1
|
Aggrawal V, Dikid T, Jain SK, Pandey A, Khasnobis P, Choudhary S, Chandra R, Patil A, Maramraj KK, Talyan A, Singh A, Babu BS, Kumar A, Kumar D, Raveesh PM, Singh J, Kumar R, Qadri SS, Madan P, Vardan V, Dzeyie KA, Gupta G, Mishra A, Vaisakh TP, Patel P, Jainul A, Kaur S, Shrivastava A, Dhuria M, Chauhan R, Singh SK. Disease surveillance during a large religious mass gathering in India: The Prayagraj Kumbh 2019 experience. Int J Infect Dis 2020; 101:167-173. [PMID: 32979588 PMCID: PMC7513824 DOI: 10.1016/j.ijid.2020.09.1424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/02/2022] Open
Abstract
At Kumbh Mela 2019, disease surveillance was established for 22 acute diseases and syndromes. Among the reported illnesses, 95% were communicable diseases such as acute respiratory illness (35%), acute fever (28%), and skin infections (18%). The incident command centre generated 12 early warning signals from indicator-based and event-based surveillance: acute diarrheal diseases (n = 8, 66%), vector-borne diseases (n = 2, 16%), vaccine-preventable disease (n = 1, 8%), and thermal event (n = 1, 8%). There were two outbreaks (acute gastroenteritis and chickenpox) that were investigated and controlled. Implementation of disease surveillance facilitated early outbreak detection and response.
Background Mass gathering (MG) events are associated with public health risks. During the period January 14 to March 4, 2019, Kumbh Mela in Prayagraj, India was attended by an estimated 120 million visitors. An onsite disease surveillance was established to identify and respond to disease outbreaks. Methods A health coordination committee was established for planning. Disease surveillance was prioritized and risk assessment was done to identify diseases/conditions based on epidemic potential, severity of illness, and reporting requirement under the International Health Regulations (IHR) of 2005. A daily indicator and event-based disease surveillance was planned. The indicator-based surveillance (IBS) manually and electronically recorded data from patient hospital visits and collected MG area water testing data to assess trends. The event-based surveillance (EBS) helped identify outbreak signals based on pre-identified event triggers from the media, private health facilities, and the food safety department. Epidemic intelligence was used to analyse the data and events to detect signals, verify alerts, and initiate the response. Results At Kumbh Mela, disease surveillance was established for 22 acute diseases/syndromes. Sixty-five health facilities reported 156 154 illnesses (21% of a total 738 526 hospital encounters). Among the reported illnesses, 95% (n = 148 834) were communicable diseases such as acute respiratory illness (n = 52 504, 5%), acute fever (n = 41 957, 28%), and skin infections (n = 27 094, 18%). The remaining 5% (n = 7300) were non-communicable diseases (injuries n = 6601, 90%; hypothermia n = 224, 3%; burns n = 210, 3%). Water samples tested inadequate for residual chlorine in 20% of samples (102/521). The incident command centre generated 12 early warning signals from IBS and EBS: acute diarrheal disease (n = 8, 66%), vector-borne disease (n = 2, 16%), vaccine-preventable disease (n = 1, 8%), and thermal event (n = 1, 8%). There were two outbreaks (acute gastroenteritis and chickenpox) that were investigated and controlled. Conclusions This onsite disease surveillance imparted a public health legacy by successfully implementing an epidemic intelligence enabled system for early disease detection and response to monitor public health risks. Acute respiratory illnesses emerged as a leading cause of morbidity among visitors. Future MG events should include disease surveillance as part of planning and augment capacity for acute respiratory illness diagnosis and management.
Collapse
Affiliation(s)
- Vikasendu Aggrawal
- State Surveillance Office, Uttar Pradesh Department of Health, Lucknow, India.
| | - Tanzin Dikid
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - S K Jain
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Ashu Pandey
- State Surveillance Office, Uttar Pradesh Department of Health, Lucknow, India.
| | - Pradeep Khasnobis
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Sushma Choudhary
- South Asia Field Epidemiology and Technology Network, Delhi, India.
| | - Ramesh Chandra
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Amol Patil
- South Asia Field Epidemiology and Technology Network, Delhi, India.
| | | | - Ashok Talyan
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Akhileshwar Singh
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Binoy S Babu
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Akshay Kumar
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Davendra Kumar
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - P M Raveesh
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Jayanti Singh
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Rakesh Kumar
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - S S Qadri
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Preeti Madan
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Vaishali Vardan
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | | | - Ginisha Gupta
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Abhishek Mishra
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - T P Vaisakh
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Purvi Patel
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Azar Jainul
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Suneet Kaur
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | | | - Meera Dhuria
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| | - Ritu Chauhan
- World Health Organization India Office, Delhi, India.
| | - S K Singh
- Epidemiology Division, National Centre for Disease Control, Delhi, India.
| |
Collapse
|