Risk factors for diarrheal diseases among pilgrims during Arba'een mass gathering: a case-control study.

BACKGROUND: A significant portion of the Muslim community participates in the Arba'een pilgrimage, with participant numbers increasing each year. There have been relatively few studies on the health of Arba'een Mass gathering (MG). Researching the prevalence and distribution of diseases among Arba'een pilgrims is essential to recognize any outbreaks and take timely responses to contain them. The current study aimed to identify exposures and risk factors for diarrheal disease in pilgrims who referred to the clinics located in Iraq among the Arba'een MG in 2023. METHODS: This case-control study randomly selected 200 outpatients (100 cases and 100 controls) who were referred to Iraq clinics. Cases were patients with gastrointestinal symptoms (diarrhea), while controls were randomly selected from unaffected pilgrims at the same time for the cases. The study groups matched for age, and sex. Face-to-face interviews using a reliable field based checklist of the Center for Disease Control and Prevention of Iran's Ministry of Health to collect potential exposures and risk factors for diarrheal disease. Multiple logistic regression was used to estimate the crude and adjusted odds ratio (AOR) for the risk of diarrhea with a 95% confidence interval (CI). RESULTS: The average age of the participants was 38.6 years. Diarrhea in 100% and fever in 81% were the most common clinical symptoms in patients. Having underlying diseases was not associated with an increased risk of diarrhea disease (P > 0.05). Regarding risk factors for diarrheal, the final analysis after adjusting for potential confounders indicated that consumption of insanitary (unpackaged) drinking water (AOR = 1.95; 95% CI: 1.05-3.6; P = 0.024), inappropriate hand washing (AOR = 3.82; 95% CI: 1.7-8.6; P = 0.001), ritual foods (AOR = 2.56; 95% CI: 1.3-5.2; P = 0.004), and public toilets (AOR = 1.46; 95% CI: 1.04-4.3; P = 0.038) were significantly increased the likelihood of diarrheal disease. CONCLUSIONS: Contamination of water sources, food, inadequate and poor hand washing were the most common sources of diarrheal diseases among Arba'een pilgrims. The results indicate that the potential occurrence of outbreaks, especially water- and foodborne diseases, threatens participants in the Arba'een MG. It is recommended to provide risk assessment, improve pilgrims' awareness, pre-and post-screening, vaccination, compliance with personal hygiene, improvement of the environment, provision of sanitary water and food sources and hygienic disposal of sewage, laboratory diagnosis to identify the common types of pathogens in Arba'een MG.

From Fax to Secure File Transfer Protocol: The 25-Year Evolution of Real-Time Syndromic Surveillance in England.

The purpose of syndromic surveillance is to provide early warning of public health incidents, real-time situational awareness during incidents and emergencies, and reassurance of the lack of impact on the population, particularly during mass gatherings. The United Kingdom Health Security Agency (UKHSA) currently coordinates a real-time syndromic surveillance service that encompasses 6 national syndromic surveillance systems reporting on daily health care usage across England. Each working day, UKHSA analyzes syndromic data from over 200,000 daily patient encounters with the National Health Service, monitoring over 140 unique syndromic indicators, risk assessing over 50 daily statistical exceedances, and taking and recommending public health action on these daily. This English syndromic surveillance service had its origins as a small exploratory pilot in a single region of England in 1999 involving a new pilot telehealth service, initially reporting only on "cold or flu" calls. This pilot showed the value of syndromic surveillance in England, providing advanced warning of the start of seasonal influenza activity over existing laboratory-based surveillance systems. Since this initial pilot, a program of real-time syndromic surveillance has evolved from the single-system, -region, -indicator pilot (using manual data transfer methods) to an all-hazard, multisystem, automated national service. The suite of systems now monitors a wide range of syndromes, from acute respiratory illness to diarrhea to cardiac conditions, and is widely used in routine public health surveillance and for monitoring seasonal respiratory disease and incidents such as the COVID-19 pandemic. Here, we describe the 25-year evolution of the English syndromic surveillance system, focusing on the expansion and improvements in data sources and data management, the technological and digital enablers, and novel methods of data analytics and visualization.

