The Olympic and Paralympic Games 2012: literature review of the logistical planning and operational challenges for public health

Sacred journeys and pilgrimages: health risks associated with travels for religious purposes

BACKGROUND

Pilgrimages and travel to religious mass gatherings (MGs) are part of all major religions. This narrative review aims to describe some characteristics, including health risks, of the more well-known and frequently undertaken ones.

METHODS

A literature search was conducted using keywords related to the characteristics (frequency of occurrence, duration, calendar period, reasons behind their undertaking and the common health risks) of Christian, Muslim, Hindu, Buddhist and Jewish religious MGs.

RESULTS

About 600 million trips are undertaken to religious sites annually. The characteristics vary between religions and between pilgrimages. However, religious MGs share common health risks, but these are reported in a heterogenous manner. European Christian pilgrimages reported both communicable diseases, such as norovirus outbreaks linked to the Marian Shrine of Lourdes in France, and non-communicable diseases (NCDs). NCDs predominated at the Catholic pilgrimage to the Basilica of Our Lady of Guadalupe in Mexico, which documented 11 million attendees in 1 week. The Zion Christian Church Easter gathering in South Africa, attended by ~10 million pilgrims, reported mostly motor vehicle accidents. Muslim pilgrimages such as the Arbaeen (20 million pilgrims) and Hajj documented a high incidence of respiratory tract infections, up to 80% during Hajj. Heat injuries and stampedes have been associated with Hajj. The Hindu Kumbh Mela pilgrimage, which attracted 100 million pilgrims in 2013, documented respiratory conditions in 70% of consultations. A deadly stampede occurred at the 2021 Jewish Lag BaOmer MG.

CONCLUSION

Communicable and NCD differ among the different religious MGs. Gaps exists in the surveillance, reporting and data accessibility of health risks associated with religious MGs. A need exists for the uniform implementation of a system of real-time monitoring of diseases and morbidity patterns, utilizing standardized modern information-sharing platforms. The health needs of pilgrims can then be prioritized by developing specific and appropriate guidelines.

Interorganizational Knowledge Transfer in Mass Gatherings: Exploring the Health and Safety Stakeholders' Perceptions Participating in the Athens Marathon

INTRODUCTION

Mass gatherings (MGs) usually represent significant challenges for the public health and safety sector of the host cities. Organizing a safe and successful mass event highly depends on the effective collaboration among different public and private organizations. It is necessary to establish successful coordination to ensure that all the key stakeholders understand their respective roles and responsibilities. The inconsistency between the variety of participating agencies because of their different culture can result in delays in decision making. Interorganizational knowledge transfer can improve the success of the event; however, knowledge transfer among professionals and agencies in MGs is not well-documented.

OBJECTIVE

This study used the 2018 Athens Marathon as the empirical setting to examine how interorganizational knowledge transfer was perceived among the multiple public health and safety professionals during the planning stage of the event.

METHODS

Data comprised 18 semi-structured, in-depth interviews with key informants, direct observations of meetings, and documentary analysis. Open coding and thematic analysis were used to analyze the data.

RESULTS

Findings indicated that sharing the acquired knowledge was a necessary and challenging step to create an enabling collaborative environment among interacting organizations. Experiential learning was identified as a significant factor, which helped promote joint understanding and partnership work. Informal interpersonal exchanges and formal knowledge transfer activities facilitated knowledge sharing across organizational boundaries, helping to break down silos.

CONCLUSION

Interorganizational knowledge transfer is a necessary step to achieve joint understanding and create an environment where interaction among agencies can be more effective. The study findings can be beneficial for organizers of marathons and other mass sporting events to support valuable interorganizational collaboration and conduct a safe event.

The Prevalence of Musculoskeletal Injuries Among Pilgrims During the 2023 Hajj Season: A Cross-Sectional Study

Background Hajj, the annual Islamic pilgrimage, brings together over two million pilgrims in the city of Makkah to participate in a series of rituals. Given the physically demanding nature of the Hajj, pilgrims are susceptible to musculoskeletal (MSK) injuries and exhaustion. MSK pain and injuries are frequent occurrences among pilgrims, necessitating an assessment of the scope of this issue. Therefore, the primary objective of this study was to determine the prevalence of MSK injuries among pilgrims during the 2023 Hajj season. Methods This is a cross-sectional questionnaire-based study that was conducted in the city of Makkah, Saudi Arabia, during the 2023 Hajj season. Results A total of 463 pilgrims were included in the analysis. The most frequently reported types of injuries were muscular injuries (169, 45.4%), primarily characterized by pain (99, 58.6%), muscle spasms (55, 32.5%), and muscle tears (eight, 4.7%). The second most commonly reported MSK injury was bony injuries (97, 26.1%), which included fractures, followed by 79 cases (21.2%) of joint injuries, predominantly featuring pain (69, 87.3%) and joint prolapse (10, 12.7%). Notably, 27 pilgrims (7.3%) suffered from ligament injuries, including tears. Regarding the mechanisms or causes of these MSK injuries, the most frequently reported factors were fatigue (206, 55.4%), falls (76, 20.4%), crowding (34, 9.1%), accidents (30, 8.1%), and the use of wheelchairs (14, 3.8%). Additionally, it is noteworthy that muscular injuries were more prevalent among all age groups, particularly among young-aged pilgrims, while joint injuries were more common among elderly pilgrims. Conclusion MSK injuries are prevalent among pilgrims, with muscular injuries being the most frequently encountered. This underscores a noteworthy public health concern that necessitates attention from the Ministry of Health of Saudi Arabia.

Imaging in international sporting event: experience from the Birmingham Commonwealth Games 2022

AIM

To explain the design and delivery of diagnostic imaging and image-guided intervention services for an international games. The authors share their experiences from the Birmingham Commonwealth Games 2022.

