London School of Hygiene & Tropical Medicine

Health surveillance technology and rapid information sharing will be vital in delivering effective public health services for the forthcoming World Cup, according to new research published in The Lancet.

The series of reports, co-authored by researchers  at the London School of Hygiene & Tropical Medicine, investigates major public events, including the Hajj pilgrimage, London 2012 Olympic Games and the 2012 European Football Championship, and the planning and surveillance systems that were used to monitor public health risks.

Co-author, Professor David Heymann at the London School of Hygiene & Tropical Medicine said: "For all of these events, the host countries and international public health agencies undertook major planning activities to assess and build capacity for disease alert and outbreak response, and to develop effective strategies for public health services. This level of preparedness obviously paid off as all the events in question took place without major disease outbreaks or public health issues. Enhancements to surveillance and reporting systems will therefore need to be made a key part of public health planning for future sporting events like the upcoming 2014 FIFA World Cup in Brazil."

Studying the Hajj, the pilgrimage to Makkah in Saudi Arabia, the researchers found that the latest technology in real-time disease surveillance helped protect more than 2 million people visiting from over 180 countries, including from infections such as MERS coronavirus.

The Command and Control Centre in Makkah used new web-based electronic health surveillance systems for rapid communication and response. Surveillance stations throughout Makkah, including hospitals, clinics, and medical centres, rapidly gathered and relayed patient and health data to the operations centre to gather information in a database for statistical analyses and decision making.

This new technology was successfully put to the test after MERS coronavirus was first discovered in September 2012, and no cases of MERS infection were later reported during the Hajj in 2012 and 2013.

Other successful public health measures for the Hajj were found to focus on provision of safe water and food supplies, sanitation, pre-travel health regulations, advice about vaccinations, and provision of free health care to pilgrims through several clinics and hospitals.

And through studying the London 2012 Olympics, the authors point out that although the risk of public health problems at large-scale international sporting events is small, public health surveillance and response systems need to be ready to detect and respond much quicker than normal.

The authorities began public health planning more than seven years before the Games, and although the UK's public health surveillance systems are very effective, the risk assessment for the Games suggested several enhancements to these systems that were implemented as part of preparations.

These included the use of data on attendance at Olympics venues, a move from weekly to daily analysis and reports, analyses of mortality data, and a new system for intensive care units to report unexplained illnesses of probable infectious cause. In addition, a national event-based surveillance team was the hub for reporting of incidents and outbreaks of an infectious disease from across the UK that might have substantially affected the Games.

As a result, no major public health incidents occurred during the London 2012 Olympic and Paralympic Games, and only a few outbreaks of gastrointestinal and respiratory infections were recorded during the period, which posed no risk to the Games.

The research also found that providing reassurance to the organising committee, UK government and media that nothing was happening proved to be very important. Routine surveillance systems are not designed to show negative findings like these, and so the authors suggest that organisers planning mass gatherings in the future should consider this new aspect of surveillance requirements.

Publications

• Ziad A Memish et al. Mass gatherings medicine: international cooperation and progress. The Lancet. DOI:10.1016/S0140-6736(14)60225-7
• Ziad A Memish et al. Hajj: infectious disease surveillance and control. The Lancet. DOI:10.1016/S0140-6736(14)60381-0
• Brian McCloskey et al. London 2012 Olympic and Paralympic Games: public health surveillance and epidemiology. The Lancet. DOI:10.1016/S0140-6736(13)62342-9
• Catherine A H Smallwood et al. Euro 2012 European Football Championship Finals: planning for a health legacy. The Lancet. DOI:10.1016/S0140-6736(13)62384-3

Related Links

• Short course: Introduction to Infectious Disease Modelling and Its Applications
• Short course: Model fitting and inference for infectious disease dynamics