Mass Gathering Events Research Articles

ABO Blood Groups and Incidence of COVID-19 in the Mass Gathering Events in Borriana (Spain), March 2020: A Retrospective Cohort Study.

Our objective was to estimate the incidence of COVID-19 and the ABO blood Groups in the mass-gathering events (MGEs) during the Falles Festival in Borriana (Spain) from 6-10 March 2020. We conducted a population-based retrospective cohort study and measured anti-SARS-CoV-2 antibodies and the ABO of participants. We performed laboratory COVID-19 tests and obtained the ABO in 775 subjects (72.8% of the original exposed cohort): O-group (45.2%), A-group (43.1%), B-group (8.5%) and AB-group (3.4%). Adjusted for confounding factors, including COVID-19 exposure during the MGEs, attack rates of COVID-19 for each ABO group were 55.4%, 59.6%, 60.2%, and 63.7%. The adjusted relative risks were for O-group 0.93 (95% Confidence Interval [CI] 0.83-1.04), for A-group 1.06 (95% CI 0.94-1.18), for B-group 1.04 (95%CI 0.88-1.24), and for AB-group 1.11 (95% CI 0.81-1.51) with no significant differences. Conclusions: Our results suggest no effect of ABO on COVID-19 incidence. We observed weak but not significant protection of the O-group and not a significantly greater infection risk for the remaining groups compared with the O-group. More studies are needed to resolve the controversies regarding the association between ABO and COVID-19.

Assessment of COVID-19 preparedness response plan on higher education students simulation of WHO intra-action review in Egypt

Because of the COVID-19 outbreak, Mass gathering restrictions were imposed. The lockdown of the Higher Education Institutions was obligatory to save lives. In February 2021 in Egypt, HEIs were allowed to ease the lockdown restrictions on a case-by-case basis gradually. In this paper, we propose a risk evaluation of planned regular mass gathering events during the pandemic, such as students gathering on-campus during indoor exams, by implementing WHO COVID-19 Strategic Preparedness and Response Plan through Intra-Action Review guidance. This one-group posttest-only design study was done on October 6 University campus during indoor students' exams in Giza, Egypt. We conducted IAR to implement the WHO's COVID- 19 SPRP; Country-level coordination; risk communication; surveillance, rapid response teams; points of entry; infection prevention control; laboratories; supply chain; case management; essential health services, and other possible topics. Between February-21, 2021; April-10, 2021, 25,927 students attended the on-campus living exams. Our result suggests that the high level of Readiness–Capacity during mass gatherings will reduce COVID-19 transmission. The most compelling evidence is the significance of synchronization between the ten pillars in preventing COVID-19 transmission. These findings may be used to influence decision-making for continual improvement of the operational planning guidelines during the outbreaks.

A Mass Gathering Medicine and Event Medicine during Thaipusam 2023: A Crowd Medicine and Medical Standby Perspective

Medical standby is an event that was assigned to the emergency department to orchestrate the flow of medical management and the safety of the people who were involved during the event. The challenge started weeks or sometimes months before the occasion, as it may include more than one team for the event according to the requirements that have been standardized by the governing bodies. The preparedness of medical standby becomes more challenging as it requires dedicated and state-of-the-art resuscitation equipment to perform maximum medical life-saving procedures prior to the patient's dispatch to the selected hospital. This is a report of the Selayang medical team, which led multiple medical agencies to stay alert 24 hours a day during the first Thaipusam’s medical stand-by after the pandemic.

Dengue Outbreak in Pakistan: Impact on Global Mass Gathering Events?

Abstract

How the Italian Formula 1 Gran Prix 2022 mass gathering event compares to the Arbon model: a descriptive study.

To describe the healthcare resources implemented during the Italian Formula 1 Grand Prix (F1GP) and to calculate the patient presentation rate (PPR) based on both real data and a prediction model. Observational and descriptive study conducted from Sep 9 to Sep 11, 2022, during the Italian F1GP hosted in Monza (Italy). Maurer's formula was applied to decide the number and type of health resources to be allocated. Patient presentation rate (PPR) was computed based on real data (PPR_real) and based on the Arbon formula (PPR_est). Of 336000 attendees, n=263 requested medical assistance with most of them receiving treatment at the advanced medical post and n=16 needing transport to the hospital. The PPR_real was 51 for Friday, 78 for Saturday, 134 for Sunday, and 263 when considering the whole event as a single one. The PPR_est resulted in 85 for Friday, 93 for Saturday, 97 for Sunday, and 221 for the total population. A careful organization of healthcare resources could mitigate the impact of the Italian F1GP on local hospital facilities. The Arbon formula is an acceptable model to predict and estimate the number of patients requesting medical assistance, but further investigation needs to be conducted to implement the model and tailor it to broader categories of MGE.

