Travelling to China for the Beijing 2008 Olympic and Paralympic Games

Risks, Epidemics, and Prevention Measures of Infectious Diseases in Major Sports Events: Scoping Review

BACKGROUND

Major sports events are the focus of the world. However, the gathering of crowds during these events creates huge risks of infectious diseases transmission, posing a significant public health threat.

OBJECTIVE

The aim of this study was to systematically review the epidemiological characteristics and prevention measures of infectious diseases at major sports events.

METHODS

The procedure of this scoping review followed Arksey and O'Malley's five-step methodological framework. Electronic databases, including PubMed, Web of Science, Scopus, and Embase, were searched systematically. The general information (ie, publication year, study type) of each study, sports events' features (ie, date and host location), infectious diseases' epidemiological characteristics (ie, epidemics, risk factors), prevention measures, and surveillance paradigm were extracted, categorized, and summarized.

RESULTS

A total of 24,460 articles were retrieved from the databases and 358 studies were included in the final data synthesis based on selection criteria. A rapid growth of studies was found over recent years. The number of studies investigating epidemics and risk factors for sports events increased from 16/254 (6.3%) before 2000 to 201/254 (79.1%) after 2010. Studies focusing on prevention measures of infectious diseases accounted for 85.0% (238/280) of the articles published after 2010. A variety of infectious diseases have been reported, including respiratory tract infection, gastrointestinal infection, vector-borne infection, blood-borne infection, and water-contact infection. Among them, respiratory tract infections were the most concerning diseases (250/358, 69.8%). Besides some routine prevention measures targeted at risk factors of different diseases, strengthening surveillance was highlighted in the literature. The surveillance system appeared to have gone through three stages of development, including manual archiving, network-based systems, and automated intelligent platforms.

CONCLUSIONS

This critical summary and collation of previous empirical evidence is meaningful to provide references for holding major sports events. It is essential to improve the surveillance techniques for timely detection of the emergence of epidemics and to improve risk perception in future practice.

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.

Meningococcal disease burden and transmission in crowded settings and mass gatherings other than Hajj/Umrah: A systematic review

BACKGROUND

Mass gatherings (MGs) such as the Hajj and Umrah pilgrimages are known to amplify the risk of invasive meningococcal disease (IMD) due to enhanced transmission of the organism between attendees. The burden of IMD at MGs other than Hajj and Umrah has not previously been quantified through a systematic review.

METHODS

A systematic search for relevant articles in PubMed and Embase was conducted using MeSH terms; this was buttressed by hand searching. Following data abstraction, a narrative synthesis was conducted to quantify the burden of IMD at MGs and identify potential risk factors and mitigation measures.

RESULTS

Thirteen studies reporting occurrence of IMD at MGs or similar crowded settings were identified. Eight studies reported cases or outbreaks in MGs of ≥1000 people; five others reported IMD in other crowded settings; all occurred between 1991 and 2015. All age groups were involved in the identified studies; however the majority of cases (∼80%) were young people aged 15-24 years. The number of affected people ranged from one to 321 cases and the overall crude estimate of incidence was calculated as 66 per 100,000 individuals. Serogroups A, C, B and W were identified, with serogroups A and C being most common. Of 450 cases of IMD reported in non-Hajj/Umrah MGs, 67 (14.9%) had fatal outcomes.

CONCLUSION

IMD outbreaks at non-Hajj/Umrah MGs are generally much smaller than Hajj-related outbreaks and affect mainly young people. Health education and vaccination should be considered for attendees of high risk non-Hajj/Umrah MGs, especially those involving adolescents and young adults.

Health risks and precautions for visitors to the Tokyo 2020 Olympic and Paralympic Games

BACKGROUND

In 2020, Japan will host the Tokyo Olympic and Paralympic Games in 2020 (Tokyo 2020) which will involve a large population influx from various countries to Tokyo, the most populated city in Japan. We summarize the potential health risks for visitors to Tokyo 2020, related to communicable disease risks and other health threats, based on recent national and local surveillance reports.

METHODS

We reviewed up-to-date surveillance reports published by the National Institute of Infectious Diseases and Tokyo Metropolitan Infectious Disease Surveillance Center.