MATERIALS AND METHODS

A retrospective analysis was undertaken of anonymised data from the Zillion, Easyvision (RIS and PACS), and Encounter platforms for image viewing, interpretation and reporting during the Games. The data collected included age and gender, type of sport, nature of the injury, and imaging findings with diagnoses.

RESULTS

The number of individuals who had radiological investigations at the Birmingham Commonwealth Games was 518 and the vast majority of them were athletes (90 %). The average age of athletes who had imaging was 28 years and that of non-athletes who accessed imaging services was 46.4 years with male predominance. Magnetic resonance imaging was the most frequently used imaging technique and the lower limb was the most frequently imaged body part. Athletes playing netball and beach volleyball had the highest percentage of injuries.

CONCLUSION

The authors share their experience from the Birmingham Commonwealth Games 2022 regarding the nuances and challenges in radiology service provision for an international sports event that would be helpful for musculoskeletal radiologists in the design and delivery of similar international events in the future.

Gold Medals, Silver Medals, Bronze Medals, and Total Medals: An Analysis of Summer Paralympic Games from 1992 to 2016

The Paralympic Games (PG) are considered one of the biggest events in the world, with increasing coverage by media and participation. The present study aimed to investigate the variation in the number of gold, silver, bronze, and totals medals in the Summer PG from 1992 to 2016. Data related to the results were extracted from the International Paralympic Committee to an SPSS database. Descriptive statistics and Friedman’s two-way analysis of variance by ranks were used to check the differences across medals in seven editions of the Summer PG, with the correspondent effect sizes. There was a peak in the maximum number of any type of medal between the 1996 and 2000 Summer PG and a decrease until 2008. After that, the number of any kind of medals has been increasing again. There were also significant differences with intermediate to large effect sizes when comparing more distant PG with more recent events. Several external factors can influence performance indicators (e.g., the number of medals) in a negative or positive way. An increase in the number of participants and a greater and better investment by the countries may explain part of our results. The preparation of an athlete must be based on a multidisciplinary team, and future organizing countries must take into account reports of previous events.

Interorganizational Communication at Mass Gatherings: Professionals' Perceptions during the Planning and Implementation Stage of Marathon Events

INTRODUCTION

Mass gatherings (MGs) often bring together professionals and organizations that collaborate irregularly or have never engaged in joint working. They involve interaction and communication among multiple and diverse services, which can often prove challenging. Planning such an event is of paramount importance for its success, and interorganizational communication ranks among its most important aspects. Nonetheless, there is limited empirical evidence to support interagency communication in MGs.

OBJECTIVE

This study used the 2017 Athens Marathon (Athens, Greece) as the empirical setting to examine how interorganizational communication was perceived among the multiple public health and safety professionals during the planning and implementation phase of the event.

METHODS

Data comprised 15 semi-structured in-depth interviews with key informants, direct observations of meetings and the event itself, and documentary analysis. Open coding and thematic analysis were used to analyze the data.

RESULTS

Findings indicated three key components of interorganizational communication in such an event: (1) shared situational awareness; (2) interorganizational understanding; and (3) implementing liaison officers.

CONCLUSION

This study outlined the factors that influenced interorganizational communication before and during a MG. Practical implications arising from this study may inform the way organizers of marathons and other mass sporting events can engage in effective interorganizational communication.

Single‐center observation of direct impact of the Tokyo 2020 Games on ambulance emergency response

The burden of the 2020 Tokyo Olympic and Paralympic Games on the local emergency medical system was limited. In addition to the Games were held without spectators, this was due to advance preparation by various organizations and the efforts of local staff, including primary care physicians.

COVID-19 risk assessment at the opening ceremony of the Tokyo 2020 Olympic Games

The 2020 Olympic/Paralympic Games have been postponed to 2021, due to the COVID-19 pandemic. We developed a model that integrated source-environment-receptor pathways to evaluate how preventive efforts can reduce the infection risk among spectators at the opening ceremony of Tokyo Olympic Games. We simulated viral loads of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emitted from infectors through talking/coughing/sneezing and modeled temporal environmental behaviors, including virus inactivation and transfer. We performed Monte Carlo simulations to estimate the expected number of newly infected individuals with and without preventive measures, yielding the crude probability of a spectator being an infector among the 60,000 people expected to attend the opening ceremony. Two indicators, i.e., the expected number of newly infected individuals and the newly infected individuals per infector entry, were proposed to demonstrate the extent of achievable infection risk reduction levels by implementing possible preventive measures. A no-prevention scenario produced 1.5-1.7 newly infected individuals per infector entry, whereas a combination of cooperative preventive measures by organizers and the spectators achieved a 99% risk reduction, corresponding to 0.009-0.012 newly infected individuals per infector entry. The expected number of newly infected individuals was calculated as 0.005 for the combination of cooperative preventive scenarios with the crude probability of a spectator being an infector of 1 × 10^-5. Based on our estimates, a combination of cooperative preventions between organizers and spectators is required to prevent a viral spread at the Tokyo Olympic/Paralympic Games. Further, under the assumption that society accepts < 10 newly infected persons traced to events held during the entire Olympic/Paralympic Games, we propose a crude probability of infectors of < 5 × 10^-5 as a benchmark for the suppression of the infection. This is the first study to develop a model that can assess the infection risk among spectators due to exposure pathways at a mass gathering event.

Development of On-Site Medical System for Mass-Gathering Events During TOKYO 2020: Vulnerability Analysis Using Healthcare Failure Mode and Effect Analysis

At mass-gathering events of the Olympic and Paralympic Games, a well-organized, on-site medical system is essential. This study evaluated the vulnerabilities of the prehospital medical system of the TOKYO 2020 Olympic and Paralympic Games (TOKYO2020) to propose corrections that can be generalized to other mass gatherings. The healthcare failure mode and effect analysis (HFMEA) was adopted to analyze vulnerabilities of the on-site medical system proposed by the organizing committee of TOKYO2020. Processes from detecting a patient on the scene to completing transport to a hospital were analyzed. Ten processes with 47 sub-processes and 122 possible failure modes were identified. HFMEA revealed 9 failure modes as vulnerabilities: misidentification of patient, delayed immediate care at the scene, misjudgment of disposition from the on-site medical suite, and inappropriate care during transportation to hospital. Proposed corrections included surveillance to decrease blind spots, first aid brochures for spectators, and uniform protocol for health care providers at the scene. The on-site medical system amended by HFMEA seemed to work appropriately in TOKYO2020.