PLANEJAMENTO MÉDICO PARA EVENTOS ESPORTIVOS DE MASSA NO BRASIL

ABSTRACT Introduction: Medical planning for mass gathering events is founded on the structuring of assistance to the population involved and the preservation of the response capacities of the local healthcare system. Large sporting events attended by crowds are increasingly common in society. These events have been shown to be dangerous, generating higher incidences of injuries and illnesses than usual. Thus, planning and the interaction among various public and private sectors are required for the prevention of and response to emergencies and incidents involving multiple victims. Methods: Recently published studies on medical planning for large sports events and current federal agency legislation were selected to conduct an updated review on the subject. Results: After reading titles and abstracts, 159 papers were chosen for a full reading, 50 of which met the eligibility criteria and were included as the basis for this review. The size of the audience, the weather, and the behavior of the crowd seem to contribute significantly to the estimated need for resources in sporting events. Conclusion: Mass events require planning for prevention and to strengthen the resilience of host communities. There is a still a lack of evidence that these events increase the risk of the mass spreading of disease. Level of Evidence: V; Expert opinion .

Super Bowl LVI: Coordinating the Joint Information Center.

The Super Bowl is one of the biggest annual sporting events that creates unique challenges for public health preparedness. The objective of this brief is to discuss the successes and challenges of the Joint Information Center (JIC) during Super Bowl LVI. This study analyzed the JIC within 4 realms: pre-activation planning, public safety and alert messaging, communication, and credentialing and access. Pre-activation planning was not attended by all agencies, which made it difficult for effective communication during the activation period. Innovative platforms and social media themes were successfully deployed to enhance inter-operational communications and public safety messaging. Lastly, delayed credentialing and access to the Super Bowl Stadium decreased the ability to have context to safety preparedness. This study recommends that many of the JIC's successes should be translated to future mass-gathering events. Additionally, we urge that all agencies participate during pre-activation and activation periods to enhance safety operations and communications moving forward.

Assessing pandemic era stadium events and infections using mobile phone based population mobility data: An exploratory study from Ireland, 2021

Mass gathering events (MGEs) attracting local, national, or international crowds presented particular challenges in the context of the coronavirus disease 2019 (COVID-19) pandemic. Sporting, religious, music and other cultural events held during the early months of the pandemic, without social distancing or other safeguards, have been regarded as so-called ‘super spreader’ events. By the summer of 2020, MGEs were generally banned or subject to severe restrictions. Regular European sporting fixtures such as England’s Football Association and Germany’s Bundesliga matches began to return in the autumn with protective measures in place, such as matches initially held behind closed doors, and later with sub-capacity crowd limits and mandatory social distancing [1, 2, 3, 4, 5]. With protective measures in place, and proof of COVID-19 vaccination or recovery required for entry, a series of six sporting MGEs, ‘the All-Ireland Finals’ were held in the Republic of Ireland’s largest stadium, Croke Park in Dublin, during August-September 2021. This study draws on a high-resolution human population mobility dataset to quantify journeys to/from the stadium area on MGE days by destination. The anonymised, aggregated, data used is based on mobile phone usage, and consists of a series of fine-grained geographical origin-destination matrices presenting daily estimates of area to area journey numbers. With mobility from the stadium area serving as a proxy for MGE attendance, this study explores associations between MGE attendance numbers and local COVID-19 infections over subsequent five week periods. No evidence was found of association between attendance at any of the six 2021 All-Ireland MGEs and COVID-19 infections over subsequent five week periods. This finding contrasts with studies of comparable MGEs in 2020, such as English Association Football matches held during spring 2020, and German Bundesliga football matches held during autumn 2020. These differing outcomes may point to the effectiveness of transmission mitigation policies and behaviours.