Pathogen prioritisation for wastewater surveillance ahead of the Paris 2024 Olympic and Paralympic Games, France.

BackgroundWastewater surveillance is an effective approach to monitor population health, as exemplified by its role throughout the COVID-19 pandemic.AimThis study explores the possibility of extending wastewater surveillance to the Paris 2024 Olympic and Paralympic Games, focusing on identifying priority pathogen targets that are relevant and feasible to monitor in wastewater for these events.MethodsA list of 60 pathogens of interest for general public health surveillance for the Games was compiled. Each pathogen was evaluated against three inclusion criteria: (A) analytical feasibility; (B) relevance, i.e. with regards to the specificities of the event and the characteristics of the pathogen; and (C) added value to inform public health decision-making. Analytical feasibility was assessed through evidence from peer-reviewed publications demonstrating the detectability of pathogens in sewage, refining the initial list to 25 pathogens. Criteria B and C were evaluated via expert opinion using the Delphi method. The panel consisting of some 30 experts proposed five additional pathogens meeting criterion A, totalling 30 pathogens assessed throughout the three-round iterative questionnaire. Pathogens failing to reach 70% group consensus threshold underwent further deliberation by a subgroup of experts.ResultsSix priority targets suitable for wastewater surveillance during the Games were successfully identified: poliovirus, influenza A virus, influenza B virus, mpox virus, SARS-CoV-2 and measles virus.ConclusionThis study introduced a model framework for identifying context-specific wastewater surveillance targets for a mass gathering. Successful implementation of a wastewater surveillance plan for Paris 2024 could incentivise similar monitoring efforts for other mass gatherings globally.

Exploring the experiences, motivations, and skillsets of nurse volunteers during Hajj: implications for enhancing volunteer programs.

BACKGROUND: The annual Islamic pilgrimage of Hajj attracts millions of pilgrims from around the world, necessitating the involvement of healthcare professionals, including nurse volunteers, to ensure the safety and well-being of attendees. This study aims to explore the experiences, motivations, and skillsets of nurse volunteers during the Hajj pilgrimage, focusing on the personal, professional, and spiritual dimensions of volunteering, and providing insights to enhance volunteer programs. METHODS: The demographic data shows that the majority of nurse volunteers during Hajj 2022 fell in the 30-39 age group and were predominantly women. The study provides insights into the interest, experience, and motives for volunteering, with spiritual motives cited as a primary driver. An overview of volunteer hours, perceived benefits, and pre-existing skills reveals diverse commitments and skillsets among the volunteers. RESULTS: Nurse volunteers during Hajj 2022 show diverse age and gender composition, strong commitment, spiritual motives, varied engagement, and professional skills. Team dynamics, skills development, and positive experiences are crucial. A potential gap exists in preparatory education. Significant associations are found between age, volunteer hours, training, skill practice, and gender. CONCLUSION: This study highlights the multifaceted benefits of volunteering during Hajj and underscores the need for decision-makers to devise strategies that cater to diverse needs, foster collaboration, and enhance the preparedness of nurse volunteers. Further research is suggested to examine the long-term impact of volunteering during Hajj on nurses' professional development and personal well-being and to evaluate the effectiveness of various recruitment strategies, training programs, and support initiatives.

Classic heat stroke in a desert climate: A systematic review of 2632 cases.

