências Aplicadas, Universidade de Campinas Limeira, Brazil
| | | | - Eduardo C Tondo
- Instituto de Ciência e Tecnologia dos Alimentos, Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil
| | - Ana B A de Oliveira
- Departamento de Nutrição, Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil
| | - Veronica C Ginani
- Departamento de Nutrição, Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil
| | | | | | | | - Elke Stedefeldt
- Centro de Desenvolvimento do Ensino Superior em Saúde, Universidade Federal de São Paulo São Paulo, Brazil
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104
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Travel Health Concerns. Food Saf (Tokyo) 2016. [DOI: 10.1201/b16705-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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105
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Aitsi-Selmi A, Murray V, Heymann D, McCloskey B, Azhar EI, Petersen E, Zumla A, Dar O. Reducing risks to health and wellbeing at mass gatherings: the role of the Sendai Framework for Disaster Risk Reduction. Int J Infect Dis 2016; 47:101-4. [PMID: 27062983 PMCID: PMC7110506 DOI: 10.1016/j.ijid.2016.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/02/2016] [Indexed: 12/05/2022] Open
Abstract
Reducing the health risks of mass gatherings and seizing the opportunities for health improvement that mass gatherings may offer requires a broader approach to the underlying determinants of risk similar to the comprehensive social determinants of health approach. One of the largest regular mass gatherings in the world is the Hajj. It is the annual mass gathering of over two million Muslims from all over the world and presents challenges to the authorities in Saudi Arabia. The battle against the spread of travel-related infections and other risks facilitated by globalization that arise from mass gatherings is a shared responsibility between different countries, sectors, and disciplines that can help to reduce risk. The Sendai Framework offers a unique opportunity to move beyond simply responding to emergencies to a more comprehensive, prevention-based approach to mass gathering management through the use of science and technical capabilities. It puts the protection of people's health, lives, and livelihoods at its centre.
Mass gatherings of people at religious pilgrimages and sporting events are linked to numerous health hazards, including the transmission of infectious diseases, physical injuries, and an impact on local and global health systems and services. As with other forms of disaster, mass gathering-related disasters are the product of the management of different hazards, levels of exposure, and vulnerability of the population and environment, and require comprehensive risk management that looks beyond single hazards and response. Incorporating an all-hazard, prevention-driven, evidence-based approach that is multisectoral and multidisciplinary is strongly advocated by the Sendai Framework for Disaster Risk Reduction 2015–2030. This paper reviews some of the broader impacts of mass gatherings, the opportunity for concerted action across policy sectors and scientific disciplines offered by the year 2015 (including through the Sendai Framework), and the elements of a 21st century approach to mass gatherings.
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Affiliation(s)
- Amina Aitsi-Selmi
- Public Health England, 133-155 Waterloo Road, London, SE1 8UG, England, UK; Epidemiology and Public Health Department, University College London, London, UK
| | - Virginia Murray
- Public Health England, 133-155 Waterloo Road, London, SE1 8UG, England, UK; UNISDR Scientific and Technical Advisory Group, Geneva, Switzerland
| | - David Heymann
- Public Health England, 133-155 Waterloo Road, London, SE1 8UG, England, UK; Chatham House Centre on Global Health Security, Royal Institute of International Affairs, London, UK
| | - Brian McCloskey
- Public Health England, 133-155 Waterloo Road, London, SE1 8UG, England, UK
| | - Esam I Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Centre, and Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Eskild Petersen
- The Royal Hospital, Muscat, Oman; Aarhus University, Aarhus, Denmark
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre (AZ), UCL Hospitals NHS Foundation Trust, London, UK
| | - Osman Dar
- Public Health England, 133-155 Waterloo Road, London, SE1 8UG, England, UK; Chatham House Centre on Global Health Security, Royal Institute of International Affairs, London, UK.
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106
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Gautret P, Steffen R. Communicable diseases as health risks at mass gatherings other than Hajj: what is the evidence? Int J Infect Dis 2016; 47:46-52. [PMID: 26987476 DOI: 10.1016/j.ijid.2016.03.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 01/06/2023] Open
Abstract
Mass gatherings are characterized by the concentration of people temporally and spatially, and may lead to the emergence of infectious diseases due to enhanced transmission between attendees. This is well-demonstrated in the context of the Hajj and Umrah pilgrimages in Saudi Arabia. The goal of this review was to present the available evidence on outbreaks associated with a variety of pathogens, or also the lack thereof, as assessed by thorough surveillance at any mass gatherings with the exception of those in Saudi Arabia. A systematic search for relevant articles in the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Sixty-eight studies were identified. Although outbreaks have not been reported frequently in or after mass gatherings outside the Hajj and Umrah pilgrimages, they have sometimes occurred at Muslim, Christian, and Hindu religious events, at sports events, and at large-scale open air festivals. In this review it was found that the most common outbreaks at these mass gatherings involved vaccine preventable diseases, mainly measles and influenza, but also mumps and hepatitis A. Meningococcal disease has rarely been recorded. Additionally it was found that the transmission of various communicable diseases that may not be prevented by vaccination has been recorded in association with mass gatherings. These were mainly gastrointestinal infections, caused by a variety of pathogens. It was also noted that some outbreaks occurring at mass gatherings have resulted in the international spread of communicable diseases.
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Affiliation(s)
- Philippe Gautret
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, F-13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France.
| | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, World Health Organization Collaborating Centre for Traveller's Health, University of Zurich, Zurich, Switzerland
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107
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Lowe R, Coelho CA, Barcellos C, Carvalho MS, Catão RDC, Coelho GE, Ramalho WM, Bailey TC, Stephenson DB, Rodó X. Evaluating probabilistic dengue risk forecasts from a prototype early warning system for Brazil. eLife 2016; 5. [PMID: 26910315 PMCID: PMC4775211 DOI: 10.7554/elife.11285] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/21/2016] [Indexed: 01/22/2023] Open
Abstract
Recently, a prototype dengue early warning system was developed to produce probabilistic forecasts of dengue risk three months ahead of the 2014 World Cup in Brazil. Here, we evaluate the categorical dengue forecasts across all microregions in Brazil, using dengue cases reported in June 2014 to validate the model. We also compare the forecast model framework to a null model, based on seasonal averages of previously observed dengue incidence. When considering the ability of the two models to predict high dengue risk across Brazil, the forecast model produced more hits and fewer missed events than the null model, with a hit rate of 57% for the forecast model compared to 33% for the null model. This early warning model framework may be useful to public health services, not only ahead of mass gatherings, but also before the peak dengue season each year, to control potentially explosive dengue epidemics.
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Affiliation(s)
- Rachel Lowe
- Climate Dynamics and Impacts Unit, Institut Català de Ciències del Clima, Barcelona, Spain
| | - Caio As Coelho
- Centro de Previsão de Tempo e Estudos Climáticos, Instituto Nacional de Pesquisas Espaciais, Cachoeira Paulista, Brazil
| | | | | | - Rafael De Castro Catão
- Climate Dynamics and Impacts Unit, Institut Català de Ciències del Clima, Barcelona, Spain.,Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil
| | - Giovanini E Coelho
- Coordenação Geral do Programa Nacional de Controle da Dengue, Ministério da Saúde, Brasília, Brazil
| | | | - Trevor C Bailey
- Exeter Climate Systems, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, United Kingdom
| | - David B Stephenson
- Exeter Climate Systems, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, United Kingdom
| | - Xavier Rodó
- Climate Dynamics and Impacts Unit, Institut Català de Ciències del Clima, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
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108
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International Consensus on Key Concepts and Data Definitions for Mass-gathering Health: Process and Progress. Prehosp Disaster Med 2016; 31:220-3. [DOI: 10.1017/s1049023x1600011x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractMass gatherings (MGs) occur worldwide on any given day, yet mass-gathering health (MGH) is a relatively new field of scientific inquiry. As the science underpinning the study of MGH continues to develop, there will be increasing opportunities to improve health and safety of those attending events. The emerging body of MG literature demonstrates considerable variation in the collection and reporting of data. This complicates comparison across settings and limits the value and utility of these reported data. Standardization of data points and/or reporting in relation to events would aid in creating a robust evidence base from which governments, researchers, clinicians, and event planners could benefit. Moving towards international consensus on any topic is a complex undertaking. This report describes a collaborative initiative to develop consensus on key concepts and data definitions for a MGH “Minimum Data Set.” This report makes transparent the process undertaken, demonstrates a pragmatic way of managing international collaboration, and proposes a number of steps for progressing international consensus. The process included correspondence through a journal, face-to-face meetings at a conference, then a four-day working meeting; virtual meetings over a two-year period supported by online project management tools; consultation with an international group of MGH researchers via an online Delphi process; and a workshop delivered at the 19thWorld Congress on Disaster and Emergency Medicine held in Cape Town, South Africa in April 2015. This resulted in an agreement by workshop participants that there is a need for international consensus on key concepts and data definitions.TurrisSA,SteenkampM,LundA,HuttonA,RanseJ,BowlesR,ArbuthnottK,AnikeevaO,ArbonP.International consensus on key concepts and data definitions for mass-gathering health: process and progress.Prehosp Disaster Med.2016;31(2):220–223.