Measurement and rapid assessment of indoor air quality at mass gathering events to assess ventilation performance and reduce aerosol transmission of SARS-CoV-2.

To assess risk factors for COVID-19 transmission and address the closure of mass gathering events since March 2020, the UK Government ran the Events Research Programme (ERP), following which it reopened live events in sports, music, and culture in July 2021. We report the rapid post-occupancy evaluation of Indoor Air Quality (IAQ) and associated long-range airborne transmission risk conducted in the Environmental Study of the ERP. Ten large venues around the UK were monitored with CO2 sensors at a high spatial and temporal resolution during 90 events. An IAQ Index based on CO2 concentration was developed, and all monitored spaces were classified in bands from A to G based on their average and maximum CO2 concentrations from all events. High resolution monitoring and the IAQ Index depicted the overall state of ventilation at live events, and allowed identification of issues with ventilation effectiveness and distribution, and of spaces with poor ventilation and the settings in which long-range airborne transmission risk may be increased. In numerous settings, CO2 concentrations were found to follow patterns relating to event management and specific occupancy of spaces around the venues. Good ventilation was observed in 90% of spaces monitored for given occupancies. Practical applications: High-resolution monitoring of indoor CO2 concentrations is necessary to detect the spatial variation of indoor air quality (IAQ) in large mass gathering event venues. The paper summarises COVID-19 ventilation guidance for buildings and defines a methodology for measurement and rapid assessment of IAQ during occupancy at live events that can be implemented by venue managers. Comparisons of the CO2 concentrations measured during the events identified the spaces at high risk of long-range transmission of airborne pathogens. Building operators should be mindful of the ventilation strategies used relative to the total occupancy in different spaces and the occupant's activities.

The Qatar FIFA World Cup 2022 and camel pageant championships increase risk of MERS-CoV transmission and global spread

Mass gatherings, such as sporting events and festivals, create ideal conditions for human-to-human transmission of a range of infectious diseases, which can rapidly spread globally due to ease of travel.1 In Qatar two mass gathering events are being held simultaneously, the FIFA World Cup 2022 championship2 and the Camel Mzayen Club's camel beauty pageant festival.3 These have attracted hundreds of thousands of people from within the Middle East and across the world. Many are attending both events, interacting closely with each other and with camels, creating ideal conditions for the transmission of camel-associated zoonotic pathogens with epidemic potential.

Large-Scale Urban Multiple-Modal Transport Evacuation Model for Mass Gathering Events Considering Pedestrian and Public Transit System

Mass gathering events occur frequently in urban regions. Not only serious traffic jams, but also safety risks are consequently caused. Although many evacuation strategies have been proposed, the spatiotemporal coordination issue of multiple-modal transport tools is not solved well to deal with the efficiency and safety risk during the traditional evacuations. This study presented a large-scale multi-modal transport macro-optimization evacuation model for urban mass gathering events. By taking full advantages of each kind of public transit vehicles and optimizing their spatiotemporal cooperation with pedestrian evacuation, our models can greatly improve the global evacuation efficiency. Experiments on a realistic event was carried to validate the proposed model. The numerical results demonstrated that, under the premise of no increasing additional vehicle supply, the efficiency of proposed multi-modal transport evacuation can be improved by 49.7%, 46.5%, 118.7%, and 20.8%, compared with pure metro-, bus-, taxi- single-modal-transport evacuation, and simulated multi-modal transport evacuation without adequate optimization, respectively.

Effectiveness of early warning systems in the detection of infectious diseases outbreaks: a systematic review