BACKGROUND: Although classic heat stroke (HS) is one of the most ancient conditions known to humans, the description of its early clinical manifestations, natural course, and complications remains uncertain. OBJECTIVES: A systematic review of the demographics, clinical characteristics, biomarkers, therapy, and outcomes of HS during the Muslim (Hajj) pilgrimage in the desert climate of Mecca, Saudi Arabia. METHODS: We searched the MEDLINE, Embase, Web of Science Core Collection, SCOPUS, and CINAHL databases from inception to April 2022. We summarized the data from eligible studies and synthesized them in narrative form using pooled descriptive statistics. RESULTS: Forty-four studies, including 2632 patients with HS, met the inclusion criteria. Overweight or obesity, diabetes, and cardiovascular disease were prevalent among cases of HS. Evidence suggests that extreme hyperthermia (pooled mean = 42.0°C [95% confidence interval (CI): 41.9, 42.1], range 40-44.8°C) with hot and dry skin (>99% of cases) and severe loss of consciousness (mean Glasgow Coma Scale <8 in 53.8% of cases) were the dominant clinical characteristics of classic HS. Hypotension, tachypnea, vomiting, diarrhea, and biochemical biomarkers indicating mild-to-moderate rhabdomyolysis, acute kidney, liver, heart injury, and coagulopathy were frequent at the onset. Concomitantly, stress hormones (cortisol and catecholamines) and biomarkers of systemic inflammation and coagulation activation were increased. HS was fatal in 1 in 18 cases (pooled case fatality rate = 5.6% [95%CI: 4.6, 6.5]). CONCLUSIONS: The findings of this review suggest that HS induces an early multiorgan injury that can progress rapidly to organ failure, culminating in death, if it is not recognized and treated promptly.

Undiagnosed and missed active pulmonary tuberculosis during mass gatherings: a prospective cross-sectional study from the Hajj pilgrimage.

Mass gatherings increase the risk of infectious diseases transmission including tuberculosis (TB). The Hajj pilgrimage to Mecca, Saudi Arabia, is attended by over 2 million pilgrims many of whom are from high TB-burden countries, and has been linked to increased risk of TB acquisition among travellers. We investigated the burden of undiagnosed and missed active pulmonary TB (PTB) among Hajj pilgrims symptomatic for cough. The study was conducted among hospitalised and non-hospitalised travellers attending the Hajj pilgrimage in 2016 and 2017. Questionnaires were used to collect relevant data and sputum samples were collected from participants and processed using the Xpert MTB-RIF assay. Non-hospitalised pilgrims (n = 1510) originating from 16 high and medium TB-burden countries were enrolled. Undiagnosed, rifampicin-sensitive, active PTB was identified in 0.7%. Comorbidities (adjOR = 5.9 [95% CI = 1.2-27.8]), close contact with a TB case (adjOR = 5.9 [95% CI = 1.2-27.8]), cough in household (adjOR = 4.46 [95% CI = 1.1-19.5]), and previous TB treatment (adjOR = 10.1 [95% CI = 4.1-98.1]) were independent risk factors for TB. Of the hospitalised pilgrims (n = 304), 2.9% were positive for PTB, and 2.3% were missed, including a rifampicin-resistant case. History of TB treatment was associated with increased risk of TB (adjOR = 8.1 [95% CI = 1.3-48.7]). International mass gatherings may play an important role in the global epidemiology of TB. Preventive measures should be directed to reducing the risk of TB importation and transmission during Hajj and other similar events.

Effectiveness of Public Health Digital Surveillance Systems for Infectious Disease Prevention and Control at Mass Gatherings: Systematic Review.