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109
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Modeling Disease Spread at Global Mass Gatherings: Data Requirements and Challenges. RECENT ADVANCES IN INFORMATION AND COMMUNICATION TECHNOLOGY 2016 2016. [PMCID: PMC7123910 DOI: 10.1007/978-3-319-40415-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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110
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Circulation of respiratory pathogens at mass gatherings, with special focus on the Hajj pilgrimage. THE MICROBIOLOGY OF RESPIRATORY SYSTEM INFECTIONS 2016. [PMCID: PMC7150026 DOI: 10.1016/b978-0-12-804543-5.00006-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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111
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Mathai D, Shamsuzzaman AKM, Feroz AA, Virani AR, Hasan A, Ravi Kumar KL, Ansari K, Forhad Hossain KA, Marda M, Wahab Zubair MA, Ali MM, Ashraf N, Basha R, Mirza S, Ahmed S, Akhtar S, Ashraf SM, Haque Z. Consensus Recommendation for India and Bangladesh for the Use of Pneumococcal Vaccine in Mass Gatherings with Special Reference to Hajj Pilgrims. J Glob Infect Dis 2016; 8:129-138. [PMID: 27942192 PMCID: PMC5126751 DOI: 10.4103/0974-777x.193749] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Respiratory tract infections are prevalent among Hajj pilgrims with pneumonia being a leading cause of hospitalization. Streptococcus pneumoniae is a common pathogen isolated from patients with pneumonia and respiratory tract infections during Hajj. There is a significant burden of pneumococcal disease in India, which can be prevented. Guidelines for preventive measures and adult immunization have been published in India, but the implementation of the guidelines is low. Data from Bangladesh are available about significant mortality due to respiratory infections; however, literature regarding guidelines for adult immunization is limited. There is a need for extensive awareness programs across India and Bangladesh. Hence, there was a general consensus about the necessity for a rapid and urgent implementation of measures to prevent respiratory infections in pilgrims traveling to Hajj. About ten countries have developed recommendations for pneumococcal vaccination in Hajj pilgrims: France, the USA, Kuwait, Qatar, Bahrain, the UAE (Dubai Health Authority), Singapore, Malaysia, Egypt, and Indonesia. At any given point whether it is Hajj or Umrah, more than a million people are present in the holy places of Mecca and Madina. Therefore, the preventive measures taken for Hajj apply for Umrah as well. This document puts forward the consensus recommendations by a group of twenty doctors following a closed-door discussion based on the scientific evidence available for India and Bangladesh regarding the prevention of respiratory tract infections in Hajj pilgrims.
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Affiliation(s)
- Dilip Mathai
- Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Hyderabad, Telangana, India
| | | | | | - Amin R Virani
- Prince Aly Khan Hospital, Mazagaon, Mumbai, Maharashtra, India
| | - Ashfaq Hasan
- Department of Pulmonary Medicine, Deccan College of Medical Sciences, Hyderabad, Telangana, India
| | - K L Ravi Kumar
- Department of Microbiology, Central Research Laboratory, Kempegowda Institute of Medical Sciences Hospital, Bengaluru, India
| | - Khalid Ansari
- Kalsekar Hospital, Thane, Mumbai, Maharashtra, India
| | | | - Mahesh Marda
- Premier Hospital, Mehdipatnam, Hyderabad, Telangana, India
| | - M A Wahab Zubair
- Princess Durru Shehvar Children and General Hospital, Hyderabad, Telangana, India
| | | | - N Ashraf
- Khadija National Hospital, New Delhi, India
| | - Riyaz Basha
- Rajiv Gandhi University of Health Sciences, Bengaluru, India
| | | | - Shafeeq Ahmed
- Haj Committee of India, Haj House, CST, Mumbai, Maharashtra, India
| | - Shamim Akhtar
- Department of Respiratory Medicine, St. Stephens Hospital, New Delhi, India
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112
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Gautret P, Simon F. Dengue, chikungunya and Zika and mass gatherings: What happened in Brazil, 2014. Travel Med Infect Dis 2015; 14:7-8. [PMID: 26778293 DOI: 10.1016/j.tmaid.2015.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 12/18/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Philippe Gautret
- Department of Infectious Diseases and Tropical Medicine, Laveran Military Teaching Hospital, Marseille, France.
| | - Fabrice Simon
- Department of Infectious Diseases and Tropical Medicine, Laveran Military Teaching Hospital, Marseille, France
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113
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Shujaa A, Alhamid S. Health response to Hajj mass gathering from emergency perspective, narrative review. Turk J Emerg Med 2015; 15:172-6. [PMID: 27239622 PMCID: PMC4882208 DOI: 10.1016/j.tjem.2015.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 12/01/2022] Open
Abstract
Hajj is a unique gathering with Mecca and Kaaba being spiritually important to many faiths across the globe, especially Muslims. This is because of the proclamation of the prophet's father, Ibrahaam, when he called all mankind to perform Hajj. That is why all Muslims on Earth feel that they have to visit Mecca and Kaaba on a specific date and time, and that is the reason this small location hosts one of the largest human gatherings in the world. Hajj is one of the five pillars of Islam that every financially and physically able Muslim must perform once in his/her lifetime. For 14 centuries countless millions of Muslim men and women from the four corners of the earth have undertaken pilgrimage to Mecca. In conclusion this review article confirm that Hajj is oldest and largest mass gathering in all mankind and there is some issues influence the health response such as size of gathering. diversity of population, climate and health facilities around hajj site, also we discuss the infectious and non infectious related illness in hajj and their prevention methods.
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Affiliation(s)
- Asaad Shujaa
- Emergency Department, Hamad Medical Corporation, Weill Corneal Medical College, Doha, Qatar
| | - Sameer Alhamid
- Emergency Department, King Saud Ibn Abdulaziz University, Riyadh, Saudi Arabia
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114
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Abstract
Mass-gathering (MG) events pose challenges to the most adept of public health practitioners in ensuring the health safety of the population. These MGs can be for sporting events, musical festivals, or more commonly, have religious undertones. The Kumbh Mela 2013 at Allahabad, India may have been the largest gathering of humanity in history with nearly 120 million pilgrims having thronged the venue. The scale of the event posed a challenge to the maintenance of public health security and safety. A snapshot of the experience of managing the hygiene and sanitation aspects of this mega event is presented herein, highlighting the importance of proactive public health planning and preparedness. There having been no outbreaks of disease is vindication of the steps undertaken in planning and preparedness, notwithstanding obvious limitations of unsanitary behaviors and traditional beliefs of those attending the festival. The evident flaw on post-event analyses was the failure to cater adequately for environmental mopping-up operations after the festival. Besides, a system of real-time monitoring of disease and morbidity patterns, harnessing low cost technology alternatives, should be planned for at all such future events.
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115
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Alqahtani AS, Alfelali M, Arbon P, Booy R, Rashid H. Burden of vaccine preventable diseases at large events. Vaccine 2015; 33:6552-63. [PMID: 26437018 DOI: 10.1016/j.vaccine.2015.09.076] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/14/2015] [Accepted: 09/22/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Large events or mass gatherings (MGs) are known to amplify the risk of infectious diseases, many of which can be prevented by vaccination. In this review we have evaluated the burden of vaccine preventable diseases (VPDs) in MGs. METHODS Major databases like PubMed and Embase, Google Scholar and pertinent websites were searched by using MeSH terms and text words; this was supplemented by hand searching. Following data abstraction, the pooled estimate of the burden of VPDs was calculated when possible; otherwise a narrative synthesis was conducted. RESULTS In the past, at religious MGs like Hajj and Kumbh Mela, cholera caused explosive outbreaks; but currently respiratory infections, notably influenza, are the commonest diseases not only at Hajj but also at World Youth Day and Winter Olympiad. The recent cumulative attack rate of influenza at Hajj is 8.7% (range 0.7-15.8%), and the cumulative prevalence is 3.6% (range: 0.3-38%). Small outbreaks of measles (13-42 cases per event) have been reported at sport, entertainment and religious events. A sizeable outbreak (>200 cases) was reported following a special Easter Festival in Austria. An outbreak of hepatitis A occurred following the 'Jam bands' music festival. Other VPDs including pneumococcal disease, pertussis and tuberculosis have been reported in relation to MG attendance. CONCLUSION VPDs not only affect the participants of MGs but also their contacts; vaccine uptake is variable and vaccine implementation is likely to have beneficial effects. Research to address the knowledge gaps surrounding VPDs at MGs is needed.
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Affiliation(s)
- Amani S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; School of Public Health, The University of Sydney, Sydney, NSW, Australia.
| | - Mohammad Alfelali
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Saudi Arabia
| | - Paul Arbon
- Flinders University World Health Organisation Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Adelaide, SA, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia
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116
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Hopkins N, Reicher S. The psychology of health and well-being in mass gatherings: A review and a research agenda. J Epidemiol Glob Health 2015; 6:49-57. [PMID: 26164280 PMCID: PMC7320437 DOI: 10.1016/j.jegh.2015.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/01/2015] [Accepted: 06/21/2015] [Indexed: 11/07/2022] Open
Abstract
Mass gatherings bring large numbers of people into physical proximity. Typically, this physical proximity has been assumed to contribute to ill health (e.g., through being stressful, facilitating infection transmission, etc.). In this paper, we add a new dimension to the emerging field of mass gatherings medicine. Drawing on psychological research concerning group processes, we consider the psychological transformations that occur when people become part of a crowd. We then consider how these transformations may have various consequences for health and well-being. Some of these consequences may be positive. For example, a sense of shared identity amongst participants may encourage participants to view others as a source of social support which in turn contributes to a sense of health and well-being. However, some consequences may be negative. Thus, this same sense of shared identity may result in a loss of disgust at the prospect of sharing resources (e.g., drinking utensils) which could, in turn, facilitate infection transmission. These, and related issues, are illustrated with research conducted at the Magh Mela (North India). We conclude with an agenda for future research concerning health practices at mass gatherings.