BackgroundGlobal pandemics have occurred with increasing frequency over the past decade reflecting the sub-optimum operationalization of surveillance systems handling human health data. Despite the wide array of current surveillance methods, their effectiveness varies with multiple factors. Here, we perform a systematic review of the effectiveness of alternative infectious diseases Early Warning Systems (EWSs) with a focus on the surveillance data collection methods, and taking into consideration feasibility in different settings.MethodsWe searched PubMed and Scopus databases on 21 October 2022. Articles were included if they covered the implementation of an early warning system and evaluated infectious diseases outbreaks that had potential to become pandemics. Of 1669 studies screened, 68 were included in the final sample. We performed quality assessment using an adapted CASP Checklist.ResultsOf the 68 articles included, 42 articles found EWSs successfully functioned independently as surveillance systems for pandemic-wide infectious diseases outbreaks, and 16 studies reported EWSs to have contributing surveillance features through complementary roles. Chief complaints from emergency departments’ data is an effective EWS but it requires standardized formats across hospitals. Centralized Public Health records-based EWSs facilitate information sharing; however, they rely on clinicians’ reporting of cases. Facilitated reporting by remote health settings and rapid alarm transmission are key advantages of Web-based EWSs. Pharmaceutical sales and laboratory results did not prove solo effectiveness. The EWS design combining surveillance data from both health records and staff was very successful. Also, daily surveillance data notification was the most successful and accepted enhancement strategy especially during mass gathering events. Eventually, in Low Middle Income Countries, working to improve and enhance existing systems was more critical than implementing new Syndromic Surveillance approaches.ConclusionsOur study was able to evaluate the effectiveness of Early Warning Systems in different contexts and resource settings based on the EWSs’ method of data collection. There is consistent evidence that EWSs compiling pre-diagnosis data are more proactive to detect outbreaks. However, the fact that Syndromic Surveillance Systems (SSS) are more proactive than diagnostic disease surveillance should not be taken as an effective clue for outbreaks detection.

Modeling vaccination and control strategies for outbreaks of monkeypox at gatherings.

The monkeypox outbreak in non-endemic countries in recent months has led the World Health Organization (WHO) to declare a public health emergency of international concern (PHEIC). It is thought that festivals, parties, and other gatherings may have contributed to the outbreak. We considered a hypothetical metropolitan city and modeled the transmission of the monkeypox virus in humans in a high-risk group (HRG) and a low-risk group (LRG) using a Susceptible-Exposed-Infectious-Recovered (SEIR) model and incorporated gathering events. Model simulations assessed how the vaccination strategies combined with other public health measures can contribute to mitigating or halting outbreaks from mass gathering events. The risk of a monkeypox outbreak was high when mass gathering events occurred in the absence of public health control measures. However, the outbreaks were controlled by isolating cases and vaccinating their close contacts. Furthermore, contact tracing, vaccinating, and isolating close contacts, if they can be implemented, were more effective for the containment of monkeypox transmission during summer gatherings than a broad vaccination campaign among HRG, when accounting for the low vaccination coverage in the overall population, and the time needed for the development of the immune responses. Reducing the number of attendees and effective contacts during the gathering could also prevent a burgeoning outbreak, as could restricting attendance through vaccination requirements. Monkeypox outbreaks following mass gatherings can be made less likely with some restrictions on either the number and density of attendees in the gathering or vaccination requirements. The ring vaccination strategy inoculating close contacts of confirmed cases may not be enough to prevent potential outbreaks; however, mass gatherings can be rendered less risky if that strategy is combined with public health measures, including identifying and isolating cases and contact tracing. Compliance with the community and promotion of awareness are also indispensable to containing the outbreak.

Globalisation of antibiotic-resistant bacteria at recurring mass gathering events

Antimicrobial resistance is associated with an estimated 4·95 million deaths annually and is currently a leading cause of death worldwide. 1 Murray CJL Ikuta KS Sharara F et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022; 399: 629-655 Summary Full Text Full Text PDF PubMed Scopus (867) Google Scholar Despite numerous global initiatives to control the surge of antimicrobial resistance, at the current rate of increase, annual deaths from antimicrobial resistance are estimated to rise to 10 million by 2050. This puzzling conundrum indicates that there are unknown factors that continue to increase antimicrobial resistance at a global scale and that identifying them will be crucial in controlling the ongoing antimicrobial resistance pandemic. There are also scarce data about the geographical distribution and evolution of antimicrobial resistance over time in settings outside of health-care facilities, 2 Hay SI Rao PC Dolecek C et al. Measuring and mapping the global burden of antimicrobial resistance. BMC Med. 2018; 16: 78 Crossref PubMed Scopus (89) Google Scholar , 3 Luz CF van Niekerk JM Keizer J et al. Mapping twenty years of antimicrobial resistance research trends. Artif Intell Med. 2022; 123: 102216 Crossref PubMed Scopus (4) Google Scholar and more accurate scientific evidence is required to promote optimal policies to combat antimicrobial resistance.

