As we discussed on Sunday for Ramadan and the Hajj (see ATS: Mass Gatherings And Lessons From The Hajj), whenever you gather hundreds of thousands of people from all over the world into a crowded venue, the risks of infectious disease transmission goes up.
And not just from local pathogens, but from exotic ones brought in by some of the visitors.
In 2012, in the run up to the London Olympics and Para-Olympic games, we looked at some of the challenges facing public health agencies in How The ECDC Will Spend Your Summer Vacation. In addition to water and food borne illnesses, measles and influenza were on the ECDC's watch list.
As hard as it is to believe, only 4 years ago the world had yet to hear of MERS-CoV, H5N6, or H7N9, Ebola wasn't considered a serious international threat, and Chikungunya and Zika were both obscure, little noticed mosquito borne diseases.
But only two years later, when Brazil was hosting another major sports event (see The ECDC Risk Assessment On Brazil’s FIFA World Cup), Ebola was raging in West Africa, MERS-CoV had infected hundreds in Saudi Arabia, and a different mosquito-borne illness - Chikungunya - was making serious inroads into the Americas (see Study: Chikungunya’s Growing Threat To The Americas).
While some threats change, others stay the same, and many of the cautions issued for the World Cup in 2014 hold true today - particularly when it comes to water and food borne illnesses and protection against mosquito borne diseases.
Today the ECDC has released a 20-page PDF risk assessment on the 2016 Summer games in Rio de Janeiro, which not only includes illnesses or infections that may be acquired while in Brazil, but also infections that may be imported into Brazil by international travelers.
First the news release, followed by excerpts from the Rapid Risk Assessment.
Gastrointestinal illness and vector-borne infections are the main risks to public health during the 2016 Olympics and Paralympics Summer Games in Rio de Janeiro, Brazil
11 May 2016
Visitors to the 2016 Olympics and Paralympics Summer Games (5–21 August and 7–18 September 2016) in Rio, Brazil will be most at risk of gastrointestinal illness and vector-borne infections. Consequently, travellers are advised to pay attention to standard hygiene measures and protect themselves against mosquito and other insect bites using insect repellent and wearing long-sleeved shirts and trousers. It should be noted though that the Games will take place during the winter season in Rio de Janeiro when the cooler and drier weather will reduce mosquito populations, thus lowering the risk of mosquito-borne infections.
A number of vaccine preventable diseases are present and as such visitors should consult the advice for vaccinations issued by the Brazilian health authorities, the Pan American Health Organization (PAHO) as well as their own country’s recommendations. Additionally, tourists are recommended to arrange comprehensive healthcare insurance before travelling.
In view of the current Zika outbreak in the Americas and the Pacific, ECDC is regularly updating its risk assessments and, to this date, its information for travellers remains valid:
- Pregnant women and women who are planning to become pregnant should consider postponing non- essential travel to affected areas until after delivery.
- Pregnant women who plan to travel to Rio 2016 and those residing in the affected areas should consult their healthcare providers for advice and follow strict measures to prevent mosquito bites.
- Travellers with immune disorders or severe chronic illnesses should consult their doctor or seek advice from a travel clinic before travelling, particularly on effective prevention measures.
- Travellers to Brazil and EU citizens residing in affected areas should be advised that using condoms could reduce the risk of sexual transmission through semen.
A small excerpt from the RRA follows, but you'll want to download the entire document, which includes detailed travel advice along with a number of maps and charts.
Main conclusions and options for response Conclusions
Visitors to the 2016 Olympics and Paralympics Summer Games (5–21 August and 7–18 September 2016) in Rio, Brazil will be most at risk of gastrointestinal illness and vector-borne infections. Therefore, they should pay attention to standard hygiene measures to reduce the risk of gastrointestinal illness and protect themselves against mosquito and other insect bites using insect repellent and/or wearing long-sleeved shirts and trousers in regions where vector-borne diseases are endemic.
The risk of colonisation (digestive tract carriage) of multidrug-resistant Enterobacteriaceae should be considered for all travellers, irrespective of contact with healthcare facilities while in Brazil, during the three months following their return from Brazil. Surveillance for communicable diseases should be sensitive enough to detect threats at a stage when interventions are likely to prevent or reduce the impact of outbreaks.
The Games will take place during the winter season in Rio de Janeiro when the cooler and drier weather will reduce mosquito populations. This will significantly lower the risk of mosquito-borne infections for visitors, such as Zika virus, dengue and chikungunya, except in Manaus where some football matches will be held. Although the probability of being bitten by an infected mosquito is expected to be very low during the events, it cannot be excluded that travellers can become infected and return to regions of the EU where competent vectors are active. This may create an opportunity for local vector-borne transmission in the EU.
Over recent years, Brazil has eliminated rubella transmission and, since July 2015, has also interrupted measles transmission. These are diseases which are still endemic in many other countries and could be imported to Brazil by international visitors. Options for response Visitors to Brazil should consult the advice for vaccinations issued by the Brazilian health authorities, the Pan American Health Organization (PAHO) as well as their own country’s recommendations.
All travellers are advised to arrange comprehensive healthcare insurance before travelling to Brazil. If healthcare is needed, travellers should contact Brazil's healthcare system (Sistema Único de Saúde – SUS) through local hospitals or use their private health insurance at any healthcare provider.
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