The second of the six papers on mass gathering health in The Lancet Infectious Disease Series , states that instead of potentially amplifying and accelerating the spread of infectious disease all over the world, mass gatherings (MGs) can also offer unique opportunities to promote public health campaigns, like vaccinations. These can not only lower the risks for the host countries or communities, but also be of benefit to the countries to which participants return.
Study leader Ibrahim Abubakar, Professor of Infectious Disease Epidemiology at the University of East Anglia in Norwich, UK, who is also head of the TB section at the Health Protection Agency in London, UK, and his international team of experts have examined the risk of infectious diseases at MGs and in this paper, discuss the increasing importance of infectious diseases control whilst planning MGs.
Large-scale events can become a potential breeding ground and reservoir for infectious diseases because of poor planning and overcrowding, and with international visitors traveling to and from different countries from these events, they provide an extraordinary opportunity to spread infections worldwide.
One of the most prevalent diseases amongst travelers and those who were in close proximity of people at MGs, is influenza. Traveling and MGs further heighten the risk of transmission of a potential pandemic arising; For example, an influenza outbreak at the World Youth Day in Sydney, Australia in 2008 spread rapidly as a consequence of overcrowded accommodation and low vaccination rates. A year later, people visiting music festivals in Belgium, Serbia, and Hungary were diagnosed with the pandemic strain of influenza H1N1.
Introducing control measures, such as better surveillance, awareness campaigns and respiratory hygiene recommendations proved successful in preventing H1N1 outbreaks of influenza during the 2009 global pandemic at the Asian Youth Games in Singapore and at the Hajj.
The 2007 Cricket World Cup, in which teams and supporters from countries around the Indian Ocean experienced a large outbreak of chikungunya, demonstrated how important planning and effective public health action is to prevent an influx and transmission of non-endemic diseases. By introducing improved surveillance, providing practical advice to reduce mosquito bites and immunization, outbreaks of chikungunya and diseases endemic in some of the Caribbean host countries, such as malaria, dengue, and yellow fever, were successfully prevented in returning supporters.
According to Abubakar and his team, the key to prevent infectious disease at MGs lies in the coordination of risk assessment and management before, during, and after the event.
Furthermore, they point out that MGs provide excellent opportunities to promote public health information and could accelerate the development of interventions to lower transmission rates of infectious diseases. In Northern Africa for example, there is a strong incentive to encourage some vaccinations in response to outbreaks of infectious diseases during the Hajj.
The researchers conclude:
“Essential to the management of health threats is the need for cooperation between national, regional, and international partners, especially for surveillance after an event. MGs provide an untapped opportunity for host countries to promote global health diplomacy and to model ideal public health behaviors.”
Written by Petra Rattue