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Affiliation(s)
- Nick Hopkins
- School of Psychology, University of Dundee, Dundee, UK.
| | - Stephen Reicher
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, UK
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117
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Alqahtani AS, Sheikh M, Wiley K, Heywood AE. Australian Hajj pilgrims' infection control beliefs and practices: Insight with implications for public health approaches. Travel Med Infect Dis 2015; 13:329-34. [PMID: 26028307 DOI: 10.1016/j.tmaid.2015.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/09/2015] [Accepted: 05/11/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hajj is one of the largest annual mass gatherings around the world. Although the Saudi Arabian health authority recommends vaccination and other infection control measures, studies identified variable uptake of these measures among pilgrims, and the reasons behind this variability remain unclear. This qualitative study aimed to addresses this knowledge gap. METHODS In-depth interviews were conducted with pilgrims over 18 years of age. RESULTS A total of 10 participants took part in the study. There was low perception of the potential severity of respiratory conditions and the need for influenza vaccination during Hajj. Different attitudes were found by age group with elderly participants believing that they were under Allah's protection, and were fatalistic about the risk of illness. While younger participants described the impact infections would have on their worship. Facemask use was infrequent with discomfort; difficulty in breathing and a feeling of isolation were commonly cited barriers to use of facemasks. Participants accepted and trusted preventative health advice from travel agents and friends who had previously undertaken the Hajj more so than primary care practitioners. CONCLUSIONS This study extended our understanding of how health beliefs influence uptake of preventive measures during the Hajj, and the gaps in the provision of Hajj-specific health information to pilgrims.
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Affiliation(s)
- Amani S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Mohamud Sheikh
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kerrie Wiley
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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118
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Gautret P, Benkouiten S, Sridhar S, Al-Tawfiq JA, Memish ZA. Diarrhea at the Hajj and Umrah. Travel Med Infect Dis 2015; 13:159-66. [PMID: 25765485 DOI: 10.1016/j.tmaid.2015.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 02/20/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022]
Abstract
This systematic review aims to summarize the incidence and etiology of diarrheal illness among pilgrims attending the Hajj and Umrah. Gastroenteritis and diarrhea have been potential threats during previous Hajj pilgrimages. The last cases of Hajj related cholera were reported in 1989. Currently, respiratory tract infections account for the majority of health problems during the Hajj. This shift in epidemiology reflects the improvement of sanitary conditions in Saudi Arabia in general, and at religious sites in particular. Nevertheless, gastrointestinal diseases, food-poisoning outbreaks, and diarrhea continue to occur among pilgrims. Available studies about diarrhea among Hajj pilgrims indicate a mean prevalence of 2% with the highest prevalence of 23% among a group of French pilgrims in 2013. There is an obvious lack of information about the etiology of diarrheal disease at the Hajj. Further studies addressing this issue in hospitalized patients as well as prospective cohort studies would be of interest. During the Hajj, hand washing is regularly carried out by pilgrims under a ritual purification, often called ablution. We recommend implementation of effective hand hygiene practices focusing on the regular use of alcohol-based hand rubs, as they require less time than traditional hand washing, act more rapidly, and contribute to sustained improvement in compliance associated with decreased infection rates.
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Affiliation(s)
- Philippe Gautret
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France.
| | - Samir Benkouiten
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France
| | - Shruti Sridhar
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France
| | - Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ziad A Memish
- Ministry of Health, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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119
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Wolfe SD. 2018 FIFA World Cup: isolating Russia could harm global health. Lancet 2015; 385:749-50. [PMID: 25752158 DOI: 10.1016/s0140-6736(15)60316-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sven Daniel Wolfe
- Department of Geography, University of Zurich, CH-8057 Zurich, Switzerland.
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120
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Olaitan AO, Dia NM, Gautret P, Benkouiten S, Belhouchat K, Drali T, Parola P, Brouqui P, Memish Z, Raoult D, Rolain JM. Acquisition of extended-spectrum cephalosporin- and colistin-resistant Salmonella enterica subsp. enterica serotype Newport by pilgrims during Hajj. Int J Antimicrob Agents 2015; 45:600-4. [PMID: 25769786 DOI: 10.1016/j.ijantimicag.2015.01.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 12/30/2022]
Abstract
Gatherings like the Hajj involving many people who travel from different parts of the world represent a risk for the acquisition and dissemination of infectious diseases. In this study, acquisition of multidrug-resistant (MDR) Salmonella spp. in 2013 Hajj pilgrims from Marseille, France, was investigated. In total, 267 rectal swabs were collected from 129 participants before their departure and after their return from the pilgrimage as well as during the pilgrimage from patients with diarrhoea. Samples were screened for the presence of Salmonella using quantitative real-time PCR and culture. Whole-genome sequencing was performed to characterise one of the isolates, and the mechanism leading to colistin resistance was investigated. Six post-Hajj samples and one sample collected during a diarrhoea episode in Hajj were positive for Salmonella by real-time PCR, with five Salmonella enterica belonging to several serotypes recovered by culture, whereas no pre-Hajj sample was positive. Two of the isolates belonged to the epidemic Newport serotype, were resistant to cephalosporins, gentamicin and colistin, and harboured the bla(CTX-M-2) gene and a 12-nucleotide deletion in the pmrB gene leading to colistin resistance. This study shows that pilgrims acquired Salmonella bacteria, including a novel MDR clone, during the Hajj pilgrimage. This calls for more improved public health surveillance during Hajj because Salmonella is one of the most common diarrhoea-causing bacteria worldwide. Therefore, returning pilgrims could disseminate MDR bacteria worldwide upon returning to their home countries.
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Affiliation(s)
- Abiola Olumuyiwa Olaitan
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Ndèye Méry Dia
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Philippe Gautret
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Samir Benkouiten
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Khadidja Belhouchat
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Tassadit Drali
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Philippe Parola
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Philippe Brouqui
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Ziad Memish
- Alfaisal University, Riyadh 11176, Saudi Arabia
| | - Didier Raoult
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France; Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Jean-Marc Rolain
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France.
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121
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Sridhar S, Belhouchat K, Drali T, Benkouiten S, Parola P, Brouqui P, Gautret P. French Hajj pilgrims' experience with pneumococcal infection and vaccination: A knowledge, attitudes and practice (KAP) evaluation. Travel Med Infect Dis 2015; 13:251-5. [PMID: 25725996 PMCID: PMC7110623 DOI: 10.1016/j.tmaid.2015.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/07/2015] [Accepted: 02/09/2015] [Indexed: 11/10/2022]
Abstract
Background Transmission of respiratory infections poses a major public health challenge during the Hajj and Umrah in the Kingdom of Saudi Arabia. Acquisition of Streptococcus pneumoniae during Hajj has been studied in the past and recommendations for vaccination against S. pneumoniae have been made for high risk groups. Methods The purpose of this study was to assess the knowledge and attitudes of French Hajj pilgrims towards pneumococcal vaccination. Adult pilgrims departing from Marseille, France to Mecca for the 2014 Hajj season were administered a face-to-face questionnaire to ascertain their knowledge and attitudes towards pneumococcal vaccination before departing for Hajj. Results A total of 300 participants took part. Their overall knowledge about the severity of pneumonia and the existence of the vaccine was very low. Out of 101 participants who had an indication for pneumococcal vaccination, irrespective of their travel status, only 7% were advised to have the vaccine by their general practitioner. Conclusions These results reinforce the need for better dissemination of information either before or during the pre-travel counselling. The visit to the travel clinic for receiving the mandatory meningococcal vaccination for Hajj is a good opportunity to update routine immunizations, including pneumococcal vaccination.
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Affiliation(s)
- Shruti Sridhar
- Aix Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Khadidja Belhouchat
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Tassadit Drali
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Samir Benkouiten
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Philippe Parola
- Aix Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Philippe Brouqui
- Aix Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Philippe Gautret
- Aix Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France.
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122
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Memish ZA, Assiri A, Turkestani A, Yezli S, Al Masri M, Charrel R, Drali T, Gaudart J, Edouard S, Parola P, Gautret P. Mass gathering and globalization of respiratory pathogens during the 2013 Hajj. Clin Microbiol Infect 2015; 21:571.e1-8. [PMID: 25700892 PMCID: PMC7129181 DOI: 10.1016/j.cmi.2015.02.008] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 01/29/2015] [Accepted: 02/09/2015] [Indexed: 12/02/2022]
Abstract
Every year, more than 10 million pilgrims arrive in the Kingdom of Saudi Arabia for the Hajj or Umrah. Crowding conditions lead to high rates of respiratory infections among the pilgrims, representing a significant cause of morbidity and a major cause of hospitalization. Pre- and post-Hajj nasal specimens were prospectively obtained from a paired cohort (692 pilgrims) and from nonpaired cohorts (514 arriving and 470 departing pilgrims) from 13 countries. The countries of residence included Africa (44.2%), Asia (40.2%), the United States (8.4%) and Europe (7.2%). Nasal specimens were tested for 34 respiratory pathogens using RT-PCR. A total of 80 512 PCRs were performed. The prevalence of viruses and bacteria increased, from 7.4% and 15.4% before the Hajj to 45.4% and 31.0% after the Hajj, respectively, due to the acquisition of rhinovirus, coronaviruses (229E, HKU1, OC43), influenza A H1N1, Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus. We did not identify Middle East respiratory coronavirus carriage. At arrival, the prevalence of several viruses was clearly dependent on the pilgrim's country of origin. After Hajj participation, these viruses were isolated among pilgrims from all countries, with few exceptions. No significant differences were observed between paired and nonpaired cohort results. Our results strongly suggest that, given the particularly crowded conditions during the rituals, an international mass gathering such as the Hajj may contribute to the globalization of respiratory pathogens after the cross-contamination of pilgrims harbouring pathogens that easily spread among participants. Influenza and pneumococcal vaccination, face mask use and hand hygiene should be considered in the context of the Hajj.
