Reflections on mass gathering preparedness

Denis Coulombier and Lara Payne HallströmEuropean Centre for Disease Prevention and ControlESCAIDE, Edinburgh, 26 October 2012

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Examples of communicable disease outbreaks detected/associated with mass gathering events

EventCountry Year

Organism/outbreak

No. of cases Deaths

International Special Olympics US 1991 Measles 25

Soccer championship Spain 1997 Hepatitis A 114

Triathlon US 1998Leptospirosis 98

|Football tournament Belgium 1997 Meningitis 11 1

Football Cup France 1998 Legionnella 20 4

Special Olympics USA national games, Iowa (media report) US 2006 Norovirus? >30

International Youth Sporting event US 2007 Measles 6

Winter Olympics Canada 2010 Measles 82

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Mass gathering in Serbia and pandemic influenza

1817 travel-related cases16 domestic cases151413121110

987654321

18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23June July

First day of EXIT

Last day of EXIT

Campsite begins

Campsite ends

Distribution of laboratory-confirmed cases of influenza A(H1N1)v by day of onset and import status, EXIT 2009 festival, as of 24 July 2009

Public health preparedness for two mass gathering events in the context of pandemic influenza (H1N1) 2009, Serbia , July 2009EUROSURVEILLANCE, Vol. 14, Issue 31, 6 August 2009, www.eurosurveillance.org

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What is ECDC’s role for MGs?

• Provided operational support to hosting countries– 9 events in 7 years

• Provided relevant information to EU stakeholders

Based on ‘business as usual’ and more:

– preparedness phase: advice based on experiences, risk assessment

– tailored daily international epidemic intelligence information: detection and communication of possible relevant threats

– EU-level risk analysis: integrated into round table or daily teleconferences

– general technical advice upon request: disease expertise, mass gathering experiences, surveillance evaluation…

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ECDC activities for EURO2012

Pre-event:

• WHO workshop Lviv, April 2010

• Missions (Ukraine + Poland), 2011

• Meetings

– Coordination meeting, February 2012– EpiNorth International EI, March 2012

• Develop EI specific tools

During the event:

• tailored epidemic intelligence

– 24/7 activity, network support– daily specific report to stakeholders

• Daily risk assessment

• ECDC liaison officers in Poland and Ukraine

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ECDC activities for London 2012

Pre-event:

• Meetings from April 2010 - Define EI needs

- Trial runs x 3

• Develop EI specific tools based on risk assessment

During the event:

• tailored epidemic intelligence

– 24/7 activity– daily risk assessment/TC– daily specific report to

stakeholders• ECDC liaison officer

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ECDC costs during the period

ECDC activated 4 months, from June to September• 38 000€ for fellows and liaison officers placements• 3.8 FTE, including liaison officers

Covered by• 5 EPIET placements• 4 UK public health

specialist trainees • ECDC EI team• ECDC liaison officers

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Conclusions

• Preparedness is effective in preventing the usual suspects to strike: food borne outbreaks, legionnaire’s disease outbreaks…

• Large mass gathering represent planned public health crises requiring– Strengthening command

and control in the organising country

– Strengthening connexions and collaborations with international stakeholders

• Smaller mass gathering may present with a higher risk

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Mass gathering are safe…

The unexpected only strikes every couple of years. What if:

• STEC outbreak in Germany had occurred at the time of the world football cup in 2006?

• the 2009 pandemic influenza had started during London 2012?

• autochthonous cases of malaria in Athens region had occurred during the Athens 2004 Olympic Games?

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Discussion…