Are mass gathering events hot spot for spreading of infectious diseases: The Kumbh Mela experience

Kumbh Mela, the largest spiritual mass gathering, witnessed around 240 million pilgrims in 2019 at Prayagraj. The huge gathering poses challenges of different kinds including easy transmission of infectious diseases. This research aims to identify the types and causes of infectious diseases and discuss the government's efforts for health and sanitation management. Secondary data from various reports have been used to support the study for which related websites, Prayagraj Mela Authority reports, peer-reviewed articles, and related literatures were studied. Qualitative and quantitative analyses have been done to find trends and have comparative studies among various Kumbh and Ardh Kumbh Melas. The study finds that there is spread of infectious diseases like Acute respiratory infections, fever, skin disease, dysentery etc. during the Kumbh Mela due to the huge population, restricted space, pressure on sanitation infrastructure, unhygienic living conditions, solid and liquid wastes generated during Mela, and pilgrims' social and religious psychologies. The number of pilgrims of the occasion has increased heavily with time. Based on the anticipated number various efforts and initiatives of the government and management such as advance disease surveillance system, HEAT map, ensuring safe drinking water, better sanitation and healthcare facilities has increased over the years to reduce its impact. Mass gathering events always draw attention to health hazards and in fact the outbreak of the COVID-19 pandemic forced to think about the organization of mass gathering events in future. The mega tent city that accommodates nearly millions of pilgrims in the river bed is significant not only for India but also for mass gathering research at the international level to draw policy and provide the opportunity to generate the evidence and document base for risk prevention, mitigation, and management planning of infectious diseases and disasters.

Transmission of Antimicrobial Resistant Bacteria at the Hajj: A Scoping Review.

The Hajj is an annual religious mass gathering event held in Makkah, Saudi Arabia. With millions of participants from across the globe attending the Hajj, the risk of importation, transmission, and global spread of infectious diseases is high. The emergence of antimicrobial resistant (AMR) bacteria is of worldwide concern and the Hajj poses a serious risk to its dissemination. This review aims to synthesize published literature on AMR bacteria acquisition and transmission associated with the Hajj. We searched electronic databases to identify literature published between January 1990 and December 2021. The search strategy included medical subject headings and keyword terms related to AMR bacteria and the Hajj. After screening 2214 search results, 51 studies were included in the analysis. The review found 6455 AMR bacteria transmissions related to the Hajj. Thirty predominantly enteric or respiratory disease-causing AMR bacterial species were reported with isolates identified in cases on five continents. Most were male, aged above 50 years and were diagnosed in Makkah. Most cases were identified through hospital-based research; few cases were detected in community or primary health care settings. This review provides a contemporary account of knowledge related to AMR transmission at the Hajj. It emphasizes the need for the enhancement of surveillance for AMR bacteria globally.

Digital COVID-19 surveillance tool for a mass gathering event - a prospective cohort study

Abstract Introduction Mass gatherings have been associated with a high risk of SARS-CoV-2 transmission. On-site research can foster knowledge of risk factors for infections and improve risk assessments and precautionary measures at future events. We tested a web-based participatory disease surveillance tool to detect COVID-19 infections at and after an outdoor mass gathering by collecting self-reported COVID-19 symptoms and tests. Methods We conducted a digital prospective observational cohort study among fully immunized attendees of a sports event that took place from September 2 to 5, 2021 in Thuringia, Germany. Participants used our study app to report demographic data, COVID-19 tests, symptoms, and their contact behavior. This self-reported data was used to define probable and confirmed COVID-19 cases during the full “study period” (08/12/2021 - 10/31/2021) and within the 14-day “surveillance period” during and after the event, in which the highest likelihood of an event related COVID-19 outbreak could be expected (09/04/2021 - 09/17/2021). Results A total of 2,808 of 9,242 (30.4%) event attendees participated in the study. During the study period, 776 symptoms and 5,255 COVID-19 tests were reported in the study app. During the surveillance period, seven PCR positive COVID-19 cases were found to be associated with the event. This translated to an estimated seven-day incidence of ∼125/100,000 cases (95% CI [67.7/100,000, 223/100,000]), which was comparable to the average age-matched incidence in Germany during this time (118.3/100,000). Conclusions COVID-19 cases attributable to the mass gathering were comparable to the German-wide age-matched incidence, implicating that our active participatory surveillance tool was able to detect mass gathering related infections. Further studies are needed to evaluate and apply our participatory disease surveillance tool in other mass gathering settings. Key messages • Our digital COVID-19 surveillance tool for mass gathering events was easy to implement within the organizational structure of the event and well accepted amongst event attendees. • Our active participatory surveillance tool was able to detect mass gathering related infections comparable to the Germany-wide incidence.