BACKGROUND: Mass gatherings (MGs; eg, religious, sporting, musical, sociocultural, and other occasions that draw large crowds) pose public health challenges and concerns related to global health. A leading global concern regarding MGs is the possible importation and exportation of infectious diseases as they spread from the attendees to the general population, resulting in epidemic outbreaks. Governments and health authorities use technological interventions to support public health surveillance and prevent and control infectious diseases. OBJECTIVE: This study aims to review the evidence on the effectiveness of public health digital surveillance systems for infectious disease prevention and control at MG events. METHODS: A systematic literature search was conducted in January 2022 using the Ovid MEDLINE, Embase, CINAHL, and Scopus databases to examine relevant articles published in English up to January 2022. Interventional studies describing or evaluating the effectiveness of public health digital surveillance systems for infectious disease prevention and control at MGs were included in the analysis. Owing to the lack of appraisal tools for interventional studies describing and evaluating public health digital surveillance systems at MGs, a critical appraisal tool was developed and used to assess the quality of the included studies. RESULTS: In total, 8 articles were included in the review, and 3 types of MGs were identified: religious (the Hajj and Prayagraj Kumbh), sporting (the Olympic and Paralympic Games, the Federation International Football Association World Cup, and the Micronesian Games), and cultural (the Festival of Pacific Arts) events. In total, 88% (7/8) of the studies described surveillance systems implemented at MG events, and 12% (1/8) of the studies described and evaluated an enhanced surveillance system that was implemented for an event. In total, 4 studies reported the implementation of a surveillance system: 2 (50%) described the enhancement of the system that was implemented for an event, 1 (25%) reported a pilot implementation of a surveillance system, and 1 (25%) reported an evaluation of an enhanced system. The types of systems investigated were 2 syndromic, 1 participatory, 1 syndromic and event-based, 1 indicator- and event-based, and 1 event-based surveillance system. In total, 62% (5/8) of the studies reported timeliness as an outcome generated after implementing or enhancing the system without measuring its effectiveness. Only 12% (1/8) of the studies followed the Centers for Disease Control and Prevention guidelines for evaluating public health surveillance systems and the outcomes of enhanced systems based on the systems' attributes to measure their effectiveness. CONCLUSIONS: On the basis of the review of the literature and the analysis of the included studies, there is limited evidence of the effectiveness of public health digital surveillance systems for infectious disease prevention and control at MGs because of the absence of evaluation studies.

Foodborne botulism outbreak involving different nationalities during the Rugby World Cup: critical role of credit card data and rapid international cooperation, France, September 2023.

In September 2023, a severe outbreak of type B botulism with fifteen cases was linked to consumption of canned sardines at a restaurant in Bordeaux, France, during the Rugby World Cup. The cases were from seven countries. One death was recorded. Outbreak investigation using credit card data, rapid communication between health authorities of the affected countries and broad media communication allowed identification of cases and exposed persons and prevented further severe outcomes.

Psychosocial interventions and strategies to support young people at mass gathering events: a scoping review.

OBJECTIVES: To improve health and safety outcomes at mass gathering events (MGEs) for young attendees, it is essential to understand the psychosocial factors that may influence behaviour so that the implementation of support strategies before, during and after MGEs can be developed to enhance outcomes. This review identifies the psychosocial outcomes that may occur at MGEs, including social connection, substance use, risky behaviours and psychological distress and examines what interventions have been implemented to target these outcomes. STUDY DESIGN: Scoping review. METHODS: This study examined MGE psychosocial interventions with predominantly youth attendees was conducted using the Preferred Reporting Items of Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Papers were collected from the databases CINAHL, MEDLINE, Embase and PsycINFO. Titles and abstracts were scanned for relevance, followed by a full-text screening. Information relevant to the research question was extracted from papers meeting the inclusion criteria. RESULTS: Twenty-six papers met the inclusion criteria. The psychosocial factors that were most studied included social influence, social interactions and psychological stressors, which lead to behaviours such as excessive alcohol consumption, drug taking, risky casual sex and risk taking amongst psychological factors of young attendees. Effective interventions implemented before or during MGEs, such as alcohol-free zones, antidrinking campaigns, psychoeducation and disapproval from parents with regard to drinking alcohol, showed promise in reducing harms. CONCLUSION: Psychosocial interventions have the potential to reduce harms and enhance well-being for young people attending MGEs. This review has identified gaps and opportunities in the current literature with regard to psychosocial interventions and strategies to support young people at MGEs and makes recommendations to support the development and refinement of evidence-based interventions aimed at young MGE attendees.

Clashes and crowds: protests, riots, and other mass gathering events in North America 2021-2022.