RESULTS

Communicable disease risks for vaccine-preventable illnesses such as measles and rubella, as well as food and waterborne diseases represent the most likely risks. The risk of acquiring vector-borne diseases is considered low in Japan. On the other hand, however, heat-related illness represents a potential risk, as Tokyo 2020 is scheduled during the hottest season in Japan, with temperatures generally expected to exceed 30 °C.

CONCLUSION

Maintaining an up-to-date routine vaccination schedule is highly recommended for visitors attending the Tokyo 2020 and appropriate hygiene measures for food and waterborne diseases as well as health promotion for heat-related illness. It may also be useful to increase the number of multilingual triage clinicians whom can be placed within emergency departments during the Tokyo 2020 to provide first contact services and coordination of emergency care among non-Japanese speaking visitors to Tokyo.

Burden of vaccine preventable diseases at large events

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.

Sex work during the 2010 FIFA World Cup: results from a three-wave cross-sectional survey

BACKGROUND

In the months leading up to the 2010 FIFA World Cup in South Africa, international media postulated that at least 40,000 foreign sex workers would enter South Africa, and that an increased HIV incidence would follow. To strengthen the evidence base of future HIV prevention and sexual health programmes during international sporting events, we monitored the supply and demand of female sex work in the weeks before, during and after the 2010 FIFA World Cup.

METHODOLOGY/PRINCIPAL FINDINGS

We conducted three telephonic surveys of female sex workers advertising online and in local newspapers, in the last week of May, June and July 2010. The overall response rate was 73.4% (718/978). The number of sex workers advertising online was 5.9% higher during the World Cup than before. The client turnover rate did not change significantly during (adjusted rate ratio [aRR] = 1.05; 95%CI: 0.90-1.23) or after (aRR = 1.06; 95%CI: 0.91-1.24) the World Cup. The fraction of non-South African sex workers declined during (adjusted odds ratio [aOR] = 0.50; 95%CI: 0.32-0.79) and after (aOR = 0.56; 95%CI: 0.37-0.86) the World Cup. Relatively more clients were foreign during the World Cup among sex workers advertising in the newspapers (aOR = 2.74; 95%CI: 1.37-5.48) but not among those advertising online (aOR = 1.06; 95%CI: 0.60-1.90). Self-reported condom use was high (99.0%) at baseline, and did not change during (aOR = 1.07; 95% CI: 0.16-7.30) or after (aOR = 1.13; 95% CI: 0.16-8.10) the Word Cup.

CONCLUSIONS/SIGNIFICANCE

Our findings do not provide evidence for mass-immigration of foreign sex workers advertising online and in local newspapers, nor a spike in sex work or risk of HIV transmission in this subpopulation of sex workers during the World Cup. Public health programmes focusing on sex work and HIV prevention during international sporting events should be based on evidence, not media-driven sensationalism that further heightens discrimination against sex workers and increases their vulnerability.

International travel and the elite athlete

International travel is a frequent occurrence in the life of the elite athlete; such travel can pose challenges to the sport medicine practitioner. Travel is also the reality of many recreational level or sub-elite athletes as opportunities for international competition and training proliferate. An appreciation of the range of responsibilities associated with the preparation for and the strategies to facilitate such travel is essential for any physician charged with the care of athletes and teams. An appreciation of (1) the medical and public health challenges associated with competition in a particular setting; (2) the requirements for vaccination and immunization; (3) the strategies for the management of jet lag and climatic or environmental extremes; (4) the range of supplies and equipment necessary for travel to certain locales; (5) the need to ensure the availability of ample familiar and nutritious foods; (6) the potential need for specialty care in strange settings; (7) the management of common travel-associated illness; and (8) the challenges associated with the evacuation of an injured athlete are fundamental to the successful management of international travel involving athletes and teams. The adoption of a methodical approach to pre-trip planning can ensure an enhanced travel experience, illness-free training and competition, and facilitate optimal performance.

The role of the traveler in emerging infections and magnitude of travel

Travel and trade have grown immensely. Travelers interact with people and microbes during their journeys, and can introduce infectious agents to new areas and populations. Studying illnesses in travelers is a source of knowledge into diseases of resource-poor regions and the control of these diseases. Travel-associated illnesses also serve to detect emerging infections.