Lancet Series –mass gatherings medicine

The Lancet
Jun 14, 2014 Volume 383 Number 9934 p2019 – 2098 e19 – 21
http://www.thelancet.com/journals/lancet/issue/current

Comment
Mass gatherings medicine: international cooperation and progress
Ziad A Memish a b, Alimuddin Zumla c, Brian McCloskey d, David Heymann e f, Abdullah A Al Rabeeah a, Maurizio Barbeschi g, Richard Horton h
Excerpt
In July, 2012, we discussed plans to move the complex public health issues surrounding mass gatherings into a formal scientific discipline, and to create a global network for mass gatherings research, training, and capacity development.1, 2 We believed that it was important for this network to be led by Saudi Arabia, since the country has extensive experience through many decades of managing millions of pilgrims from 184 countries at the largest yearly recurring religious mass gathering in the world—the Hajj. Subsequently, the Saudi Government and WHO3 strongly supported mass gatherings medicine as a scientific discipline, establishing the Saudi Global Center for Mass Gathering Medicine (GCMGM), with its headquarters in Riyadh and membership from other Gulf countries,4 and a virtual research network linked with other WHO collaborating centres for mass gatherings. This network has brought together global academic and public health institutions with complementary expertise to gather and translate the most appropriate public health policy evidence for use by countries that host, or plan to host, mass gathering events…
…Mass gatherings medicine provides an opportunity to generate a wealth of knowledge and expertise, and sharing the experiences of organisers can assist in shaping a positive legacy and provide valuable lessons for organisers of future events. The value to planners of mass gatherings and their governments in sharing best practices is clear, as is the need for new operational research into mass gatherings, with systematic collection and analysis of data to inform planning activities for future events. Through provision of scientific evidence, the GCMGM aims to drive the best health promotion and prevention guidelines and practice, including health education for attendees of mass gatherings across different contexts. The Hajj provides an ideal model for research into mass gatherings that recur yearly in the same location, and the very large sporting events provide a different context and complementary opportunities for research and training. Substantial gaps in research remain, particularly in relation to mass gatherings in low-resource settings and in unplanned or spontaneous mass gatherings….

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Lancet Series –mass gatherings medicine

Hajj: infectious disease surveillance and control
Prof Ziad A Memish FRCPC a b c d, Prof Alimuddin Zumla FRCP a e f, Rafat F Alhakeem MD a d, Abdullah Assiri MD d, Abdulhafeez Turkestani MD d, Khalid D Al Harby MD d, Mohamed Alyemni PhD d, Khalid Dhafar MD d, Philippe Gautret MD g, Maurizio Barbeschi PhD a h, Brian McCloskey MD a i, Prof David Heymann MD a j k, Abdullah A Al Rabeeah FRCS a d, Jaffar A Al-Tawfiq FACP l m
Summary
Religious festivals attract a large number of pilgrims from worldwide and are a potential risk for the transmission of infectious diseases between pilgrims, and to the indigenous population. The gathering of a large number of pilgrims could compromise the health system of the host country. The threat to global health security posed by infectious diseases with epidemic potential shows the importance of advanced planning of public health surveillance and response at these religious events. Saudi Arabia has extensive experience of providing health care at mass gatherings acquired through decades of managing millions of pilgrims at the Hajj. In this report, we describe the extensive public health planning, surveillance systems used to monitor public health risks, and health services provided and accessed during Hajj 2012 and Hajj 2013 that together attracted more than 5 million pilgrims from 184 countries. We also describe the recent establishment of the Global Center for Mass Gathering Medicine, a Saudi Government partnership with the WHO Collaborating Centre for Mass Gatherings Medicine, Gulf Co-operation Council states, UK universities, and public health institutions globally.

London 2012 Olympic and Paralympic Games: public health surveillance and epidemiology
Brian McCloskey FFPH a b, Tina Endericks MBA b, Mike Catchpole FRCP c, Maria Zambon FRCPath d, Jim McLauchlin PhD e, Nandini Shetty FRCPath l, Rohini Manuel FRCPath l, Deborah Turbitt FFPH l, Gillian Smith FFPH f, Paul Crook MSc g, Ettore Severi MSc h, Jane Jones MFPH i, Sue Ibbotson FFPH j, Roberta Marshall FFPH k, Catherine A H Smallwood m, Nicolas Isla MSc n, Prof Ziad A Memish FRCP a o p, Abdullah A Al-Rabeeah FRCS a o, Maurizio Barbeschi PhD a m, David L Heymann FMEDSci a l q r, Alimuddin Zumla FRCP a s t
Summary
Mass gatherings are regarded as potential risks for transmission of infectious diseases, and might compromise the health system of countries in which they are hosted. The evidence for increased transmission of infectious diseases at international sporting mass gatherings that attract many visitors from all over the world is not clear, and the evidence base for public health surveillance, epidemiology, and response at events such as the Olympics is small. However, infectious diseases are a recognised risk, and public health planning is, and should remain, a crucial part of the overall planning of sporting events. In this Series paper, we set out the planning and the surveillance systems that were used to monitor public health risks during the London 2012 Olympic and Paralympic Games in the summer of 2012, and draw attention to the public health issues—infectious diseases and chemical, radiation, and environmental hazards—that arose. Although the absolute risk of health-protection problems, including infectious diseases, at sporting mass gatherings is small, the need for reassurance of the absence of problems is higher than has previously been considered; this could challenge conventional public health surveillance systems. Recognition of the limitations of health-surveillance systems needs to be part of the planning for future sporting events.

Euro 2012 European Football Championship Finals: planning for a health legacy
Catherine A H Smallwood DPhil a, Katherine G Arbuthnott BMBCh a, Barbara Banczak-Mysiak MD h, Mariya Borodina MD c, Ana Paula Coutinho MSc e, Lara Payne-Hallström MSc g, Elzbieta Lipska MD i, Viktor Lyashko MD j, Miroslaw Miklasz MD l, Paulina Miskiewicz MD l, Dorit Nitzan MD b, Igor Pokanevych MD b, Marek Posobkiewicz MD h, Gerald Rockenschaub MD f, Malgorzata Sadkowska-Todys PhD k, Svetlana Sinelnik d, Daniel Smiley PhD c, Rysard Tomialoic MSc q, Volodimir Yurchenko MD d, Prof Ziad A Memish FRCPC m, Prof David Heymann MD n o p, Tina Endericks MBA r, Brian McCloskey FFPH r, Prof Alimuddin Zumla FRCP s t, Maurizio Barbeschi PhD a
Summary
The revised international health regulations offer a framework that can be used by host countries to organise public health activities for mass gatherings. From June 8, to July 1, 2012, Poland and Ukraine jointly hosted the Union of European Football Associations European Football Championship Finals (Euro 2012). More than 8 million people from around the world congregated to watch the games. Host countries and international public health agencies planned extensively to assess and build capacity in the host countries and to develop effective strategies for dissemination of public health messages. The effectiveness of public health services was maximised through rapid sharing of information between parties, early use of networks of experienced individuals, and the momentum of existing national health programmes. Organisers of future mass gatherings for sporting events should share best practice and their experiences through the WHO International Observer Program. Research about behaviour of large crowds is needed for crowd management and the evidence base translated into practice. A framework to measure and evaluate the legacy of Euro 2012 is needed based on the experiences and the medium-term and long-term benefits of the tournament.