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Affiliation(s)
- Z A Memish
- Public Health Directorate, Saudi Ministry of Health, WHO Collaborating Center for Mass Gathering Medicine, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - A Assiri
- Public Health Directorate, Saudi Ministry of Health, WHO Collaborating Center for Mass Gathering Medicine, Riyadh, Saudi Arabia
| | - A Turkestani
- Public Health Directorate, Saudi Ministry of Health, WHO Collaborating Center for Mass Gathering Medicine, Riyadh, Saudi Arabia
| | - S Yezli
- Public Health Directorate, Saudi Ministry of Health, WHO Collaborating Center for Mass Gathering Medicine, Riyadh, Saudi Arabia
| | - M Al Masri
- Public Health Directorate, Saudi Ministry of Health, WHO Collaborating Center for Mass Gathering Medicine, Riyadh, Saudi Arabia
| | - R Charrel
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France; Aix Marseille Université, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", Marseille, France
| | - T Drali
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France
| | - J Gaudart
- Equipe Biostatistiques, LERTIM, Faculté de Médecine, Marseille, France
| | - S Edouard
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - P Parola
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - P Gautret
- Public Health Directorate, Saudi Ministry of Health, WHO Collaborating Center for Mass Gathering Medicine, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
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123
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Nsoesie EO, Kluberg SA, Mekaru SR, Majumder MS, Khan K, Hay SI, Brownstein JS. New digital technologies for the surveillance of infectious diseases at mass gathering events. Clin Microbiol Infect 2015; 21:134-40. [PMID: 25636385 PMCID: PMC4332877 DOI: 10.1016/j.cmi.2014.12.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/18/2014] [Accepted: 12/19/2014] [Indexed: 11/17/2022]
Abstract
Outbreaks of infectious diseases at mass gatherings can strain the health system of the host region and pose a threat to local and global health. In addition to strengthening existing surveillance systems, most host nations also use novel technologies to assess disease risk and augment traditional surveillance approaches. We review novel approaches to disease surveillance using the Internet, mobile phone applications, and wireless sensor networks. These novel approaches to disease surveillance can result in prompt detection.
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Affiliation(s)
- E O Nsoesie
- Children's Hospital Informatics Program, Boston Children's Hospital, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - S A Kluberg
- Children's Hospital Informatics Program, Boston Children's Hospital, MA, USA
| | - S R Mekaru
- Children's Hospital Informatics Program, Boston Children's Hospital, MA, USA
| | - M S Majumder
- Children's Hospital Informatics Program, Boston Children's Hospital, MA, USA; Engineering Systems Division, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - K Khan
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - S I Hay
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, UK; Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - J S Brownstein
- Children's Hospital Informatics Program, Boston Children's Hospital, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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124
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Abstract
Mass gatherings present the medical community with an excellent window of opportunity to study infectious diseases that can be transmitted over long distances. This is because the venue of a mass gathering usually does not change year-to-year. As a result, special attention can be given to the public health risks that are introduced by travelers from around the world into these mass gatherings. Travelers can also be infected with diseases that are endemic in the host country and transport the locally acquired infectious diseases to their home environments. Therefore, mass gatherings can be thought of as global-to-local-to-global events because of the initial convergence of global populations and the subsequent divergence of populations throughout the world. This chapter discusses three active areas of geographic research that have emerged from our understanding of disease surveillance at mass gatherings: the role of transportation and population geographies in disease surveillance; the spatial and temporal dimensions of environmental geography in the spread of disease; and the advances in GIScience that provide real-world surveillance and monitoring of disease and injuries at mass gatherings.
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125
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Sridhar S, Gautret P, Brouqui P. A comprehensive review of the Kumbh Mela: identifying risks for spread of infectious diseases. Clin Microbiol Infect 2014; 21:128-33. [PMID: 25682278 PMCID: PMC7128512 DOI: 10.1016/j.cmi.2014.11.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 11/21/2014] [Accepted: 11/21/2014] [Indexed: 11/17/2022]
Abstract
The Kumbh Mela in India is the largest mass gathering in the world which witnessed close to 100 million visitors in 2013. An event of this magnitude presents challenges. Increased population density, reduced hygienic conditions and exposure to environmental pollutants pave the way for easy transmission of pathogens. Due to the possibility of epidemics, the primary focus should be on identifying the potential risk factors and implementing appropriate preventive measures. The context of religion and psychology of the pilgrims is also closely associated with the evolution of the risk factors and so forms an important part of the discussion. We provide a brief background to the Kumbh Mela with a description of the existing and potential risk factors that require our attention.
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Affiliation(s)
- S Sridhar
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, Marseille, France
| | - P Gautret
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, Marseille, France
| | - P Brouqui
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, Marseille, France.
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126
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Gautret P. Religious mass gatherings: connecting people and infectious agents. Clin Microbiol Infect 2014; 21:107-8. [PMID: 25682275 DOI: 10.1016/j.cmi.2014.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 11/21/2014] [Indexed: 11/28/2022]
Affiliation(s)
- P Gautret
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, 13015 Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, Marseille, France.
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127
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Dabrera G, Said B, Kirkbride H. Evaluation of the surveillance system for undiagnosed serious infectious illness (USII) in intensive care units, England, 2011 to 2013. ACTA ACUST UNITED AC 2014; 19. [PMID: 25425512 DOI: 10.2807/1560-7917.es2014.19.46.20961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Emerging infections are a potential risk during mass gathering events due to the congregation of large numbers of international travellers. To mitigate this risk for the London 2012 Olympic and Paralympic Games, a sentinel surveillance system was developed to identify clusters of emerging infections presenting as undiagnosed serious infectious illness (USII) in intensive care units (ICUs). Following a six month pilot period, which had begun in January 2011, the surveillance was operational for a further 18 months spanning the Games. The surveillance system and reported USII cases were reviewed and evaluated after this 18 month operational period including assessment of positive predictive value (PPV), timeliness, acceptability and sensitivity of the system. Surveillance records were used to review reported cases and calculate the PPV and median reporting times of USII surveillance. Sensitivity was assessed through comparison with the pilot period. Participating clinicians completed a five-point Likert scale questionnaire about the acceptability of surveillance. Between 11 July 2011 and 10 January 2013, 34 cases were reported. Of these, 22 remained classified as USII at the time of the evaluation, none of which were still hospitalised. No clusters were identified. The 22 USII cases had no association with the Games, suggesting that they represented the background level of USII in the area covered by the surveillance. This corresponded to an annualised rate of 0.39 cases/100,000 population and a PPV of 65%. Clinicians involved in the surveillance reported high acceptability levels. The USII surveillance model could be a useful public health tool in other countries and during mass gathering events for identifying potential clusters of emerging infections.
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Affiliation(s)
- G Dabrera
- UK Field Epidemiology Training Programme, Public Health England, London, United Kingdom
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Mass-gathering health research foundational theory: part 1 - population models for mass gatherings. Prehosp Disaster Med 2014; 29:648-54. [PMID: 25400164 DOI: 10.1017/s1049023x14001216] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The science underpinning the study of mass-gathering health (MGH) is developing rapidly. Current knowledge fails to adequately inform the understanding of the science of mass gatherings (MGs) because of the lack of theory development and adequate conceptual analysis. Defining populations of interest in the context of MGs is required to permit meaningful comparison and meta-analysis between events. Process A critique of existing definitions and descriptions of MGs was undertaken. Analyzing gaps in current knowledge, the authors sought to delineate the populations affected by MGs, employing a consensus approach to formulating a population model. The proposed conceptual model evolved through face-to-face group meetings, structured break out sessions, asynchronous collaboration, and virtual international meetings. Findings and Interpretation Reporting on the incidence of health conditions at specific MGs, and comparing those rates between and across events, requires a common understanding of the denominators, or the total populations in question. There are many, nested populations to consider within a MG, such as the population of patients, the population of medical services providers, the population of attendees/audience/participants, the crew, contractors, staff, and volunteers, as well as the population of the host community affected by, but not necessarily attending, the event. A pictorial representation of a basic population model was generated, followed by a more complex representation, capturing a global-health perspective, as well as academically- and operationally-relevant divisions in MG populations. CONCLUSIONS Consistent definitions of MG populations will support more rigorous data collection. This, in turn, will support meta-analysis and pooling of data sources internationally, creating a foundation for risk assessment as well as illness and injury prediction modeling. Ultimately, more rigorous data collection will support methodology for evaluating health promotion, harm reduction, and clinical-response interventions at MGs. Delineating MG populations progresses the current body of knowledge of MGs and informs the understanding of the full scope of their health effects.
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129
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Mass-gathering health research foundational theory: part 2 - event modeling for mass gatherings. Prehosp Disaster Med 2014; 29:655-63. [PMID: 25399520 DOI: 10.1017/s1049023x14001228] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Current knowledge about mass-gathering health (MGH) fails to adequately inform the understanding of mass gatherings (MGs) because of a relative lack of theory development and adequate conceptual analysis. This report describes the development of a series of event lenses that serve as a beginning "MG event model," complimenting the "MG population model" reported elsewhere. METHODS Existing descriptions of "MGs" were considered. Analyzing gaps in current knowledge, the authors sought to delineate the population of events being reported. Employing a consensus approach, the authors strove to capture the diversity, range, and scope of MG events, identifying common variables that might assist researchers in determining when events are similar and might be compared. Through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings, a conceptual approach to classifying and describing events evolved in an iterative fashion. Findings Embedded within existing literature are a variety of approaches to event classification and description. Arising from these approaches, the authors discuss the interplay between event demographics, event dynamics, and event design. Specifically, the report details current understandings about event types, geography, scale, temporality, crowd dynamics, medical support, protective factors, and special hazards. A series of tables are presented to model the different analytic lenses that might be employed in understanding the context of MG events. Interpretation The development of an event model addresses a gap in the current body of knowledge vis a vis understanding and reporting the full scope of the health effects related to MGs. Consistent use of a consensus-based event model will support more rigorous data collection. This in turn will support meta-analysis, create a foundation for risk assessment, allow for the pooling of data for illness and injury prediction, and support methodology for evaluating health promotion, harm reduction, and clinical response interventions at MGs.