Public health risks threatening health of people participating in mass gatherings: A qualitative study

Background

Mass gatherings (MGs) have made many problems for the health system and potentially threaten the health of those participated in these gatherings. MGs account for a range of public health risks including communicable diseases, waterborne diseases, water treatment, and outbreaks.

Objectives

The present study aimed to identify public health risks threatening the health of people participating in MGs in Iran.

Methods

A qualitative study was designed using a conventional qualitative content analysis approach. Participants were selected using a purposive sampling method among the managers and staff who have experiences in the field of health in MGs in Iran. Subjects were interviewed through individual in-depth interviews after obtaining informed consent. Semi-structured interviews were used to collect the data from December 2018 to February 2019. To analyze the data, the content of recorded interviews was written verbatim. Preliminary data were repeatedly and simultaneously retrieved to give a general understanding of them.

Results

The main theme emerged from data analysis on 16 interviews was related to public health risks involving the following categories: food hygiene deficiencies, communicable diseases risks, defects in health supervision, and the risk of environmental contamination.

Conclusion

It is of paramount importance to identify the risks threatening the health of people participating in MGs. In the present study, the main public health risks were detected.

Environmental Influences on Patient Presentations: Considerations for Research and Evaluation at Mass-Gathering Events

Aim:

This paper discusses the need for consistency in mass-gathering research and evaluation from an environmental reporting perspective.

Background:

Mass gatherings occur frequently throughout the world. Having an understanding of the complexities of mass gatherings is important to inform health services about the possible required health resources. Factors within the environmental, psychosocial, and biomedical domains influence the usage of health services at mass gatherings. A minimum data set (MDS) has been proposed to standardize collection of biomedical data across various mass gatherings, and there is a need for an environmental component. The environmental domain includes factors such as the nature of the event, availability of drugs or alcohol, venue characteristics, and meteorological factors.

Method:

This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2018. Data were analyzed and categorized using the existing MDS as a framework.

Results:

In total, 39 manuscripts were identified that met the inclusion criteria.

Conclusion:

In collecting environmental data from mass gatherings, there must be an agreed-upon MDS. A set of variables can be used to collect de-identified environmental variables for the purpose of making comparisons across societies for mass-gathering events (MGEs).

Organizing Health Care Services for the 2017 "Athens Marathon, The Authentic:" Perspectives on Collaboration among Health and Safety Personnel in the Marathon Command Center

INTRODUCTION

Mass gatherings pose unique challenges for interorganizational collaboration. The "Athens Marathon, The Authentic" is a 42,195m (26.2mile) race with approximately 18,000 runners that increases annually. On the same day, additional races take place and a grand total of more than 50,000 runners fill the city center of Athens, Greece. Responding effectively to unexpected incidents requires comprehensive planning, clear decision-making structure, and effective collaboration. Nonetheless, there is limited empirical evidence to support interagency collaboration in mass gatherings.

PURPOSE

This study used the 2017 Athens Marathon and related races as the empirical setting to examine how interagency collaboration was perceived among the multiple public health and safety professionals involved in the marathon command center.

METHODS

Data comprised 10 semi-structured, in-depth interviews with key informants, direct observations of meetings and the event itself, and documentary analysis. Open coding and thematic analysis were used to analyze the data.

RESULTS

Findings indicated four key components of interagency collaboration in such an event: organizational culture, team synthesis, on-site spatial planning, and the usage of radio-amateurs.

CONCLUSION

This study outlined the factors that shaped interagency collaboration in the context of a mass event. Practical implications arising from this study may inform the ways organizers of marathons and other mass sporting events can engage in effective partnerships and joint working.

Health Care Provision During a Sporting Mass Gathering: A Structure and Process Description of On-Site Care Delivery

INTRODUCTION

Mass gatherings such as marathons are increasingly frequent. During mass gatherings, the provision of timely access to health care services is required for the mass-gathering population, as well as for the local community. However, the nature and impact of health care provision during sporting mass gatherings is not well-understood.

PURPOSE

The aim of this study was to describe the structures and processes developed for an emergency health team to operate an in-event, acute health care facility during one of the largest mass-sporting participation events in the southern hemisphere, the Gold Coast Marathon (Queensland, Australia).

METHODS

A pragmatic, qualitative methodology was used to describe the structures and processes required to operate an in-event, acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with emergency department (ED) clinical staff working during the two-day event was undertaken in 2016.

FINDINGS

Important structural elements of the in-event health care facility included: physical spaces, such as the clinical zones in the marathon health tent and surrounding area, and access and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms (ECGs) and intravenous fluids. Process elements of the in-event health care facility included clear communication pathways, as well as inter-professional care coordination and engagement involving shared knowledge of and access to resources, and distinct but overlapping clinical scope between nurses and doctors. This was seen to be critical for timely care provision and appropriate case management. Staff reported many perceived benefits and opportunities of in-event health care delivery, including ED avoidance and disaster training.

CONCLUSIONS

This in-event model of emergency care delivery, established in an out-of-hospital location, enabled the delivery of acute health care that could be clearly described and defined. Staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.JohnstonANB, WadhamJ, Polong-BrownJ, AitkenM, RanseJ, HuttonA, RichardsB, CrillyJ.Health care provision during a sporting mass gathering: a structure and process description of on-site care delivery. Prehosp Disaster Med. 2019;34(1):62-71.

