Friday, June 08, 2012

How The ECDC Will Spend Your Summer Vacation



# 6374


This summer there will be three high profile, well-attended public events in Europe; The London Olympics and Para-Olympics Games, and the UEFA EURO 2012 football championship (which is being hosted by Poland and the Ukraine).


Hundreds of thousands of visitors will converge on multiple venues over the summer, coming from all parts of Europe and around the world.  And as with any large gathering of people, there are serious public health concerns.


Over the past few months we’ve seen some hyperbolic media stories suggesting that these games could help launch the next pandemic, but past experience with other big travel events, like the Hajj, the Carnival in rio, The World Cup,  or our own Super Bowl suggests that is unlikely.


It is true that some disease outbreaks have been exacerbated by the gathering of large crowds. 


This past year a number of people were exposed to measles at the Super Bowl in Indianapolis, leading to a limited outbreak of the disease (mostly among the unvaccinated).


Perhaps most famously, the city of Philadelphia went ahead with plans to hold a Liberty Loan parade in September of 1918, which was attended by 200,000 people.


Although the flu pandemic had already begun, the city fathers were apparently heartened by the low number of cases that had been reported in Philadelphia. Other cities, like St. Louis, banned public gatherings, closed movie theatres, and even limited church gatherings.


What happened next is best demonstrated by the following graph, which depicts an explosion of pandemic flu cases beginning just days after the parade.

The chart above, taken from the PNAS journal article entitled Public Health Interventions and Pandemic Intensity During the 1918 Influenza Pandemic , shows the excess mortality in two American cities.


The tall spike represents Philadelphia, while the lower curve represents St. Louis.


Over the next three weeks, at least 6,081 deaths from influenza and 2,651 deaths from pneumonia were registered in Pennsylvania, most occurring in Philadelphia (CDC source).


So the potential is there, assuming that a novel pathogen to which there is limited immunity is introduced to the crowds.


The good news is, that while mass gatherings provide greater opportunities for disease outbreaks, history has shown that serious outbreaks like that which followed the 1918 Philadelphia parade are a rarity.


Still, there is enough concern that a good deal of planning has gone into the surveillance and prevention of disease spread at these summer events. Earlier this year in Lancet: Mass Gatherings And Health, we looked at a 6-part series on public health measures during mass gathering events.



The ECDC has published a report today outlining some of the steps they are taking to try to prevent disease outbreaks during these mass gathering events.


Watching the summer games

08 Jun 2012

Two large mass gathering events involving millions of EU citizens and worldwide visitors are being hosted this summer in the EU: the UEFA EURO 2012 football championship and London 2012 Olympic and Paralympic Games.


ECDC is enhancing its surveillance activities this summer, watching for any infectious disease health events that could present a public health threat during these sport events. As of today, a summary of relevant health events will be included in the weekly Communicable Disease Threat Report (CDTR), published on this website.


ECDC is working with the hosting country competent bodies of Poland, the United Kingdom and the Ukraine to provide international surveillance activities in order to support their public health actions.


Global mass gathering events can present challenges for public health because of their scale and the possible additional demands made of the public health services. To tackle these challenges, surveillance systems can be enhanced to target specific diseases or syndromes and to support timely response actions to reduce their impact and risk of spread.


Based on its founding regulation, one of the core functions of ECDC is undertaking daily 24/7 epidemic intelligence. This term encompasses activities related to early identification of potential health threats, as well as their verification, assessment and investigation, in order to recommend adequate public health control measures. Epidemic intelligence sources of information vary from health data routinely collected through standardised surveillance systems to unstructured official and unofficial reports of any origin.


What will ECDC be doing during these mass gathering events?

During the months of June-September 2012, ECDC is undertaking enhanced event-based surveillance as part of its routine epidemic intelligence activities. It has adapted media screening tools and its procedures to assist detecting timely infectious disease threats which may be relevant for these events, and the hosting and participating countries. The use of social media and blog fora as a mechanism of timely identification of disease threats is being explored in this context.


ECDC is working very closely with the hosting countries and international partners such as the World Health Organisation, including having liaison officers to facilitate daily communication with ECDC. A daily bulletin containing information on events relevant from a public health perspective will be provided to public health authorities of Member States and the event-hosting countries.


A summary of relevant infectious disease threats will be included in the weekly CDTR published on this website.


What kind of infectious diseases is ECDC looking for?

Large gatherings of people may be subject to increased public health risks, including non-communicable diseases. Based on experience from previous such mass gatherings, it is unlikely that infectious diseases will be a major problem at these two events.


The greatest risk for visitors to these mass gatherings is likely to be related to food and waterborne diseases, such as food poisoning due to inappropriately handled food items or inadequate hand hygiene practices. At the same time, in the context of outbreaks of measles and other vaccine preventable diseases in Europe, unvaccinated and non-immune people may be at increased risk of infection.


In addition to food- and water-borne diseases and vaccine preventable diseases, ECDC will be monitoring for a wide range of infectious diseases and syndromes through available data sources and networks, as it does on a daily basis, in order to detect unusual events or outbreaks.


The organisers of these mass gatherings have published public messages about how to stay healthy in order to best enjoy these events. Preventative measures that people can take themselves and can contribute to keeping others healthy include things such as: washing hands regularly, ensure relevant vaccinations are up to date, practice safe sex, stay out of the sun, and stay at home if you feel unwell. For those seeking travel or health advice, specific information for EURO 2012 and London 2012 can be found below.

ECDC Rapid risk assessment on measles

WHO European Region on health planning for large events



Assuming that no large outbreaks of illness or disease occurs, it will be due primarily to the advance work done by local and regional public health officials in planning for these events.


The old saying is true, `When public health works, nothing happens’.

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