SARS-COV-2 ANTIGEN SCREENING DURING THE FIRST POST-LOCKDOWN MAJOR MUSIC FESTIVAL IN NOVI SAD, SERBIA, IN JULY 2021

Many countries have resumed mass gathering events like music festivals, despite potential risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmissions. This study aimed to examine the frequency of SARS-CoV-2 infection among visitors to a mass event, the EXIT festival, in relation to the proposed preventive measures. A total of 466 visitors were included in this longitudinal study conducted in Novi Sad, Serbia, during July, 2021. All subjects were tested with RDT-Ag test for the presence of SARS-CoV-2 virus at the beginning of the study and seven days after. Basic socio-demographic and epidemiological data were collected through a questionnaire. The average age of participants was 28.34 ± 8.87 years with the majority of men (53.7%). There were 170 (36.5%) vaccinated participants. A 97.1% in vaccinated and 92.2% in unvaccinated group, reported to regularly wear a protective mask (p=0.029). At the second cross-sectional testing, 354 subjects were tested, of which 150 (42.4%) were vaccinated. There was no statistically significant difference in application of preventive measures during and after the festival, in respect to vaccination status of the participants. Twenty participants (5.6%) reported some of the COVID-19-like symptoms in the first seven days after visiting the festival, but no COVID-19 infection was confirmed at the RDT-Ag testing. Despite the potential effectiveness of applied preventive measures such as RDT-Ag screening, mask-wearing and vaccination, additional caution is needed when holding these events during a period of high SARS-CoV-2 transmission, as well as when the new virus variants emerge in community.

The experiences of victims in the mass gatherings: a phenomenological study

INTRODUCTION: The mass gathering events are becoming a big source of concern among public health practitioners. These events can affect a population’s health in different ways. The study aimed to identify mechanisms associated with morbidity and mortality in mass gathering (MGs) events. MATERIAL AND METHODS: This is a qualitative study that was conducted under a phenomenological approach. The study population included 21 people who were hospitalized due to injuries in the mass gatherings. Data collection was conducted through semi-structured and in-depth interviews. RESULTS: A total number of 21 interviews were conducted in this study. Participants included 17 males and four females. Thematic analysis was used to identify 21 different themes and the themes were classified into five main areas. These five areas include Individuals' unpreparedness, unprepared relief organizations, lack of proper response plans, and risky behavior and psychological reactions. CONCLUSIONS: The lived experiences of MGs victims showed that they need to be better educated at the community level about the potential MGs’ health risks. One of the most effective measures to reduce mortality in the MGs is risk governance. Risk governance must be a national policy and priority at the time of holding large gatherings.

Modelling the dynamic relationship between spread of infection and observed crowd movement patterns at large scale events

Understanding how contact patterns arise from crowd movement is crucial for assessing the spread of infection at mass gathering events. Here we study contact patterns from Wi-Fi mobility data of large sports and entertainment events in the Johan Cruijff ArenA stadium in Amsterdam. We show that crowd movement behaviour at mass gathering events is not homogeneous in time, but naturally consists of alternating periods of movement and rest. As a result, contact duration distributions are heavy-tailed, an observation which is not explained by models assuming that pedestrian contacts are analogous to collisions in the kinetic gas model. We investigate the effect of heavy-tailed contact duration patterns on the spread of infection using various random walk models. We show how different types of intermittent movement behaviour interact with a time-dependent infection probability. Our results point to the existence of a crossover point where increased contact duration presents a higher level of transmission risk than increasing the number of contacts. In addition, we show that different types of intermittent movement behaviour give rise to different mass-action kinetics, but also show that neither one of two mass-action mechanisms uniquely describes events.