OBJECTIVE: This study aimed to provide an overview of the scope and challenges of historic events and help better prepare emergency healthcare services for future similar mass gathering events. STUDY DESIGN: This was a retrospective descriptive analysis of protest and conflict events in North America from 2021 to 2022. INTRODUCTION: Recent protests, riots, and other conflict events in North America have highlighted the increasing challenges hospital-based and prehospital healthcare providers face. This study provides a retrospective descriptive analysis of protest and conflict events in North America from 2021 to 2022, which may aid emergency healthcare services in understanding the scope and challenges of historic events and help better prepare for future similar mass gathering events. METHODS: Data collection was performed using a retrospective database search through the Armed Conflict Location & Event Data Project (ACLED) database. The ACLED database was searched using the internal database search functions for recorded events that occurred in North America from January 1, 2021 to December 31, 2022. Date, event type, event subtype, the country of incident, and fatality numbers were extracted. The results were exported into an Excel spreadsheet and analyzed independently by L.C., H.S., and R.H. RESULTS: There were a total of 52,529 recorded events of political conflict in North America, with 30,269 events in 2021 and 29,260 in 2022. Political conflict events included protests (40,934, 68.8%), violence against civilians (11,532, 19.4%), strategic developments (2,819, 4.7%), battles (2,293, 3.9%), riots (1,909, 3.2%), and remote violence (42, 0.1%). Violence against civilians caused the highest fatalities (13,466, 82.6%), followed by battles (2,662, 16.3%), riots (111, 0.7%), strategic developments, remote violence, and protests (57, 6, and 3 respectively). CONCLUSION: Mexico and the United States accounted for most of the political conflicts in North America across 2021 and 2022. In Mexico, protests and violence against civilians were the most common types of conflict, with the latter accounting for the comparatively high fatality compared with the other countries. Battles in Mexico between cartels were the most deadly political conflicts recorded in North America.

Contagion of coronavirus disease-the first family cluster of Pakistan: a case series.

Coronavirus Disease has resulted in public health crisis all over the world. We describe the case series of a family, who travelled together to a mass gathering in Iraq, toured Syria, Lebanon, and Doha and returned to Karachi. The data describes the demographic and clinical features of these six members. There were three males and three females. One developed severe disease and died. Incubation period was between 8-14 days. Four patients were symptomatic, had diabetes mellitus and hypertension; and presented with fever. They also had bilateral airspace opacifications on chest X-ray. Our study describes familial clustering of SARS-CoV-2 and its person-to-person transmission.

Large-scale sporting events during the COVID-19 pandemic: insights from the FIFA World Cup 2022 in Qatar with an analysis of patterns of COVID-19 metrics.

The 2022 FIFA World Cup (FIFA-WC) held in Qatar presented unique challenges, given the potential for rapid transmission of coronavirus disease 2019 (COVID-19) among over 1.4 million international fans attending the event. This study aimed to investigate the impact of the FIFA-WC 2022 on COVID-19 cases, deaths, and reproduction rate (R0) in Qatar. Additionally, it sought to understand the implications of hosting large-scale events during a pandemic without COVID-19 restrictive measures, providing critical insights for future decision-making. Data from "Our World in Data" were analysed for three distinct periods: one week before the FIFA-WC (week-preWC), the four weeks of the event (week-1WC to week-4WC), and one week after (week-postWC). The results revealed a significant increase in COVID-19 cases during week-3WC and week-4WC (compared to week-preWC) in Qatar, followed by a subsequent decrease during the week-postWC. Notably, Qatar experienced a more pronounced surge in positive cases than the global trend. Regarding COVID-19-related deaths, Qatar's peak occurred during week-2WC, while globally deaths peaked from week-3WC to week-postWC. Nevertheless, Qatar's death toll remained relatively low compared to the global trend throughout the event. The findings highlight that the FIFA-WC 2022 in Qatar demonstrated the feasibility of organizing large-scale sporting events during a pandemic with appropriate measures in place. They emphasize the importance of high vaccination coverage, continuous monitoring, and effective collaboration between event organizers, healthcare authorities, and governments. As such, the event serves as a valuable model for future gatherings, underlining the significance of evidence-based decision-making and comprehensive public health preparedness.