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Jost M, Luzi D, Metzler S, Miran B, Mutsch M. Measles associated with international travel in the region of the Americas, Australia and Europe, 2001-2013: a systematic review. Travel Med Infect Dis 2014; 13:10-8. [PMID: 25468523 DOI: 10.1016/j.tmaid.2014.10.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/11/2014] [Accepted: 10/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Travel volumes are still increasing resulting in a more interconnected world and fostering the spread of infectious diseases. We aimed to evaluate the relevance of travel-related measles, a highly transmissible and vaccine-preventable disease. METHOD Between 2001 and 2013, surveillance and travel-related measles data were systematically reviewed according to the PRISMA guidelines with extraction of relevant articles from Medline, Embase, GoogleScholar and from public health authorities in the Region of the Americas, Europe and Australia. RESULTS From a total of 960 records 44 articles were included and they comprised 2128 imported measles cases between 2001 and 2011. The proportion of imported cases in Europe was low at 1-2%, which reflects the situation in a measles-endemic region. In contrast, imported and import-related measles accounted for up to 100% of all cases in regions with interrupted endemic measles transmission. Eleven air-travel related reports described 132 measles index cases leading to 47 secondary cases. Secondary transmission was significantly more likely to occur if the index case was younger or when there were multiple infectious cases on board. Further spread to health care settings was found. Measles cases associated with cruise ship travel or mass gatherings were sporadically observed. CONCLUSIONS Within both, endemic and non-endemic home countries, pretravel health advice should assess MMR immunity routinely to avoid measles spread by nonimmune travelers. To identify measles spread as well as to increase and sustain high vaccination coverages joint efforts of public health specialists, health care practitioners and travel medicine providers are needed.
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Affiliation(s)
- M Jost
- Epidemiology, Biostatistics and Prevention Institute, Department of Public Health, Division of Infectious Diseases, University of Zurich, Zurich, Switzerland.
| | - D Luzi
- Epidemiology, Biostatistics and Prevention Institute, Department of Public Health, Division of Infectious Diseases, University of Zurich, Zurich, Switzerland.
| | - S Metzler
- Epidemiology, Biostatistics and Prevention Institute, Department of Public Health, Division of Infectious Diseases, University of Zurich, Zurich, Switzerland.
| | - B Miran
- Epidemiology, Biostatistics and Prevention Institute, Department of Public Health, Division of Infectious Diseases, University of Zurich, Zurich, Switzerland.
| | - M Mutsch
- Epidemiology, Biostatistics and Prevention Institute, Department of Public Health, Division of Infectious Diseases, University of Zurich, Zurich, Switzerland.
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Improving Olympic health services: what are the common health care planning issues? Prehosp Disaster Med 2014; 29:623-8. [PMID: 25351206 DOI: 10.1017/s1049023x14001113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Due to their scale, the Olympic and Paralympic Games have the potential to place significant strain on local health services. The Sydney 2000, Athens 2004, Beijing 2008, Vancouver 2010, and London 2012 Olympic host cities shared their experiences by publishing reports describing health care arrangements. HYPOTHESIS Olympic planning reports were compared to highlight best practices, to understand whether and which lessons are transferable, and to identify recurring health care planning issues for future hosts. METHODS A structured, critical, qualitative analysis of all available Olympic health care reports was conducted. Recommendations and issues with implications for future Olympic host cities were extracted from each report. RESULTS The six identified themes were: (1) the importance of early planning and relationship building: clarifying roles early to agree on responsibility and expectations, and engaging external and internal groups in the planning process from the start; (2) the development of appropriate medical provision: most health care needs are addressed inside Olympic venues rather than by hospitals which do not experience significant increases in attendance during the Games; (3) preparing for risks: gastrointestinal and food-borne illnesses are the most common communicable diseases experienced during the Games, but the incidence is still very low; (4) addressing the security risk: security arrangements are one of the most resource-demanding tasks; (5) managing administration and logistical issues: arranging staff permission to work at Games venues ("accreditation") is the most complex administrative task that is likely to encounter delays and errors; and (6) planning and assessing health legacy programs: no previous Games were able to demonstrate that their health legacy initiatives were effective. Although each report identified similar health care planning issues, subsequent Olympic host cities did not appear to have drawn on the transferable experiences of previous host cities. CONCLUSION Repeated recommendations and lessons from host cities show that similar health care planning issues occur despite different health systems. To improve health care planning and delivery, host cities should pay heed to the specific planning issues that have been highlighted. It is also advisable to establish good communication with organizers from previous Games to learn first-hand about planning from previous hosts.
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Willis C, Elviss N, McLauchlin J. A follow-up study of hygiene in catering premises at large-scale events in the United Kingdom. J Appl Microbiol 2014; 118:222-32. [PMID: 25346113 DOI: 10.1111/jam.12668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/09/2014] [Accepted: 10/14/2014] [Indexed: 11/30/2022]
Abstract
AIMS To investigate food hygiene practices at large events by assessing the microbiological quality of ready-to-eat food, drinking water, food preparation surfaces, cleaning cloths and wristbands worn by food handlers for event security purposes. METHODS AND RESULTS Over a 7-month period, 1662 samples were collected at 153 events and examined for microbiological contamination. Eight per cent of food samples were of an unsatisfactory quality. A further one per cent contained potentially hazardous levels of human pathogenic bacteria. 27% of water samples, 32% of swabs and 56% of cloths were also unsatisfactory. These results represented an improvement in hygiene compared to a previous study carried out 12 months previously. A fifth of food handler wristbands were contaminated with Enterobacteriaceae, Escherichia coli and/or coagulase-positive staphylococci, with those bands made from fabric being more frequently contaminated than those made from plastic or other materials. CONCLUSIONS This study provides evidence that the food hygiene at large-scale events may have improved. However, there is still a need for continued efforts to maintain an ongoing improvement in cleaning regimes and food hygiene management. SIGNIFICANCE AND IMPACT OF THE STUDY This study was part of an ongoing focus on large events in the lead-up to the London 2012 Olympics. Lessons learnt here will be important in the planning of future large events.
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Affiliation(s)
- C Willis
- Public Health England Food Water and Environmental Microbiology Laboratory Porton, Salisbury, UK
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Rainey JJ, Cheriyadat A, Radke RJ, Suzuki Crumly J, Koch DB. Estimating contact rates at a mass gathering by using video analysis: a proof-of-concept project. BMC Public Health 2014; 14:1101. [PMID: 25341363 PMCID: PMC4223750 DOI: 10.1186/1471-2458-14-1101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 10/03/2014] [Indexed: 08/30/2023] Open
Abstract
Background Current approaches for estimating social mixing patterns and infectious disease transmission at mass gatherings have been limited by various constraints, including low participation rates for volunteer-based research projects and challenges in quantifying spatially and temporally accurate person-to-person interactions. We developed a proof-of-concept project to assess the use of automated video analysis for estimating contact rates of attendees of the GameFest 2013 event at Rensselaer Polytechnic Institute (RPI) in Troy, New York. Methods Video tracking and analysis algorithms were used to estimate the number and duration of contacts for 5 attendees during a 3-minute clip from the RPI video. Attendees were considered to have a contact event if the distance between them and another person was ≤1 meter. Contact duration was estimated in seconds. We also simulated 50 attendees assuming random mixing using a geo-spatially accurate representation of the same GameFest location. Results The 5 attendees had an overall median of 2 contact events during the 3-minute video clip (range: 0–6). Contact events varied from less than 5 seconds to the full duration of the 3-minute clip. The random mixing simulation was visualized and presented as a contrasting example. Conclusion We were able to estimate the number and duration of contacts for 5 GameFest attendees from a 3-minute video clip that can be compared to a random mixing simulation model at the same location. The next phase will involve scaling the system for simultaneous analysis of mixing patterns from hours-long videos and comparing our results with other approaches for collecting contact data from mass gathering attendees.
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Affiliation(s)
- Jeanette J Rainey
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Memish ZA, Yezli S, Almasri M, Assiri A, Turkestani A, Findlow H, Bai X, Borrow R. Meningococcal serogroup A, C, W, and Y serum bactericidal antibody profiles in Hajj pilgrims. Int J Infect Dis 2014; 28:171-5. [PMID: 25307887 DOI: 10.1016/j.ijid.2014.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 09/17/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The religious seasons of Hajj and Umra in the Kingdom of Saudi Arabia (KSA) have historically been associated with epidemics of meningococcal disease. Due to the effective preventive measures taken in recent years, including vaccination, no meningococcal outbreaks have been reported during Hajj or were Hajj-associated. However, little is known about the immunological profile of pilgrims. The aim of this study was to assess the immunological profile of pilgrims on arrival in KSA against the four meningococcal serogroups, A, C, W, and Y, contained within the quadrivalent vaccine. METHODS Following consent, socio-demographic factors and health-related information was collected from pilgrims arriving at King Abdul Aziz International Airport and a blood sample taken. Antibodies were quantified by serum bactericidal antibody assay using baby rabbit complement (rSBA) against the four meningococcal serogroups, A, C, W, and Y. RESULTS Serum samples were collected from 796 pilgrims; rSBA results were obtained for all four serogroups for 741 of these samples. A total of 48 (6.5%) Hajjis had previously attended Hajj, ranging from 1 to 14 times (median 2 times); 98.2% had received meningococcal quadrivalent vaccine in the last 3 years. Of the 13 who had not, all originated from Bangladesh, with four reporting no previous meningococcal vaccination and nine reporting having received the vaccination more than 3 years ago. For serogroup A, only one pilgrim from Indonesia had an rSBA titre <8. For serogroups C, W, and Y, the percentages of pilgrims with rSBA titres <8 were 9.9%, 17.4%, and 9.4%, respectively. Of note was the high prevalence of non-complement-mediated lysis in pilgrims originating from Nigeria (28/47; 59.6%) and Afghanistan (21/47; 44.7%), but not the other countries. This may be a reflection of the type and pattern of antibiotic usage among these communities. CONCLUSION The vast majority of pilgrims are vaccinated and protected against meningococcal serogroups A, C, W, and Y.