Leading interagency planning and collaboration in mass gatherings: public health and safety in the 2012 London Olympics

OBJECTIVES

Planning and implementing public health initiatives in mass gatherings such as the Olympic Games pose unique challenges for interorganizational collaboration, which involves interaction among multiple and diverse agencies. Nonetheless, there is limited empirical evidence to support interagency collaboration and public health planning decisions in mass gatherings and how leadership can shape such interactions. We empirically explored these topics in the 2012 London Olympics to identify lessons to inform planning for future mass gatherings.

STUDY DESIGN

This is a qualitative case study.

METHODS

Data comprised 39 semistructured interviews with key informants conducted before, during, and after the games; in addition, direct observations of field exercises and documentary analysis were also used. Open coding and thematic analysis was used to analyze the data.

RESULTS

We identified two main leadership challenges that influenced interagency collaboration: organizational public health leadership and coordinating collaborative decision-making. Two facilitative conditions helped overcome the previous challenges: nurturing interorganizational linkages and creating shared understanding by activating codified frameworks at the organizational level.

CONCLUSIONS

Our study highlights leadership issues in interagency collaboration in mass gatherings. Practical implications arising from this study may inform the ways the organizers of mass gatherings, public health and safety agencies, and professionals can engage in effective partnerships and joint working.

Public health surveillance for the Toronto 2015 Pan/Parapan American Games

Background

Public health surveillance for previous Olympic and Paralympic Games have been described in the literature, but surveillance for regional, multisport events on a smaller scale have rarely been explored.

Objective

To describe the public health surveillance planning, implementation, results, and lessons learned from the 2015 Pan/Parapan American Games in Toronto, Ontario, Canada.

Intervention

Public health surveillance planning for the Games began two years in advance and involved local, provincial and federal partners, primarily focusing on infectious disease. From June to August, 2015, enhanced public health surveillance was conducted to support situational awareness and to facilitate the detection of infectious diseases and outbreaks, environmental health hazards and impacts and other major health events.

Outcomes

No major public health incidents occurred that were associated with or a result of hosting the Games. There were two cases of reportable infectious diseases associated with the Games, and 18 public health investigations involving Games-accredited individuals (six related to vaccine-preventable diseases and 12 related to gastrointestinal illnesses or food/water safety violations). Enhanced communication mechanisms, rather than routine and syndromic surveillance systems, were the primary sources of initial notification to surveillance partners on investigations.

Conclusion

Working with its partners, Ontario created a robust public health surveillance system for the 2015 Pan/Parapan American Games. Lessons learned, as well as the relationships and capacity developed through this experience, will be applied towards public health surveillance planning for future events.

Expected hazards and hospital beds in host cities of the 2014 FIFA World Cup in Brazil

Planning for mass gatherings involves health system preparedness based on an understanding of natural and technological hazards identified through prior risk assessment. We present the expected hazards reported by health administrators of the host cities for the 2014 FIFA World Cup in Brazil and discuss the hazards considering minimal available public hospital beds in the 12 cities at the time of the event. Four different groups of respondents were interviewed: pharmaceutical service administrators and overall health administrators at both the municipal and hospital levels. The hospital bed occupancy rate was calculated, based on the Brazilian Health Informatics Department (DATASUS). The number of surplus beds was calculated using parameters from the literature regarding surge and mass casualty needs and number of unoccupied beds. In all groups, physical injuries ranked first, followed by emerging and endemic diseases. Baseline occupancy rates were high (95%CI: 0.93-2.19) in all 12 cities. Total shortage, considering all the cities, ranged from -47,670 (for surges) to -60,569 beds (for mass casualties). The study can contribute to discussions on mass-gathering preparedness.

The Effect of Sporting Events on Medical Transport Time at a Level 1 Trauma Center: a Retrospective Cohort Study

OBJECTIVE

We investigate how West Virginia University football games affect transport to Ruby Memorial Hospital, which shares a parking lot with Milan Puskar Football Stadium.

METHODS

A retrospective chart review of a trauma registry from a level 1-trauma center was conducted from 2007 to 2011 for all home and away football games. Home games served as time period of interest and away games served as a control time period. Patient charts were collected for a 36-hour time window surrounding the game. 250 patient charts were complete for home games and 185 patient charts for away games. Data analyzed were time from scene to arrival at hospital, use of air transport, transport time in relation to kick-off, and comparison between demographic and emergency department disposition of patients arriving during home games vs. patients arriving during away games.

RESULTS

No statistically significant differences were found for demographic data or emergency department disposition between groups. For ground transport directly from scene, the average time to arrival at the hospital was 44.9 minutes for home games and 45.1 minutes for away games. For air transport directly from the scene, the average time to arrival at the hospital was 44.9 minutes for home games and 44.0 minutes for away games. For ground transfer from another facility, the average time to arrival at the hospital was 76.4 minutes for home games and 52.9 minutes for away games. For air transport from another facility, the average time to arrival at the hospital was 37.4 minutes for home games and 24.0 minutes for away games. Air transportation utilization was increased in inter-facility transfers during home games (5/16, 31.3% vs. 4/20, 22.2%), and helicopters traveled a further distance (avg. 66.6 vs. 50.25 air miles). For patients coming from the scene during a home game, if the start of the game occurred after the trauma but before arrival to the trauma center, the average time of ground transport increased from 44.9 minutes to 120 minutes (p<0.0001).

CONCLUSION

A mass gathering in close proximity to a rural trauma center does affect transport patterns and transport times for trauma patients. Further investigation is warranted in order to improve patient care during mass gathering events.

Emergency nurse disaster preparedness during mass gatherings: a cross-sectional survey of emergency nurses' perceptions in hospitals in Mecca, Saudi Arabia

OBJECTIVES

To assess hospital emergency nurses' self-reported knowledge, role awareness and skills in disaster response with respect to the Hajj mass gathering in Mecca.