FIFA World Cup Qatar 2022TM stadium patient evacuation: A system testing simulation-based exercise.

BACKGROUND: As the State of Qatar is soon to host the Federation International of Football Associations (FIFA) 2022 World Cup tournament, the health sector has also been preparing for the event to increase its capacity to meet the expected additional health demand. The readiness of the health sector is being tested and improved through a number of simulation-based exercises. In this case, it relates to testing in a realistic manner the complete evacuation process of a patient using two very different modes of transportation, from a distant FIFA stadium up to the handover phase in the main trauma center in the State of Qatar. METHOD: In this controlled simulation-based pilot study, the total evacuation time of a patient from the 60,000-fan capacity Al Bayt Stadium (ABS), situated in a rural northern part of Qatar, to Hamad General Hospital (HGH) Trauma Resuscitation Unit (TRU) situated approximately 50 km away, was compared when transported by helicopter and by ambulance. The Scenario for the simulation was based on a player who sustained a fractured lower leg and a concussion during a football match and needed urgent evacuation from the ABS Players' Medical Clinic near Al Khor to HGH in Doha. The same Scenario was enacted twice, the first time with a ground Hamad Medical Corporation Ambulance Service (HMCAS) ambulance and the second time with an HMCAS LifeFlight helicopter. RESULTS: The transportation phase for Scenario 2 (LifeFlight helicopter) was 63% faster than for Scenario 1 (ground ambulance). However, upon arrival at HGH, the patient arrived sooner at the TRU in Scenario 1 compared with Scenario 2. The overall mission time was thus only 6 minutes and 22 seconds faster by LifeFlight helicopter as compared with the ground ambulance. CONCLUSIONS: According to this simulation-based pilot study, using a helicopter to transport patients 50 km from the ABS 2022 FIFA World Cup stadium to the HGH TRU was only marginally faster by helicopter than using a ground-based ambulance. In addition, the ambulance was not using emergency driving operations, which when used would have further reduced the time taken for the ambulance to reach HGH TRU. Therefore, having a helicopter on standby there would not significantly improve the transport time of a critically ill/injured patient's access to definitive care and will not be available during the FIFA World Cup Qatar 2022TM unless it is called upon to respond to a mass casualty incident or bring additional Critical Care Paramedic resources to the stadium.

Faith Community Engagement to Mitigate COVID-19 Transmission Associated with Mass Gathering, Uman, Ukraine, September 2021.

Annually, ≈30,000 Hasidic and Orthodox Jews travel to Uman, Ukraine, during the Jewish New Year to pray at the burial place of the founder of the Breslov Hasidic movement. Many pilgrims come from the northeastern United States. The global health implications of this event were seen in 2019 when measles outbreaks in the United States and Israel were linked to the pilgrimage. The 2020 pilgrimage was cancelled as part of the COVID-19 travel restrictions imposed by the government of Ukraine. To prepare for the 2021 event, the National Public Health Institute, the Public Health Center of Ukraine, organized mitigation measures for pilgrims arriving in Uman, and the CDC COVID-19 International Task Force assisted with mitigation measures for pilgrims coming from the United States. We describe efforts to support COVID-19 mitigation measures before, during, and after this mass gathering and lessons learned for future mass gatherings during pandemics.

COVID-19 cases in spectators returning to Finland from UEFA Euro 2020 matches in Saint Petersburg.

UEFA Euro 2020 tournament was scheduled to take place in 2020, but due to the coronavirus disease 2019 (COVID-19) pandemic was rescheduled to start on 11 June 2021. Approximately 4500 Finnish spectators participated, travelling between Finland and Russia during the period of 16 to 30 June to attend matches played on 16 and 21 June. A total of 419 persons returning from Russia or with a connection to Russia were detected positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Of the 321 sequenced samples 303 turned out to be of the Delta variant. None of these cases was hospitalised. In the following weeks findings of the Delta variant increased rapidly. Thus, EURO 2020 travel-related imported cases likely facilitated this rapid surge of Delta variant, but this impact would likely have been seen with the typical increase in the number of travellers entering Finland later in the summer.