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Affiliation(s)
- Ziad A Memish
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
| | - Saber Yezli
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Malak Almasri
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Assiri
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | | | - Helen Findlow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Xilian Bai
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
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Gautret P, Benkouiten S, Parola P, Brouqui P, Memish Z, Raoult D. Occurrence of Tropheryma whipplei during diarrhea in Hajj pilgrims: A PCR analysis of paired rectal swabs. Travel Med Infect Dis 2014; 12:481-4. [DOI: 10.1016/j.tmaid.2014.04.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 04/10/2014] [Accepted: 04/14/2014] [Indexed: 11/26/2022]
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Lorenc A, Robinson N. Evaluating sexual health planning for the London 2012 Olympics. J Public Health (Oxf) 2014; 37:506-14. [PMID: 25174041 DOI: 10.1093/pubmed/fdu064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The public health impact of mass gatherings should not be underestimated, requiring careful planning. This evaluation identified the successes and failures of a programme targeted to mitigate against potential increases in sexual ill health during the London 2012 Olympics. METHODS Programme planning was evaluated using documentary analysis. Stakeholders' experiences were explored using an online survey. Finally, selected stakeholders were interviewed in depth. RESULTS Over 100 documents were analysed, 36 survey responses received and 12 interviews conducted. Most respondents felt aims were appropriate, potentially overambitious. 'Business as usual', with no disruption or increased demand, was reported in sexual health services. Some interviewees felt evidence for increased demand was limited, although contingency planning was needed. Signposting service users and providing 'residual risk responses' appeared successful. Planned service transformation was not fully achieved and perhaps inappropriate, although new service collaborations emerged. Over 2000 individuals participated; wider public engagement was seen as inappropriate. A 'Sex Factor 2012' competition was particularly successful. Legacy opportunities included planning work, groundwork for transformation, relationship building and continuing the resilience changes. CONCLUSIONS The Games allowed sexual health services to explore new ways of working, engage with stakeholders and develop new relationships, although in reality demand for services did not increase.
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Affiliation(s)
- Ava Lorenc
- Faculty of Health and Social Care, London South Bank University, London SE1 0AA, UK
| | - Nicola Robinson
- Faculty of Health and Social Care, London South Bank University, London SE1 0AA, UK
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Al-Tawfiq JA, Memish ZA. Mass gathering medicine: 2014 Hajj and Umra preparation as a leading example. Int J Infect Dis 2014; 27:26-31. [PMID: 25128639 PMCID: PMC7110515 DOI: 10.1016/j.ijid.2014.07.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 07/28/2014] [Indexed: 12/27/2022] Open
Abstract
The importation of infectious diseases during a mass gathering may result in outbreaks. Infectious diseases associated with mass gatherings vary depending on the type and location of the mass gathering. The annual Hajj to Makkah in Saudi Arabia is one of the largest annual religious mass gatherings in the world. Preparation for the Hajj encompasses multiple sectors to develop comprehensive plans. These plans include risk assessment, utilizing existing medical infrastructure, developing electronic and paper-based surveillance activity, and the use of information technology. In this review, we describe key features of the preparedness for the 2014 Hajj and Umra, review the recent impact of emerging viruses such as Ebola in West Africa and the Middle East respiratory syndrome coronavirus (MERS-CoV) in affected countries, and highlight the updated requirements and the required vaccines.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indiana, USA
| | - Ziad A Memish
- Ministry of Health and Al-Faisal University, PO Box 54146, Riyadh, 11514, Saudi Arabia.
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Gaines J, Sotir MJ, Cunningham TJ, Harvey KA, Lee CV, Stoney RJ, Gershman MD, Brunette GW, Kozarsky PE. Health and safety issues for travelers attending the World Cup and Summer Olympic and Paralympic Games in Brazil, 2014 to 2016. JAMA Intern Med 2014; 174:1383-90. [PMID: 24887552 PMCID: PMC4655589 DOI: 10.1001/jamainternmed.2014.2227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
IMPORTANCE Travelers from around the globe will attend the 2014 Fédération Internationale de Football Association (FIFA) World Cup and the 2016 Olympic and Paralympic Games in Brazil. Travelers to these mass gathering events may be exposed to a range of health risks, including a variety of infectious diseases. Most travelers who become ill will present to their primary care physicians, and thus it is important that clinicians are aware of the risks their patients encountered. OBJECTIVE To highlight health and safety concerns for people traveling to these events in Brazil so that health care practitioners can better prepare travelers before they travel and more effectively diagnose and treat travelers after they return. EVIDENCE REVIEW We reviewed both peer-reviewed and gray literature to identify health outcomes associated with travel to Brazil and mass gatherings. Thirteen specific infectious diseases are described in terms of signs, symptoms, and treatment. Relevant safety and security concerns are also discussed. FINDINGS Travelers to Brazil for mass gathering events face unique health risks associated with their travel. CONCLUSIONS AND RELEVANCE Travelers should consult a health care practitioner 4 to 6 weeks before travel to Brazil and seek up-to-date information regarding their specific itineraries. For the most up-to-date information, health care practitioners can visit the Centers for Disease Control and Prevention (CDC) Travelers' Health website (http://wwwnc.cdc.gov/travel) or review CDC's Yellow Book online (http://wwwnc.cdc.gov/travel/page/yellowbook-home-2014).
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Affiliation(s)
- Joanna Gaines
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Mark J Sotir
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Timothy J Cunningham
- Epidemiology and Surveillance Branch, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Kira A Harvey
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - C Virginia Lee
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Rhett J Stoney
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Mark D Gershman
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Gary W Brunette
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Phyllis E Kozarsky
- Geographic Medicine and Health Promotion Branch, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia3Emory University School of Medi
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van Panhuis WG, Hyun S, Blaney K, Marques ETA, Coelho GE, Siqueira JB, Tibshirani R, da Silva JB, Rosenfeld R. Risk of dengue for tourists and teams during the World Cup 2014 in Brazil. PLoS Negl Trop Dis 2014; 8:e3063. [PMID: 25079960 PMCID: PMC4120682 DOI: 10.1371/journal.pntd.0003063] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/13/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This year, Brazil will host about 600,000 foreign visitors during the 2014 FIFA World Cup. The concern of possible dengue transmission during this event has been raised given the high transmission rates reported in the past by this country. METHODOLOGY/PRINCIPAL FINDINGS We used dengue incidence rates reported by each host city during previous years (2001-2013) to estimate the risk of dengue during the World Cup for tourists and teams. Two statistical models were used: a percentile rank (PR) and an Empirical Bayes (EB) model. Expected IR's during the games were generally low (<10/100,000) but predictions varied across locations and between models. Based on current ticket allocations, the mean number of expected symptomatic dengue cases ranged from 26 (PR, 10th-100th percentile: 5-334 cases) to 59 (EB, 95% credible interval: 30-77 cases) among foreign tourists but none are expected among teams. These numbers will highly depend on actual travel schedules and dengue immunity among visitors. Sensitivity analysis for both models indicated that the expected number of cases could be as low as 4 or 5 with 100,000 visitors and as high as 38 or 70 with 800,000 visitors (PR and EB, respectively). CONCLUSION/SIGNIFICANCE The risk of dengue among tourists during the World Cup is expected to be small due to immunity among the Brazil host population provided by last year's epidemic with the same DENV serotypes. Quantitative risk estimates by different groups and methodologies should be made routinely for mass gathering events.
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Affiliation(s)
- Willem G. van Panhuis
- University of Pittsburgh Graduate School of
Public Health, Pittsburgh, Pennsylvania, United States of
America
- * E-mail:
| | - Sangwon Hyun
- Carnegie Mellon University, Pittsburgh,
Pennsylvania, United States of America
| | - Kayleigh Blaney
- University of Pittsburgh Graduate School of
Public Health, Pittsburgh, Pennsylvania, United States of
America
| | - Ernesto T. A. Marques
- University of Pittsburgh Center for Vaccine
Research, Pittsburgh, Pennsylvania, United States of America
| | | | | | - Ryan Tibshirani
- Carnegie Mellon University, Pittsburgh,
Pennsylvania, United States of America
| | | | - Roni Rosenfeld
- Carnegie Mellon University, Pittsburgh,
Pennsylvania, United States of America
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Ferraro CF, Trotter CL, Nascimento MC, Jusot JF, Omotara BA, Hodgson A, Ali O, Alavo S, Sow S, Daugla DM, Stuart JM. Household crowding, social mixing patterns and respiratory symptoms in seven countries of the African meningitis belt. PLoS One 2014; 9:e101129. [PMID: 24988195 PMCID: PMC4079295 DOI: 10.1371/journal.pone.0101129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/03/2014] [Indexed: 12/24/2022] Open
Abstract
Objectives To describe the variation in household crowding and social mixing patterns in the African meningitis belt and to assess any association with self-reported recent respiratory symptoms. Methods In 2010, the African Meningococcal Carriage Consortium (MenAfriCar) conducted cross-sectional surveys in urban and rural areas of seven countries. The number of household members, rooms per household, attendance at social gatherings and meeting places were recorded. Associations with self-reported recent respiratory symptoms were analysed by univariate and multivariate regression models. Results The geometric mean people per room ranged from 1.9 to 2.8 between Ghana and Ethiopia respectively. Attendance at different types of social gatherings was variable by country, ranging from 0.5 to 1.5 per week. Those who attended 3 or more different types of social gatherings a week (frequent mixers) were more likely to be older, male (OR 1.27, p<0.001) and live in urban areas (OR 1.45, p<0.001). Frequent mixing and young age, but not increased household crowding, were associated with higher odds of self-reported respiratory symptoms (aOR 2.2, p<0.001 and OR 2.8, p<0.001 respectively). A limitation is that we did not measure school and workplace attendance. Conclusion There are substantial variations in household crowding and social mixing patterns across the African meningitis belt. This study finds a clear association between age, increased social mixing and respiratory symptoms. It lays the foundation for designing and implementing more detailed studies of social contact patterns in this region.
