Event-Based Surveillance During EXPO Milan 2015: Rationale, Tools, Procedures, and Initial Results

Winning during a pandemic: epidemiology of SARS-CoV-2 during EURO2020 in Italy

Introduction

EURO2020 generated a growing media and population interest across the month period, that peaked with large spontaneous celebrations across the country upon winning the tournament.

Methods

We retrospectively analysed data from the national surveillance system (indicator-based) and from event-based surveillance to assess how the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) changed in June–July 2021 and to describe cases and clusters linked with EURO2020.

Results

Widespread increases in transmission and case numbers, mainly among younger males, were documented in Italy, none were linked with stadium attendance. Vaccination coverage against SARS-CoV-2 was longer among cases linked to EURO2020 than among the general population.

Conclusions

Transmission increased across the country, mainly due to gatherings outside the stadium, where, conversely, strict infection control measures were enforced. These informal ‘side’ gatherings were dispersed across the entire country and difficult to control. Targeted communication and control strategies to limit the impact of informal gatherings occurring outside official sites of mass gathering events should be further developed.

COVID-19 response: effectiveness of weekly rapid risk assessments, Italy

Problem

After Italy’s first national restriction measures in 2020, a robust approach was needed to monitor the emerging epidemic of coronavirus disease 2019 (COVID-19) at subnational level and provide data to inform the strengthening or easing of epidemic control measures.

Approach

We adapted the European Centre for Disease Prevention and Control rapid risk assessment tool by including quantitative and qualitative indicators from existing national surveillance systems. We defined COVID-19 risk as a combination of the probability of uncontrolled transmission of severe acute respiratory syndrome coronavirus 2 and of an unsustainable impact of COVID-19 cases on hospital services, adjusted in relation to the health system’s resilience. The monitoring system was implemented with no additional cost in May 2020.

Local setting

The infectious diseases surveillance system in Italy uses consistent data collection methods across the country’s decentralized regions and autonomous provinces.

Relevant changes

Weekly risk assessments using this approach were sustainable in monitoring the epidemic at regional level from 4 May 2020 to 24 September 2021. The tool provided reliable assessments of when and where a rapid increase in demand for health-care services would occur if control or mitigation measures were not increased in the following 3 weeks.

Lessons learnt

Although the system worked well, framing the risk assessment tool in a legal decree hampered its flexibility, as indicators could not be changed without changing the law. The relative complexity of the tool, the impossibility of real-time validation and its use for the definition of restrictions posed communication challenges.

Emergency Management in Resolving an Emergency Situation

Experience gained from NATO operations shows that the basis for an effective solution to a crisis is a combination of a comprehensive political, civilian and military approach. The cooperation of all stakeholders is thus a basic prerequisite for the effective resolution of crisis situations. These aspects and stakeholders include emergency management. This paper deals with civil-military cooperation in times of emergency caused by the COVID-19 pandemic in the Czech Republic. It qualitatively evaluates the findings resulting from the questionnaire survey focused on the state of crisis preparedness of the Army of the Czech Republic and the functionality of emergency management in cooperation with rescue work with other teams of the rescue system. The questionnaire was carried out at military units in all regions of the Czech Republic; organizational units of the Ministry of Defence with nationwide competence, which were directly involved in securing measures related to the declaration of a state of emergency due to the COVID-19 pandemic in March—May, 2020; Operations Command, which currently manages operations in the Czech Republic designed to manage the consequences of a pandemic; and members of the Ministry of Defence participating in the activities of the Strategic Command and Control Group. A total of 21 stakeholders took part. The experience in managing the consequences of the COVID-19 pandemic have shown that armed forces around the world have an irreplaceable position in dealing with nonmilitary crises. The conclusions and recommendations obtained from the research survey are the content of this paper.

Public Health Threats in Mass Gatherings: A Systematic Review

Mass gatherings (MGs) are held throughout the world. The aim of this review was to assess and identify the health threats based on the type of the MG, type of diseases, and injuries. Research platforms such as Web of Science, Medline, and Scopus were searched through June 2017. All epidemiologic studies that investigated the health threats during the MGs, such as communicable diseases, injuries, high-risk behaviors, and environmental health problems, were included in this review. Out of 1264 references, 45 articles were included in the review.Three main types of MGs include religious, festival, and sporting event; and fairs such as trade, book, and agricultural types were also reported in the selected studies. In the religious MGs, infectious diseases were the most common health threat. Road traffic accidents and environmental health problems were additional health threats. At MG sporting events, injuries were the most common health problems. Infectious diseases and alcohol and drug-related disorders were other reported public health concerns. In the festival MGs, alcohol and drug-related problems were commonly reported. This review showed that health threats vary, based on the type of mass gathering. The health organizers of MGs should consider the type of the MG and the health needs and safety of the participants to help them plan their action and provide the needed health care services.

Utility and potential of rapid epidemic intelligence from internet-based sources

OBJECTIVES

Rapid epidemic detection is an important objective of surveillance to enable timely intervention, but traditional validated surveillance data may not be available in the required timeframe for acute epidemic control. Increasing volumes of data on the Internet have prompted interest in methods that could use unstructured sources to enhance traditional disease surveillance and gain rapid epidemic intelligence. We aimed to summarise Internet-based methods that use freely-accessible, unstructured data for epidemic surveillance and explore their timeliness and accuracy outcomes.

METHODS

Steps outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist were used to guide a systematic review of research related to the use of informal or unstructured data by Internet-based intelligence methods for surveillance.

RESULTS

We identified 84 articles published between 2006-2016 relating to Internet-based public health surveillance methods. Studies used search queries, social media posts and approaches derived from existing Internet-based systems for early epidemic alerts and real-time monitoring. Most studies noted improved timeliness compared to official reporting, such as in the 2014 Ebola epidemic where epidemic alerts were generated first from ProMED-mail. Internet-based methods showed variable correlation strength with official datasets, with some methods showing reasonable accuracy.

CONCLUSION

The proliferation of publicly available information on the Internet provided a new avenue for epidemic intelligence. Methodologies have been developed to collect Internet data and some systems are already used to enhance the timeliness of traditional surveillance systems. To improve the utility of Internet-based systems, the key attributes of timeliness and data accuracy should be included in future evaluations of surveillance systems.