Disease transmission and mass gatherings: a case study on meningococcal infection during Hajj.

BACKGROUND: Mass gatherings can not only trigger major outbreaks on-site but also facilitate global spread of infectious pathogens. Hajj is one of the largest mass gathering events worldwide where over two million pilgrims from all over the world gather annually creating intense congestion. METHODS: We developed a meta-population model to represent the transmission dynamics of Neisseria meningitidis and the impact of Hajj pilgrimage on the risk of invasive meningococcal disease (IMD) for pilgrims population, local population at the Hajj site and country of origin of Hajj pilgrims. This model was calibrated using data on IMD over 17 years (1995-2011) and further used to simulate potential changes in vaccine policy and endemic conditions. RESULTS: The effect of increased density of contacts during Hajj was estimated to generate a 78-fold increase in disease transmission that impacts not only pilgrims but also the local population. Quadrivalent ACWY vaccination was found to be very effective in reducing the risk of outbreak during Hajj. Hajj has more limited impact on IMD transmission and exportation in the pilgrim countries of origin, although not negligible given the size of the population considered. CONCLUSION: The analysis performed highlighted the amplifying effect of mass gathering on N. meningitidis transmission and confirm vaccination as a very effective preventive measure to mitigate outbreak risks.

Implementing a Patient Tracking System in a Large EMS System.

Objective: Accurate tracking of patients poses a significant challenge to prehospital and hospital emergency medical providers in planned and unplanned events. Previous reports on patient tracking systems are limited primarily to descriptive reports of post incident reviews or simulated exercises. Our objective is to report our experience with implementing a patient barcode tracking system during various planned events within a large urban EMS system.Methods: In 2018, representatives from the Chicago Department of Public Health, Chicago Fire Department EMS, private EMS agencies, and 27 hospitals in the Chicago EMS System were trained on the use of a web-based patient tracking system using barcoded triage tags and wristbands to monitor triage category and hospital destination during an event. The tracking system was used on two planned operational days and three pre-planned mass gathering events. The primary outcome was the percent of patients initially scanned by EMS that were scanned by the hospital. Descriptive statistics were collected. Barriers to patient tracking system use were identified.Results: Each event was reviewed for the number of patients assigned a barcode identifier and scanned by EMS that were then scanned by the hospital. In the first planned operational day, 57% (359/622) of patients initially scanned by EMS were scanned by the hospital. In the second planned operational day, 88% (355/402) of EMS scanned patients were scanned by the hospital and 37% (133/355) were assigned a final disposition. At three city mass gathering events, there were 79% (50/63), 95% (190/199), and 82% (46/56) of EMS scanned patients also scanned by hospitals. Logistical and technological challenges were documented.Conclusions: Use of a web-based system with barcode identifiers successfully tracked patients from prehospital to hospital during planned operational days and mass gathering events. Percent of scanned patients increased after the first operational day and remained consistent in subsequent events. Limitations to the patient tracking system included logistical and technological barriers. Similar patient tracking systems may be implemented to assist with event management in other EMS systems.

Predicting medical usage rate at mass gathering events in Belgium: development and validation of a nonlinear multivariable regression model.