DESIGN

Cross-sectional online survey with primary data collection and non-probabilistic purposive sample conducted in late 2014.

SETTING

All 4 public hospitals in Mecca, Saudi Arabia.

PARTICIPANTS

106 registered nurses in hospital emergency departments.

MAIN OUTCOME MEASURE

Awareness, knowledge, skills and perceptions of emergency nurses in Mecca with regard to mass gathering disaster preparedness.

RESULTS

Although emergency nurses' clinical role awareness in disaster response was reported to be high, nurses reported limited knowledge and awareness of the wider emergency and disaster preparedness plans, including key elements of their hospital strategies for managing a mass gathering disaster. Over half of the emergency nurses in Mecca's public hospitals had not thoroughly read the plan, and almost 1 in 10 were not even aware of its existence. Emergency nurses reported seeing their main role as providing timely general clinical assessment and care; however, fewer emergency nurses saw their role as providing surveillance, prevention, leadership or psychological care in a mass gathering disaster, despite all these broader roles being described in the hospitals' emergency disaster response plans. Emergency nurses' responses to topics where there are often misconceptions on appropriate disaster management indicated a significant knowledge deficit with only 1 in 3 nurses at best or 1 in 6 at worst giving correct answers. Respondents identified 3 key training initiatives as opportunities to further develop their professional skills in this area: (1) hospital education sessions, (2) the Emergency Management Saudi Course, (3) bespoke short courses in disaster management.

CONCLUSIONS

Recommendations are suggested to help enhance clinical and educational efforts in disaster preparedness.

Epidemiology of Sexually Transmitted Infections in Visitors for the London 2012 Olympic Games: A Review of Attendees at Sexual Health Services

BACKGROUND

Mass gatherings and large sporting events, such as the Olympics, may potentially pose a risk of increased sexually transmitted infection (STI) transmission and increase burden on local STI services. The objectives of this analysis were to assess whether the STI profile of Olympic visitors differed from that of the local STI clinic population and to investigate what impact these visitors had on local STI services.

METHODS

Self-administered questionnaires (completed by 29,292 patients) were used to determine the visitor status of patients attending 20 STI clinics, between July 20, 2012, and September 16, 2012, in the host cities, London and Weymouth. Using routine surveillance data from the Genitourinary Medicine Clinic Activity Dataset version 2, Olympic visitors were compared with usual attendees (local residents and non-Olympic visitors) in terms of their demographic characteristics, services utilized, and STIs diagnosed using univariate and multivariate methods.

RESULTS

Compared with usual attendees, Olympic visitors were more likely to be heterosexual males (56.0% vs. 34.9%, P = 0.001), aged between 15 and 24 years of age (47.1% vs. 34.0%, P = 0.001), of white ethnicity (81.9% vs. 66.4%, P = 0.001), and born in Australasia, Asia, North America, or South America (18.8% vs. 12.0%, P = 0.006). Olympic visitors constituted 1% of new clinic attendances and were less likely to be diagnosed as having a new STI (adjusted odds ratio, 0.69; 95% confidence interval, 0.48-0.98; P = 0.040).

CONCLUSIONS

In this first multisite study to examine the effect of Olympic visitors on local sexual health services, the 2012 Olympic Games was found to have minimal impact. This suggests that a "business as usual" approach would have been sufficient.

[Mass gatherings, [corrected] disasters and public health]

Brazil has hosted mass event (ME) and participants are exposed to health risks. The scope of this paper is to systematize the main relationships between ME and the occurrence of disasters of interest to Public Health. Three methodological strategies were used: systematic search and review of the literature on ME; systematization of the main information on ME; and selection and systematization of the references located for the theme of disaster in the search for key words, title or abstract. 28 references for ME were selected, mostly scientific papers, literature reviews, publications in 2012 and sports events. The main subjects addressed were surveillance systems and planning of ME. There was little analytical information about ME, as well as the importance of non-communicable events for the occurrence of disasters with emphasis on those related to crowds. It is important to consider the risk of disasters when planning ME to increase response time. Strategic areas such as medical emergencies, surveillance of communicable diseases and vectors, food and health service security, environmental health and laboratories should be considered. The importance of analytical research and registration of experience acquired in ME should be stressed for disaster risk reduction.

Smoke Rings: Towards a Comprehensive Tobacco Free Policy for the Olympic Games

BACKGROUND

The tobacco industry has long sought affiliation with major sporting events, including the Olympic Games, for marketing, advertising and promotion purposes. Since 1988, each Olympic Games has adopted a tobacco-free policy. Limited study of the effectiveness of the smoke-free policy has been undertaken to date, with none examining the tobacco industry's involvement with the Olympics or use of the Olympic brand.

METHODS AND FINDINGS

A comparison of the contents of Olympic tobacco-free policies from 1988 to 2014 was carried out by searching the websites of the IOC and host NOCs. The specific tobacco control measures adopted for each Games were compiled and compared with measures recommended by the WHO Tobacco Free Sports Initiative and Article 13 of the Framework Convention on Tobacco Control (FCTC). This was supported by semi-structured interviews of key informants involved with the adoption of tobacco-free policies for selected games. To understand the industry's interests in the Olympics, the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) was systematically searched between June 2013 and August 2014. Company websites, secondary sources and media reports were also searched to triangulate the above data sources. This paper finds that, while most direct associations between tobacco and the Olympics have been prohibited since 1988, a variety of indirect associations undermine the Olympic tobacco-free policy. This is due to variation in the scope of tobacco-free policies, limited jurisdiction and continued efforts by the industry to be associated with Olympic ideals.

CONCLUSIONS

The paper concludes that, compatible with the IOC's commitment to promoting healthy lifestyles, a comprehensive tobacco-free policy with standardized and binding measures should be adopted by the International Olympic Committee and all national Olympic committees.