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Affiliation(s)
- Claire F. Ferraro
- Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Caroline L. Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Maria C. Nascimento
- Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jean-François Jusot
- Unité d'Epidémiologie, Centre de Recherches Médicales et Sanitaires (CERMES), Niamey, Niger
| | | | - Abraham Hodgson
- Navrongo Health Research Centre, Navrongo, Ghana
- Research and Development Division, Ghana Health Service, Ghana
| | - Oumer Ali
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Serge Alavo
- L'institut de recherche pour le développement, Dakar, Senegal
| | - Samba Sow
- Center for Vaccine Development-Mali (CVD-MALI), Bamako, Mali
| | | | - James M. Stuart
- Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Zumla A, Mwaba P, Bates M, Al‐Tawfiq JA, Maeurer M, Memish ZA. The Hajj pilgrimage and surveillance for Middle East Respiratory syndrome coronavirus in pilgrims from African countries. Trop Med Int Health 2014; 19:838-40. [PMID: 24750482 PMCID: PMC7169761 DOI: 10.1111/tmi.12318] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Alimuddin Zumla
- Global Centre for Mass Gatherings MedicineMinistry of HealthRiyadhSaudi Arabia
- UNZA‐UCLMS Research and Training ProgrammeUniversity Teaching HospitalLusakaZambia
- Division of Infection and ImmunityUniversity College LondonLondonUK
- UCL Hospitals NHS Foundation TrustLondonUK
| | - Peter Mwaba
- UNZA‐UCLMS Research and Training ProgrammeUniversity Teaching HospitalLusakaZambia
| | - Matthew Bates
- UNZA‐UCLMS Research and Training ProgrammeUniversity Teaching HospitalLusakaZambia
- Division of Infection and ImmunityUniversity College LondonLondonUK
| | - Jaffar A. Al‐Tawfiq
- Global Centre for Mass Gatherings MedicineMinistry of HealthRiyadhSaudi Arabia
- Saudi Aramco Medical Services OrganizationSaudi AramcoDhahranSaudi Arabia
| | - Markus Maeurer
- Therapeutic Immunology DivisionDepartment of Laboratory MedicineKarolinska InstitutetStockholmSweden
| | - Ziad A. Memish
- Global Centre for Mass Gatherings MedicineMinistry of HealthRiyadhSaudi Arabia
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142
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Benkouiten S, Brouqui P, Gautret P. Non-pharmaceutical interventions for the prevention of respiratory tract infections during Hajj pilgrimage. Travel Med Infect Dis 2014; 12:429-42. [PMID: 24999278 PMCID: PMC7110686 DOI: 10.1016/j.tmaid.2014.06.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/10/2014] [Accepted: 06/16/2014] [Indexed: 11/27/2022]
Abstract
Overcrowding during the yearly Hajj mass gatherings is associated with increased risk of spreading infectious diseases, particularly respiratory diseases. Non-pharmaceutical interventions (e.g., hand hygiene, wearing face masks, social distancing) are known to reduce the spread of respiratory viruses from person to person and are therefore recommended to pilgrims by public health agencies. The implementation of effective public health policies and recommendations involves evaluating the adherence to and effectiveness of these measures in the specific context of the Hajj. This review summarizes the evidence related to the effectiveness of non-pharmaceutical interventions in preventing the spread of respiratory infectious diseases during the Hajj. Overall, although hand hygiene compliance is high among pilgrims, face mask use and social distancing remain difficult challenges. Data about the effectiveness of these measures at the Hajj are limited, and results are contradictory, highlighting the need for future large-scale studies.
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Affiliation(s)
- Samir Benkouiten
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France
| | - Philippe Brouqui
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France
| | - Philippe Gautret
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France.
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143
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Severi E, Kitching A, Crook P. Evaluation of the Health Protection Event-Based Surveillance for the London 2012 Olympic and Paralympic Games. ACTA ACUST UNITED AC 2014; 19. [PMID: 24970374 DOI: 10.2807/1560-7917.es2014.19.24.20832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Health Protection Agency (HPA) (currently Public Health England) implemented the Health Protection Event-Based Surveillance (EBS) to provide additional national epidemic intelligence for the 2012 London Olympic and Paralympic Games (the Games). We describe EBS and evaluate the system attributes. EBS aimed at identifying, assessing and reporting to the HPA Olympic Coordination Centre (OCC) possible national infectious disease threats that may significantly impact the Games. EBS reported events in England from 2 July to 12 September 2012. EBS sourced events from reports from local health protection units and from screening an electronic application 'HPZone Dashboard' (DB). During this period, 147 new events were reported to EBS, mostly food-borne and vaccine-preventable diseases: 79 from regional units, 144 from DB (76 from both). EBS reported 61 events to the OCC: 21 of these were reported onwards. EBS sensitivity was 95.2%; positive predictive value was 32.8%; reports were timely (median one day; 10th percentile: 0 days - same day; 90th percentile: 3.6 days); completeness was 99.7%; stability was 100%; EBS simplicity was assessed as good; the daily time per regional or national unit dedicated to EBS was approximately 4 hours (weekdays) and 3 hours (weekends). OCC directors judged EBS as efficient, fast and responsive. EBS provided reliable, reassuring, timely, simple and stable national epidemic intelligence for the Games.
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Affiliation(s)
- E Severi
- Health Protection Agency, London regional Epidemiology Unit, London, United Kingdom
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144
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McCloskey B, Endericks T, Catchpole M, Zambon M, McLauchlin J, Shetty N, Manuel R, Turbitt D, Smith G, Crook P, Severi E, Jones J, Ibbotson S, Marshall R, Smallwood CAH, Isla N, Memish ZA, Al-Rabeeah AA, Barbeschi M, Heymann DL, Zumla A. London 2012 Olympic and Paralympic Games: public health surveillance and epidemiology. Lancet 2014; 383:2083-2089. [PMID: 24857700 PMCID: PMC7138022 DOI: 10.1016/s0140-6736(13)62342-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mass gatherings are regarded as potential risks for transmission of infectious diseases, and might compromise the health system of countries in which they are hosted. The evidence for increased transmission of infectious diseases at international sporting mass gatherings that attract many visitors from all over the world is not clear, and the evidence base for public health surveillance, epidemiology, and response at events such as the Olympics is small. However, infectious diseases are a recognised risk, and public health planning is, and should remain, a crucial part of the overall planning of sporting events. In this Series paper, we set out the planning and the surveillance systems that were used to monitor public health risks during the London 2012 Olympic and Paralympic Games in the summer of 2012, and draw attention to the public health issues-infectious diseases and chemical, radiation, and environmental hazards-that arose. Although the absolute risk of health-protection problems, including infectious diseases, at sporting mass gatherings is small, the need for reassurance of the absence of problems is higher than has previously been considered; this could challenge conventional public health surveillance systems. Recognition of the limitations of health-surveillance systems needs to be part of the planning for future sporting events.
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Affiliation(s)
- Brian McCloskey
- Global Center for Mass Gathering Medicine, Riyadh, Saudi Arabia; Global Health and WHO Collaborating Centre on Mass Gatherings, London, UK.
| | - Tina Endericks
- Global Health and WHO Collaborating Centre on Mass Gatherings, London, UK
| | - Mike Catchpole
- Centre for Infectious Disease Surveillance and Control, London, UK
| | | | - Jim McLauchlin
- Food, Water, and Environmental Microbiology Services, London, UK
| | | | | | | | | | | | - Ettore Severi
- European Programme for Intervention Epidemiology Training, London, UK
| | - Jane Jones
- Travel and Migrant Health Section, London, UK
| | | | | | | | - Nicolas Isla
- Global Preparedness, Surveillance and and Response, WHO, Geneva, Switzerland
| | - Ziad A Memish
- Global Center for Mass Gathering Medicine, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia; Al-Faisal University, Riyadh, Saudi Arabia
| | - Abdullah A Al-Rabeeah
- Global Center for Mass Gathering Medicine, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia
| | - Maurizio Barbeschi
- Global Center for Mass Gathering Medicine, Riyadh, Saudi Arabia; Global Capacities, Alert and Response, WHO, Geneva, Switzerland
| | - David L Heymann
- Global Center for Mass Gathering Medicine, Riyadh, Saudi Arabia; Public Health England, London, UK; Royal Institute of International Affairs, Chatham House, London, UK; London School of Hygiene and Tropical Medicine, London, UK
| | - Alimuddin Zumla
- Global Center for Mass Gathering Medicine, Riyadh, Saudi Arabia; Division of Infection and Immunity, University College London, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
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145
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Smallwood CAH, Arbuthnott KG, Banczak-Mysiak B, Borodina M, Coutinho AP, Payne-Hallström L, Lipska E, Lyashko V, Miklasz M, Miskiewicz P, Nitzan D, Pokanevych I, Posobkiewicz M, Rockenschaub G, Sadkowska-Todys M, Sinelnik S, Smiley D, Tomialoic R, Yurchenko V, Memish ZA, Heymann D, Endericks T, McCloskey B, Zumla A, Barbeschi M. Euro 2012 European Football Championship Finals: planning for a health legacy. Lancet 2014; 383:2090-2097. [PMID: 24857705 DOI: 10.1016/s0140-6736(13)62384-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The revised international health regulations offer a framework that can be used by host countries to organise public health activities for mass gatherings. From June 8, to July 1, 2012, Poland and Ukraine jointly hosted the Union of European Football Associations European Football Championship Finals (Euro 2012). More than 8 million people from around the world congregated to watch the games. Host countries and international public health agencies planned extensively to assess and build capacity in the host countries and to develop effective strategies for dissemination of public health messages. The effectiveness of public health services was maximised through rapid sharing of information between parties, early use of networks of experienced individuals, and the momentum of existing national health programmes. Organisers of future mass gatherings for sporting events should share best practice and their experiences through the WHO International Observer Program. Research about behaviour of large crowds is needed for crowd management and the evidence base translated into practice. A framework to measure and evaluate the legacy of Euro 2012 is needed based on the experiences and the medium-term and long-term benefits of the tournament.