BACKGROUND: Every year, volunteers of the Belgian Red Cross provide onsite medical care at more than 8000 mass gathering events and other manifestations. Today standardized planning tools for optimal preventive medical resource use during these events are lacking. This study aimed to develop and validate a prediction model of patient presentation rate (PPR) and transfer to hospital rate (TTHR) at mass gatherings in Belgium. METHODS: More than 200,000 medical interventions from 2006 to 2018 were pooled in a database. We used a subset of 28 different mass gatherings (194 unique events) to develop a nonlinear prediction model. Using regression trees, we identified potential predictors for PPR and TTHR at these mass gatherings. The additional effect of ambient temperature was studied by linear regression analysis. Finally, we validated the prediction models using two other subsets of the database. RESULTS: The regression tree for PPR consisted of 7 splits, with mass gathering category as the most important predictor variable. Other predictor variables were attendance, number of days, and age class. Ambient temperature was positively associated with PPR at outdoor events in summer. Calibration of the model revealed an R2 of 0.68 (95% confidence interval 0.60-0.75). For TTHR, the most determining predictor variables were mass gathering category and predicted PPR (R2 = 0.48). External validation indicated limited predictive value for other events (R2 = 0.02 for PPR; R2 = 0.03 for TTHR). CONCLUSIONS: Our nonlinear model performed well in predicting PPR at the events used to build the model on, but had poor predictive value for other mass gatherings. The mass gathering categories "outdoor music" and "sports event" warrant further splitting in subcategories, and variables such as attendance, temperature and resource deployment need to be better recorded in the future to optimize prediction of medical usage rates, and hence, of resources needed for onsite emergency medical care.

Participatory disease surveillance for a mass gathering - a prospective cohort study on COVID-19, Germany 2021.

BACKGROUND: Mass gatherings (MGs) such as music festivals and sports events 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 MGs. We tested a web-based participatory disease surveillance tool to detect COVID-19 infections at and after an outdoor MG 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 festival that took place from September 2 to 5, 2021 in Saxony-Anhalt, 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 for the full "study period" (08/12/2021 - 10/31/2021) and within the 14-day "surveillance period" during and after the MG, with the highest likelihood of an MG-related COVID-19 outbreak (09/04/2021 - 09/17/2021). RESULTS: A total of 2,808 of 9,242 (30.4%) event attendees participated in the study. Within the study period, 776 individual symptoms and 5,255 COVID-19 tests were reported. During the 14-day surveillance period around and after the MG, seven probable and seven PCR-confirmed COVID-19 cases were detected. The confirmed cases translated to an estimated seven-day incidence of 125 per 100,000 participants (95% CI [67.7/100,000, 223/100,000]), which was comparable to the average age-matched incidence in Germany during this time. Overall, weekly numbers of COVID-19 cases were fluctuating over the study period, with another increase at the end of the study period. CONCLUSION: COVID-19 cases attributable to the mass gathering were comparable to the Germany-wide age-matched incidence, implicating that our active participatory disease surveillance tool was able to detect MG-related infections. Further studies are needed to evaluate and apply our participatory disease surveillance tool in other mass gathering settings.

The role of religion in mitigating the COVID-19 pandemic: the Malaysian multi-faith perspectives.

Social distancing is crucial in breaking the cycle of transmission of COVID-19. However, many religions require the faithful to congregate. In Malaysia, the number of COVID-19 cases spiked up from below 30 in February 2020 to more than a thousand a month later. The sudden increase was mostly linked to a large Islamic gathering attended by 16,000 near the capital, Kuala Lumpur. Another large COVID-19 cluster was from a church gathering in Kuching, Sarawak. Within a few weeks, Malaysia became the worst hit country by COVID-19 in Southeast Asia. While religious leaders have advised social distancing among their congregants, the belief that "God is our shield" is often cited for gathering. There is a need to promote sound decision-making among religious adherents so that they will not prioritize their loyalty to the subjective interpretation of religion over evidence-based medicine. Malaysia, a multi-cultural and multi-faith country, is an example of how religious beliefs could strongly influence health behaviours at individual and community levels. In this article, we detail the religious aspects of COVID-19 prevention and control in Malaysia and discuss the possible role of religious organizations in encouraging sound decision-making among religious adherents in mitigating this crisis. We make recommendations on how to promote a partnership between the healthcare system and religious organizations, and how religion and faith could be integrated into health promotion channels and resources in the response of COVID-19 and future communicable diseases.