Four Global Flu Field Experiments

#13,104


The month of February is notable for a couple of epidemiological reasons. First, in the Northern Hemisphere, influenza (both human and avian) is usually near its peak.  And second, this is the time of the year when we see 3 (and sometimes 4) large mass gathering/travel events around the globe.

As the map above illustrates, this year is no exception, with 2018's biggest events including:

Feb 4th             -  Super Bowl LII   Minnesota
Feb into Mar.    -  Chinese New Year, aka Lunar New Year 
Feb 9th - 14th   -  Carnival in Rio
Feb 9th - 25th   -  XXIII Olympic Winter Games in South Korea

Combined, we're talking about hundreds of millions of people who will be traveling over the next 30 days - often via crowded trains, buses, and airplanes - to destinations all across Asia, and to venues in the United States and Brazil. 
 

Nearly four years ago, in The Global Reach Of Infectious Disease, we looked at rationale behind several national and international initiatives designed to deal with the growing threat of the international spread of infectious diseases. 

• In WHO: IHR & Global Health Security, we looked at the large number of member states which have yet to meet the core surveillance and response requirements of the International Health Regulations that went into force in 2007.
• In Be Prepared For Surprises (Redux), we looked at calls for further extensions on implementing the IHR core requirements.
• An Assessment by the Director of National Security in 2014 (see DNI: An Influenza Pandemic As A National Security Threat) found the global spread of infectious diseases – along with cyber attacks, terrorism, extreme weather events, WMDs, food and water insecurity, and global economic concerns.- constitutes a genuine threat to national security.

While emerging threats like MERS-CoV, Ebola, or Avian Flu are often the first things we think of, most infectious illnesses acquired during these mass gathering/migration events are far less exotic; seasonal flu, pneumonia, vector borne infections (Zika, CHKV,  Dengue, Malaria,Yellow Fever, etc.), norovirus, etc.

• In 2010, in The Impact Of Mass Gatherings & Travel On Flu Epidemics , we looked at a study  published in BMC Public Health, that looked at and attempted to quantify the impacts of mass gatherings and holiday travel on the spread of an influenza epidemic.
• And in 2011, in Viruses With A Ticket To Ride, we looked at a study that  appeared in BMC Infectious Diseases, that looked at the incidence of ARI (Acute Respiratory Infection) presenting within 5 days of train or tram travel in the UK. They found that recent  bus  or  tram  use  within  five  days  of  symptom  onset  was  associated  with  an  almost  six-fold  increased  risk  of  consulting  for  ARI.
• The  EID Journal: Respiratory Viruses & Bacteria Among Pilgrims During The 2013 Hajj found 8 of 10 pilgrims tested showed nasal or throat acquisition of respiratory pathogens during their pilgrimage, and another study by the same author found the most common cause of hospitalization during the Hajj is pneumonia (20%).  
  

Simply put, the international exchange rate of infectious diseases is increasing, and that's a trend that is unlikely to change anytime soon.

The CDC has already issued a Yellow Fever in Brazil Alert - Level 2, Practice Enhanced Precautions on their Travel Notices page, along with the following Watch Level 1, Practice Usual Precautions advisories.  

• 2018 Winter Olympics (PyeongChang 2018) December 15, 2017 The 2018 Winter Olympics will take place in PyeongChang, South Korea, from February 9 to February 25, 2018. The Paralympic Games are scheduled for March 9 to March 18, 2018. Read More >>
• Carnival and Mardi Gras December 06, 2017 If you plan to travel outside the United States to celebrate Carnival, you can take some simple precautions to help you stay safe and healthy. Destinations include Brazil, Canada, France, Germany, Italy, and Trinidad and Tobago. Read More >>
• Lunar New Year December 06, 2017 The Year of the Dog begins on February 16, 2018, and many people will travel to Asia to celebrate the Lunar New Year. Destinations include Australia, China, Hong Kong, Indonesia, Laos, Macau, Malaysia, Mauritius, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam. Read More >>

Anyone planning to travel to these (or any other) destination should review this advice (and get whatever vaccines are required) well before departure.

While seasonal influenza is either at or approaching severe levels across much of the Northern Hemisphere, the dominant subtypes and/or strains of flu are not the same around the world; North America is reeling from H3N2, the Middle East and Africa are dealing with H1N1, while Asia is primarily battling influenza B (see WHO flu map below).

No one can predict how the intermingling of millions of people (and their viruses) on three different continents over the month will affect the rest of this winter's flu season (or next year's for that matter), but you can bet that epidemiologists will be keeping a close watch on flu trends in the months ahead.

In recent years mass gathering medicine has become a specialty (see Lancet: Mass Gathering and Health), and public health agencies around the world gear up for every large gathering event (see How The ECDC Will Spend Your Summer Vacation & The ECDC Risk Assessment On Brazil’s FIFA World Cup).

So it is of little surprise that less than a week after the Super Bowl, and on the same day (Feb 9th) that the Winter Olympics and Carnival in Rio both kick off, doctors from across the globe will gathering in Miami for The Mass Gathering Medicine Summit 2018 February 9-10, 2018.


One of the realities of life in this highly mobile, interconnected, 21st century is that oceans and vast distances no longer afford protection against infectious diseases, and that modern medicine must evolve to meet those new challenges.