Medical planning for very large events: Special Olympics World Games Los Angeles 2015

Mass gathering events that involve special populations have challenges that require unique medical planning. The key to a successful mass event is in the preparation, planning, and communication. Concerns in communication such as language barriers, age of participants, and intellectual disability should be addressed early in the planning. In the event of a mass casualty disaster, there should be a clear chain of command and escalation policy. The primary concern of the sports medicine team is to ensure safety for the participation of an athlete. The risk of injury to an athlete varies depending on the event and venue. The sporting venue may require special consideration for access to athletes, crowd control, and ingress/egress of medical personnel and transports. In order to ensure safety and efficient care, it is paramount to have the necessary medical planning and preparedness to manage a large-scale sporting event.

Medical care delivery at the Beijing 2008 Olympic Games

BACKGROUND

Beijing successfully hosted the 2008 Olympic Games, and the services including medical services were widely appreciated by both participants and visitors. We retrospectively analyzed the quality of the medical services provided to athletes, spectators, VIPs, and the workforce during the Beijing 2008 Olympic Games. The information thus gathered would be useful for planning strategies for managing mass gatherings.

METHODS

Medical encounter forms filled during the Beijing 2008 Olympic Games were retrospectively reviewed. Descriptive statistics was used to characterize the data by accreditation and diagnostic categories.

RESULTS

A total of 22 892 medical encounters were documented during the Beijing 2008 Olympic Games. Among them, 10 549 (46.08%) involved the workforce, 3 365 (14.70%) athletes, 3 019 (13.19%) spectators, 585 (2.56%) members of the media, 1 065 (4.65%) VIPs, and 4 309 (18.82%) others. Of the 22 892 cases, physical injury accounted for 27.90% (6 386), respiratory disease 18.21% (4 169), and heat-related illnesses 2.68% (615).

CONCLUSIONS

Preparations of the medical service for the Beijing 2008 Olympic Games were made for 7 years, and the service provided has been praised worldwide. This study provides valuable information that may be useful for planning medical services for upcoming Olympic Games, including the London 2012 Olympic Games and other mass gatherings.

Evaluating sexual health planning for the London 2012 Olympics

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.

London 2012 Olympic and Paralympic Games: public health surveillance and epidemiology

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.

Euro 2012 European Football Championship Finals: planning for a health legacy

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.

Impact of the London 2012 Olympic and Paralympic Games on demand for microbiology gastrointestinal diagnostic services at the Public Health Laboratory London

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.

Healthcare planning for the Olympics in London: a qualitative evaluation

BACKGROUND

Mass gatherings, such as the Olympic and Paralympic Games, represent an enormous logistical challenge for the host city. Health service planners must deliver routine and emergency services and, in recent Games, health legacy initiatives, for the local and visiting population. However there is little evidence to support their planning decisions. We therefore evaluated the strategic health planning programme for the London 2012 Olympic and Paralympic Games to identify generalisable information for future Games.

METHODS

We thematically analysed data from stakeholder interviews and documents. The data were prospectively collected in three phases, before, during and after the Games.

FINDINGS

We identified five key themes: (1) Systemic Improvement for example in communications, (2) Effective relationships led to efficiencies and permanent gains, such as new relationships with the private sector (3) Difficult relationships led to inefficiencies, for instance, duplication in testing and exercising emergency scenarios, (4) Tendency to over-estimate demand for care, particularly emergency medicine, and (5) Difficulties establishing a health legacy due to its deprioritisation and lack of vision by the programme team.

INTERPRETATION

Enduring improvements which are sustained after the Games are possible, such as the establishment of new and productive partnerships. Relationships must be established early on to avoid duplication, delay and unnecessary expense. There should be greater critical evaluation of the likely demand for health services to reduce the wasting of resources. Finally, if a health legacy is planned, then clear definitions and commitment to its measurement is essential.

Prevention and surveillance of public health risks during extended mass gatherings in rural areas: the experience of the Tamworth Country Music Festival, Australia

OBJECTIVE

To describe and evaluate the public health response to the Tamworth Country Music Festival, an annual extended mass gathering in rural New South Wales, Australia; and to propose a framework for responding to similar rural mass gatherings.

STUDY DESIGN

Process evaluation by direct observation, archival analysis and focus group discussion.

METHODS

The various components of the public health response to the 2011 Tamworth Country Music Festival were actively recorded. An archival review of documentation from 2007 to 2010 was performed to provide context. A focus group was also conducted to discuss the evolution of the public health response and the consequences of public health involvement.

RESULTS

Public health risks increased with increasing duration of the rural mass gathering. Major events held within the rural mass gathering further strained resources. The prevention, preparedness, response and recovery principles provided a useful framework for public health actions. Particular risks included inadequately trained food preparation volunteers functioning in poorly equipped temporary facilities, heat-related ailments and arboviral disease.

CONCLUSION

Extended mass gatherings in rural areas pose particular public health challenges; surge capacity is limited and local infrastructure may be overwhelmed in the event of an acute incident or outbreak. There is value in proactive public health surveillance and monitoring. Annual mass gatherings provide opportunities for continual systems improvement. Early multi-agency planning can identify key risks and identify opportunities for partnership. Special consideration is required for major events within mass gatherings.

Triage During Mass Gatherings

Triage is a complex process and is one means for determining which patients most need access to limited resources. Triage has been studied extensively, particularly in relation to triage in overcrowded emergency departments, where individuals presenting for treatment often are competing for the available stretchers. Research also has been done in relation to the use of prehospital and field triage during mass-casualty incidents and disasters.

In contrast, scant research has been done to develop and test an effective triage approach for use in mass-gathering and mass-participation events, although there is a growing body of knowledge regarding the health needs of persons attending large events. Existing triage and acuity scoring systems are suboptimal for this unique population, as these events can involve high patient presentation rates (PPR) and, occasionally, critically ill patients. Mass-gathering events are dangerous; a higher incidence of injury occurs than would be expected from general population statistics.

