Purpose: To describe the implementation and results of an active syndromic surveillance team in a planned and recurrent international mass gathering (MG) allowing early detection of outbreaks, and thereby, allowing intervention by local, national and international authorities. Methods & Materials: A field team of 17 health-care workers performed active and syndromic surveillance at Boom Festival 2018 between 21st and 29th of July 2018, in Portugal. Data including demographic characteristics, signs, symptoms, and environmental exposure was collected during admission at Boom Medical Service (BMS). Paper records were transcribed and analyzed with Microsoft Excel® 2016 (v 16.0). Descriptive analysis was performed and reported daily to relevant stakeholders. Results: Approximately 30,000 people from 147 countries attended the BOOM Festival, and 3,100 healthcare episodes occurred, including 451 (14.5%) complaints of gastrointestinal symptoms. During the Festival, there was a considerable increase in the incidence of gastrointestinal symptoms and an early warning alert for a possible outbreak of acute gastroenteritis was issued to the national health authorities on 24th of July. Interventions were carried out in collaboration with local public health authorities to control the outbreak and to address possible common-sources of infection. Contaminated food or water were suspected, and a person-to-person transmission was not excluded since several cases mentioned attending another MG and symptom onset before arrival at the festival. The concern about an early stage outbreak was valid since 62.5% (n = 282) of the cases with gastrointestinal symptoms were reported between 26th-29th of July. Conclusion: Active and syndromic surveillance are essential for timely data collection and analysis in MGs, delivering a comprehensive snapshot of daily incidents, enabling rapid response to possible outbreaks and providing early-warning alerts for stakeholders. Nevertheless, enhancements are needed: data sharing and improved communication channels between stakeholders and similar international MG are necessary to create an effective syndromic surveillance system. Author response to letter from Gomez et al.International Journal of Infectious DiseasesVol. 91PreviewThe abstract by Maki et al. (2019) contained limited information from a poster presented in a late-breaking session at the Seventh International Meeting on Emerging Diseases and Surveillance. The work had IRB approval (HFHS #12383), and informed consent was obtained prior to collecting samples. Full-Text PDF Open AccessBacterial colonization in point-of-use filters and deaths in Flint, MichiganInternational Journal of Infectious DiseasesVol. 91PreviewThe study by Maki et al. (2019) examined the effects of point-of-use (PoU) filters on bacterial infections in residents of Flint, Michigan homes. The authors noted that 12 pathogens (including Pseudomonas aeruginosa) were detected in PoU filters in 10 Flint homes and that residents of 70% of these homes had severe respiratory infections. Additionally alarming, the authors reported an astounding 50% mortality rate in their study sample. Full-Text PDF Open Access