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Affiliation(s)
| | | | | | - Mariya Borodina
- WHO Virtual Inter-disciplinary Advisory Group on Mass Gatherings, Geneva, Switzerland
| | - Ana Paula Coutinho
- Alert and Response Operations, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Lara Payne-Hallström
- Surveillance and Response Support Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | | | - Miroslaw Miklasz
- Country Office in Poland, WHO, Ministry of Health, Warsaw, Poland
| | | | | | | | | | - Gerald Rockenschaub
- Country Emergency Preparedness, WHO Regional Office for Europe, Copenhagen, Denmark
| | | | | | - Daniel Smiley
- WHO Virtual Inter-disciplinary Advisory Group on Mass Gatherings, Geneva, Switzerland
| | - Rysard Tomialoic
- European Programme for Intervention Epidemiology Training, Stockholm, Sweden
| | | | | | - David Heymann
- Chatham House, London, UK; London School of Hygiene & Tropical Medicine, London, UK; Public Health England, London, UK
| | - Tina Endericks
- WHO Collaborating Centre on Mass Gatherings, Public Health England, London, UK
| | - Brian McCloskey
- WHO Collaborating Centre on Mass Gatherings, Public Health England, London, UK
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
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146
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Memish ZA, Zumla A, Alhakeem RF, Assiri A, Turkestani A, Al Harby KD, Alyemni M, Dhafar K, Gautret P, Barbeschi M, McCloskey B, Heymann D, Al Rabeeah AA, Al-Tawfiq JA. Hajj: infectious disease surveillance and control. Lancet 2014; 383:2073-2082. [PMID: 24857703 PMCID: PMC7137990 DOI: 10.1016/s0140-6736(14)60381-0] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Religious festivals attract a large number of pilgrims from worldwide and are a potential risk for the transmission of infectious diseases between pilgrims, and to the indigenous population. The gathering of a large number of pilgrims could compromise the health system of the host country. The threat to global health security posed by infectious diseases with epidemic potential shows the importance of advanced planning of public health surveillance and response at these religious events. Saudi Arabia has extensive experience of providing health care at mass gatherings acquired through decades of managing millions of pilgrims at the Hajj. In this report, we describe the extensive public health planning, surveillance systems used to monitor public health risks, and health services provided and accessed during Hajj 2012 and Hajj 2013 that together attracted more than 5 million pilgrims from 184 countries. We also describe the recent establishment of the Global Center for Mass Gathering Medicine, a Saudi Government partnership with the WHO Collaborating Centre for Mass Gatherings Medicine, Gulf Co-operation Council states, UK universities, and public health institutions globally.
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Affiliation(s)
- Ziad A Memish
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; WHO Collaborating Centre for Mass Gatherings Medicine, Riyadh, Saudi Arabia; Al-Faisal University, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia.
| | - Alimuddin Zumla
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Division of Infection and Immunity, University College London, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
| | - Rafat F Alhakeem
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia
| | | | | | | | | | | | - Philippe Gautret
- Aix Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Inserm, and Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Maurizio Barbeschi
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Preparedness, Surveillance and Response, Global Capacity Alert and Response, World Health Organization, Geneva, Switzerland
| | - Brian McCloskey
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; WHO Collaborating Centre on Mass Gatherings and High Visibility/High Consequence Events, London, UK
| | - David Heymann
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Chatham House, London, UK; London School of Hygiene & Tropical Medicine, London, UK
| | - Abdullah A Al Rabeeah
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA
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147
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Social identification moderates the effect of crowd density on safety at the Hajj. Proc Natl Acad Sci U S A 2014; 111:9091-6. [PMID: 24927593 DOI: 10.1073/pnas.1404953111] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Crowd safety is a major concern for those attending and managing mass gatherings, such as the annual Hajj or pilgrimage to Mecca (also called Makkah). One threat to crowd safety at such events is crowd density. However, recent research also suggests that psychological membership of crowds can have positive benefits. We tested the hypothesis that the effect of density on safety might vary depending on whether there is shared social identification in the crowd. We surveyed 1,194 pilgrims at the Holy Mosque, Mecca, during the 2012 Hajj. Analysis of the data showed that the negative effect of crowd density on reported safety was moderated by social identification with the crowd. Whereas low identifiers reported reduced safety with greater crowd density, high identifiers reported increased safety with greater crowd density. Mediation analysis suggested that a reason for these moderation effects was the perception that other crowd members were supportive. Differences in reported safety across national groups (Arab countries and Iran compared with the rest) were also explicable in terms of crowd identification and perceived support. These findings support a social identity account of crowd behavior and offer a novel perspective on crowd safety management.
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148
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Williams K, Sinclair C, McEwan R, Fleet K, Balasegaram S, Manuel R. Impact of the London 2012 Olympic and Paralympic Games on demand for microbiology gastrointestinal diagnostic services at the Public Health Laboratory London. J Med Microbiol 2014; 63:968-974. [PMID: 24809387 DOI: 10.1099/jmm.0.070821-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Planning for the London 2012 Olympic and Paralympic Games at the Public Health Laboratory London was based on the requirement to meet potential increased demand with scalable capacity. The aim of this study was to determine the impact on demand for microbiology gastrointestinal diagnostic services during the Games period. Retrospective cross-sectional time-series data analysis was used to assess the number of gastrointestinal specimens received in the laboratory and the number of positive results. There was no increase in the number of gastrointestinal specimens received during the Games period, thus the Games had no impact on demand for microbiology gastrointestinal diagnostic services at the laboratory. There was a decrease in the number of public health specimens received for culture [incidence rate ratio = 0.34, 95% confidence interval (CI) = 0.13-0.86, P = 0.02] and a decrease in the number of culture positive community specimens (odds ratio = 0.59, 95 % CI = 0.40-0.85, P = 0.005), suggesting a decrease in gastrointestinal illness during the Games period. As previous planning assumptions were not based on actual specimen activity, the results of this study may modify the extent of additional planning for microbiological services required for mass gatherings.
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Affiliation(s)
- K Williams
- Public Health Laboratory London, Public Health England, London, UK
| | - C Sinclair
- Field Epidemiology Services Victoria, Public Health England, London, UK
| | - R McEwan
- Public Health Laboratory London, Public Health England, London, UK
| | - K Fleet
- North East and North Central London Health Protection Team, Public Health England, London, UK
| | - S Balasegaram
- Field Epidemiology Services Victoria, Public Health England, London, UK
| | - R Manuel
- Public Health Laboratory London, Public Health England, London, UK
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149
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Wilson ME, Chen LH. Health risks among travelers to Brazil: implications for the 2014 FIFA World Cup and 2016 Olympic Games. Travel Med Infect Dis 2014; 12:205-7. [PMID: 24786668 PMCID: PMC7128226 DOI: 10.1016/j.tmaid.2014.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/04/2014] [Indexed: 11/18/2022]
Affiliation(s)
| | - Lin H Chen
- Mount Auburn Hospital, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
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150
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Economopoulou A, Kinross P, Domanovic D, Coulombier D. Infectious diseases prioritisation for event-based surveillance at the European Union level for the 2012 Olympic and Paralympic Games. ACTA ACUST UNITED AC 2014; 19. [PMID: 24762663 DOI: 10.2807/1560-7917.es2014.19.15.20770] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In 2012, London hosted the Olympic and Paralympic Games (the Games), with events occurring throughout the United Kingdom (UK) between 27 July and 9 September 2012. Public health surveillance was performed by the Health Protection Agency (HPA). Collaboration between the HPA and the European Centre for Disease Prevention and Control (ECDC) was established for the detection and assessment of significant infectious disease events (SIDEs) occurring outside the UK during the time of the Games. Additionally, ECDC undertook an internal prioritisation exercise to facilitate ECDC’s decisions on which SIDEs should have preferentially enhanced monitoring through epidemic intelligence activities for detection and reporting in daily surveillance in the European Union (EU). A team of ECDC experts evaluated potential public health risks to the Games, selecting and prioritising SIDEs for event-based surveillance with regard to their potential for importation to the Games, occurrence during the Games or export to the EU/European Economic Area from the Games. The team opted for a multilevel approach including comprehensive disease selection, development and use of a qualitative matrix scoring system and a Delphi method for disease prioritisation. The experts selected 71 infectious diseases to enter the prioritisation exercise of which 27 were considered as priority for epidemic intelligence activities by ECDC for the EU for the Games.
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Affiliation(s)
- A Economopoulou
- European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
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