The need for an effective triage and acuity scoring system for use during mass gatherings is clear, as these events not only create multiple patient encounters, but also have the potential to become mass-casualty incidents. Furthermore, triage during a large-scale disaster or mass-casualty incident requires that multiple, local agencies work together, necessitating a common language for triage and acuity scoring.

In reviewing existing literature with regard to triage systems that might be employed for this population, it is noted that existing systems are biased toward traumatic injuries, usually ignoring mitigating factors such as alcohol and drug use and environmental exposures. Moreover, there is a substantial amount of over-triage that occurs with existing prehospital triage systems, which may lead to misallocation of limited resources. This manuscript presents a review of the available literature and proposes a triage system for use during mass gatherings that also may be used in the setting of mass-casualty incidents or disaster responses.

TurrisSA, LundA. Triage during mass gatherings. Prehosp Disaster Med. 2012;27(6):1-5.

Nighttime assaults: using a national emergency department monitoring system to predict occurrence, target prevention and plan services

BACKGROUND

Emergency department (ED) data have the potential to provide critical intelligence on when violence is most likely to occur and the characteristics of those who suffer the greatest health impacts. We use a national experimental ED monitoring system to examine how it could target violence prevention interventions towards at risk communities and optimise acute responses to calendar, holiday and other celebration-related changes in nighttime assaults.

METHODS

A cross-sectional examination of nighttime assault presentations (6.01 pm to 6.00 am; n = 330,172) over a three-year period (31st March 2008 to 30th March 2011) to English EDs analysing changes by weekday, month, holidays, major sporting events, and demographics of those presenting.

RESULTS

Males are at greater risk of assault presentation (adjusted odds ratio [AOR] 3.14, 95% confidence intervals [CIs] 3.11-3.16; P < 0.001); with male:female ratios increasing on more violent nights. Risks peak at age 18 years. Deprived individuals have greater risks of presenting across all ages (AOR 3.87, 95% CIs 3.82-3.92; P < 0.001). Proportions of assaults from deprived communities increase midweek. Female presentations in affluent areas peak aged 20 years. By age 13, females from deprived communities exceed this peak. Presentations peak on Friday and Saturday nights and the eves of public holidays; the largest peak is on New Year's Eve. Assaults increase over summer with a nadir in January. Impacts of annual celebrations without holidays vary. Some (Halloween, Guy Fawkes and St Patrick's nights) see increased assaults while others (St George's and Valentine's Day nights) do not. Home nation World Cup football matches are associated with nearly a three times increase in midweek assault presentation. Other football and rugby events examined show no impact. The 2008 Olympics saw assaults fall. The overall calendar model strongly predicts observed presentations (R2 = 0.918; P < 0.001).

CONCLUSIONS

To date, the role of ED data has focused on helping target nightlife police activity. Its utility is much greater; capable of targeting and evaluating multi-agency life course approaches to violence prevention and optimising frontline resources. National ED data are critical for fully engaging health services in the prevention of violence.

Differences in Medical Care Usage between Two Mass-Gathering Sporting Events

Background

Event planning for mass gatherings involves the utilization of methods that prospectively can predict medical resource use. However, there is growing recognition that historical data for a specific event can help to accurately forecast medical requirements. This study was designed to investigate the differences in medical usage rates between two popular mass-gathering sports events in the UK: rugby matches and horse races.

Methods

A retrospective study of all attendee consultations with the on-site medical teams at the Leicester Tigers Rugby Football Club and the Leicester Racecourse from September 2008 through August 2009 was undertaken. Patient demographics, medical usage rates, level of care, as well as professional input and the effects of alcohol use were recorded.

Results

Medical usage rates were higher at the Leicester Racecourse (P < .01), although the demographics of the patients were similar and included 24% children and 16% staff. There was no difference in level of care required between the two venues with the majority of cases being minor, although a higher proportion of casualties at the Leicester Tigers event were seen by a health care professional compared with the Leicester Racecourse (P < .001). Alcohol was a contributing factor in only 5% of consultations.

Conclusions

These two major sporting venues had similar attendance requirements for medical treatment that are comparable to other mass-gathering sports events. High levels of staff and pediatric presentations may have an impact on human resource planning for events on a larger scale, and the separation of treatment areas may help to minimize the number of unnecessary or opportunistic reviews by the on-site health care professionals.

BurtonJO, CorrySJ, LewisG, PriestmanWS. Differences in medical care usage between two mass-gathering sporting events. Prehosp Disaster Med.2012;27(4):1-5.

The FIFA Women's World Cup in Germany 2011--a practical example for tailoring an event-specific enhanced infectious disease surveillance system

BACKGROUND

Mass gatherings require a decision from public health authorities on how to monitor infectious diseases during the event. The appropriate level of enhanced surveillance depends on parameters like the scale of the event (duration, spatial distribution, season), participants' origin, amount of public attention, and baseline disease activity in the host country. For the FIFA Men's World Cup 2006, Germany implemented enhanced surveillance. As the scale of the FIFA Women's World Cup (June 26 - July 17, 2011) was estimated to be substantially smaller in size, visitors and duration, it was not feasible to simply adopt the previously implemented measures. Our aim was therefore to develop a strategy to tailor an event-specific enhanced surveillance for this smaller-scale mass gathering.

METHODS

Based on the enhanced surveillance measures during the Men's Cup, we conducted a needs assessment with the district health authorities in the 9 host cities in March 2011. Specific measures with a majority consent were implemented. After the event, we surveyed the 9 district and their corresponding 7 state health authorities to evaluate the implemented measures.

RESULTS

All 9 district health authorities participated in the pre-event needs assessment. The majority of sites consented to moving from weekly to daily (Monday-Friday) notification reporting of routine infectious diseases, receiving regular feedback on those notification reports and summaries of national/international World Cup-relevant epidemiological incidents, e.g. outbreaks in countries of participating teams. In addition, we decided to implement twice-weekly reports of "unusual events" at district and state level. This enhanced system would commence on the first day and continue to one day following the tournament. No World Cup-related infectious disease outbreaks were reported during this time period. Eight of 9 district and 6 of 8 state health authorities participated in the final evaluation. The majority perceived the implemented measures as adequate.

CONCLUSIONS

Our approach to tailor an event-specific enhanced surveillance concept worked well. Involvement of the participating stakeholders early-on in the planning phase secured ownership of and guaranteed support for the chosen strategy. The enhanced surveillance for this event resulted as a low-level surveillance. However, we included mechanisms for rapid upscaling if the situation would require adaptations.

Paralympic medicine

Paralympic medicine describes the health-care issues of those 4500 or so athletes who gather every 4 years to compete in 20 sports at the Summer Paralympic Games and in five sports at the Winter Paralympic Games. Paralympic athletes compete within six impairment groups: amputation or limb deficiencies, cerebral palsy, spinal cord-related disability, visual impairment, intellectual impairment, or a range of physically impairing disorders that do not fall into the other classification categories, known as les autres. The variety of impairments, many of which are severe, fluctuating, or progressive disorders (and are sometimes rare), makes maintenance of health in thousands of Paralympians while they undertake elite competition an unusual demand on health-care resources. The increased physical fitness of athletes with disabilities has important implications for cardiovascular risk reduction in a population for whom the prevalence of risk factors can be high.

Estimation of Healthcare Resources at Sporting Events

Background:

The consequences of a major incident at a sporting event could be catastrophic. Therefore, there should be an estimation of the healthcare resources at such events as part of the planning. Although there are National guidelines (e.g., Planning Safe Public Events: Practical Guidelines in Australia) defining the role of the healthcare system at sporting events, these guidelines either lack a simple calculating method to estimate the need for healthcare resources or the methods are complex and impractical to use. The objective of this study was to find a safe and easy method for the estimation of healthcare resources at sporting events.

Methods:

A model for the estimation of healthcare resources at music events recently has been approved in Sweden. After minor adjustments, this model was used at sport events by a number of planning officers. The models' accuracy and usability was evaluated by analyzing its outcome in a pilot and a controlled study using different sporting and non-sporting scenarios.

Results:

The pilot study showed that the model was valid and easily could be used for various sporting events. The obtained estimations were consistent with the methods used by experienced planning officers in 97% of cases. The results of the controlled study showed that by using this model, the minimum amount of resources required easily could be calculated at sporting events and by people with different backgrounds.

Conclusions:

This model safely can be used at sporting events.

Non-communicable health risks during mass gatherings

Mass gatherings (MGs) have been associated with high rates of morbidity and mortality from non-communicable diseases, accidents, and terrorist attacks, thus posing complex public health challenges. We assessed the health risks and public health responses to MGs to identify an evidence-based framework for public health interventions. Human stampedes and heat-related illnesses are the leading causes of mortality. Minor traumatic injuries and medical complaints are the main contributors to morbidity and, particularly, the need for on-site medical care. Infrastructure, crowd density and mood, weather, age, and sex determine the risks to health. Many predictive models for deployment of medical resources are proposed, but none have been validated. We identified the risks for mortality and morbidity during MGs, most efficient public health interventions, and need for robust research into health risks for non-communicable diseases during MGs.

Medical Support for the 2009 World Police and Fire Games: A Descriptive Analysis of a Large-Scale Participation Event and its Impact

Introduction: In the summer of 2009, British Columbia hosted the World Police and Fire Games (WPFG). The event brought together 10,599 athletes from 55 countries. In this descriptive, Canadian study, the composition of the medical team is analyzed, the unique challenges faced are discussed, and an analysis of the illness and injury rates is presented. This event occurred during a labor dispute affecting the sole provider of emergency ambulance service in the jurisdiction, which necessitated additional planning and resource allocation. As such, the context of this event as it relates to the literature on mass gathering medicine is discussed with a focus on how large-scale public events can impact emergency services for the community.

Methods: This is a case report study.

Results: There were 1,462 patient encounters. The majority involved musculo-skeletal injuries (53.8%). The patient presentation rate (PPR) was 109.40/1,000. The medical transfer rate (MTR) was 2.32/1,000. The ambulance transfer rate (ATR) for the 2009 WPFG was 0.52/1,000. In total, 31 patients were transported to the hospital, the majority for diagnostic evaluation. Only seven calls were placed to 9-1-1 for emergency ambulance service.

Conclusions: The 2009 WPFG was a mass-gathering sporting event that presented specific challenges in relation to medical support. Despite relatively high patient presentation rates, the widely spread geography of the event, and a reduced ability to depend on 9-1-1 emergency medical services, there was minimal impact on local emergency services. Adequate planning and preparation is crucial for events that have the potential to degrade existing public resources and access to emergency health services for participants and the public at large.

Influenza outbreaks during World Youth Day 2008 mass gathering

Influenza outbreaks during mass gatherings have been rarely described, and detailed virologic assessment is lacking. An influenza outbreak occurred during World Youth Day in Sydney, Australia, July 2008 (WYD2008). We assessed epidemiologic data and respiratory samples collected from attendees who sought treatment for influenza-like illness at emergency clinics in Sydney during this outbreak. Isolated influenza viruses were compared with seasonal influenza viruses from the 2008 influenza season. From 100 infected attendees, numerous strains were identified: oseltamivir-resistant influenza A (H1N1) viruses, oseltamivir-sensitive influenza A (H1N1) viruses, influenza A (H3N2) viruses, and strains from both influenza B lineages (B/Florida/4/2006-like and B/Malaysia/2506/2004-like). Novel viruses were introduced, and pre-WYD2008 seasonal viruses were amplified. Viruses isolated at mass gatherings can have substantial, complex, and unpredictable effects on community influenza activity. Greater flexibility by public health authorities and hospitals is required to appropriately manage and contain these outbreaks.