Investigating Crimean-Congo haemorrhagic fever virus seropositivity in camels and human behavioural risks in an abattoir in Nigeria.

Crimean-Congo haemorrhagic fever virus (CCHFV) is an emerging viral pathogen with pandemic potential that is often misdiagnosed. Case fatality in low-resource settings could be up to 40% due to close contact between animals and humans. A two-year cross-sectional study was conducted in Fagge abattoir, Kano State, Nigeria, to estimate the seropositivity of CCHFV in camels using a commercial multi-species competitive enzyme-linked immunosorbent assay (ELISA). A closed-ended questionnaire was administered to the abattoir workers to assess their awareness, mitigation, and behavioural practices associated with CCHF. Of the 184 camels tested, 179 (97%) were seropositive for CCHFV (95% confidence interval (CI): 93.77, 99.11). The median (interquartile range (IQR)) age of respondents was 41 (35-52), with 62% having no education. Respondents had little knowledge about CCHFV and the concept of zoonotic disease. In this study, the high estimated prevalence of antibodies to CCHFV in camels highlights the heightened risk of transmission of CCHFV in Nigeria. Similarly, a concerning lack of knowledge and inadequate preventive practices, alongside a prevalence of high-risk behaviours associated with CCHF among abattoir workers, were noted in this study. Thus, there is an urgent need for comprehensive public health education and collaborative One Health strategies to avert the threats of spillover events.

Monkeypox Outbreak 2022, from a Rare Disease to Global Health Emergence: Implications for Travellers.

Monkeypox (mpox), a zoonotic disease caused by the monkeypox virus (MPXV), poses a significant public health threat with the potential for global dissemination beyond its endemic regions in Central and West Africa. This study explores the multifaceted aspects of monkeypox, covering its epidemiology, genomics, travel-related spread, mass gathering implications, and economic consequences. Epidemiologically, mpox exhibits distinct patterns, with variations in age and gender susceptibility. Severe cases can arise in immunocompromised individuals, underscoring the importance of understanding the factors contributing to its transmission. Genomic analysis of MPXV highlights its evolutionary relationship with the variola virus and vaccinia virus. Different MPXV clades exhibit varying levels of virulence and transmission potential, with Clade I associated with higher mortality rates. Moreover, the role of recombination in MPXV evolution remains a subject of interest, with implications for understanding its genetic diversity. Travel and mass gatherings play a pivotal role in the spread of monkeypox. The ease of international travel and increasing globalization have led to outbreaks beyond African borders. The economic ramifications of mpox outbreaks extend beyond public health. Direct treatment costs, productivity losses, and resource-intensive control efforts can strain healthcare systems and economies. While vaccination and mitigation strategies have proven effective, the cost-effectiveness of routine vaccination in non-endemic countries remains a subject of debate. This study emphasizes the role of travel, mass gatherings, and genomics in its spread and underscores the economic impacts on affected regions. Enhancing surveillance, vaccination strategies, and public health measures are essential in controlling this emerging infectious disease.

A scoping review of Islamic pilgrimage to Mecca: Mapping the health concerns and proposed solutions.

OBJECTIVES: To map the current evidence about the health concerns and the potential solutions related to the Islamic pilgrimage to Mecca. DESIGN: A scoping review was applied. Papers published in English between 2012 and 2023 were included but non-human research and sources without any related data were excluded. Data charting and extraction were used to map the current evidence. RESULTS: The total of 36 papers were included with the total number of pilgrims of 17,075,887. The majority of studies were published in the Asia Pacific region (36.11%) as original articles (88.89%). The health concerns were grouped into five main aspects. There were 7603 deaths recorded or about 44 incidences of deaths per 100,000 pilgrims during the pilgrimage. There were recorded 11,018; 6178; 3393; and 17,810 cases for communicable diseases; non-communicable diseases; injuries and trauma; and health services (i.e., cardiac catheterization) and vaccination, respectively. CONCLUSION: Relating to the five health concerns, this study identified the top seven issues in each category (i.e., hypertension, influenza vaccination), except for the death record. Moreover, there were three solutions (for general health, non- and communicable-diseases) presented. Stakeholders could use this evidence to improve healthcare quality particularly related to the annual Islamic pilgrimage to Mecca.

Effectiveness of public health measures to prevent the transmission of SARS-CoV-2 at mass gatherings: A rapid review.

Mass gatherings play an important role in society, but since the onset of the Covid-19 pandemic, they have generally been restricted in order to mitigate transmission of SARS-CoV-2. The aim of this study was to summarise the evidence regarding the effectiveness of public health measures at preventing the transmission of SARS-CoV-2 at mass gatherings, and hence inform guidance on the organisation of these events. A rapid review was undertaken in Cochrane, Embase (OVID), Medline (OVID), Google, Web of Science and Europe PMC from 1 January 2020 to 3 June 2021. Of the identified 1,624 citations, 14 articles referring to 11 unique studies were included. This rapid review found evidence from 11 studies (involving approximately 30,482 participants) that implementing a range of measures may reduce the risk of SARS-CoV-2 transmission at mass gatherings; however, it is unlikely that this risk can be eliminated entirely. All studies adopted a layered mitigation approach involving multiple measures, which may be more effective than relying on any single measure. The number and intensity of measures implemented varied across studies, with most implementing resource intense measures. Importantly, all included studies were only of 'fair' to 'poor' quality. In conclusion, there is currently limited evidence on the effectiveness of measures to prevent SARS-CoV-2 transmission at mass gatherings. As mass gatherings recommence, continued adoption of known mitigation measures is required to limit the risk of transmission, as well as ongoing research and surveillance to monitor the potential impact of these events on the wider population and healthcare system.

Global warming and the Summer Olympic and Paralympic games: a perspective from the Tokyo 2020 Games.

The Tokyo 2020 Olympic and Paralympic Games provided a significant opportunity to consider global warming as an issue to be seriously addressed to run the safe and fair games in the era of climate change. As the global temperature continuously rises and extreme hot-weather events increase in frequency and intensity, the future summer Olympic and Paralympic games will need to deal with the heat by applying thorough and appropriate countermeasures. In the recent decades, many mitigation measures to protect athletes from heat have been rapidly discussed by the sports community, including countermeasures to hold games at times and places with moderate temperature and climatic risk assessments with Wet Bulb Globe Temperature (WBGT) during the games. However, the excessive heat conditions in the Tokyo 2020 Games affected not only athletes, but also all people concerned the events. While deliberate considerations by organizers had been given to mitigate extraordinary heat, the evaluations of these measures and epidemiological analyses of risk factors of patients must be further enhanced to develop efficient measures for the future. Therefore, we discussed the underlying climate-related problems of the summer Olympic and Paralympic Games in view of what we had experienced in the Tokyo 2020 Games. Facing with emerging global warming, future intervention against heat in the summer Olympic and Paralympic games will need to integrate systematic disease surveillance and evaluation of intervention with an effective combination with the approaches previously conducted. The Tokyo 2020 Games is a wake-up call to accelerate the public health measures towards the creeping global warming.

Contributions of the EURO 2020 football championship events to a third wave of SARS-CoV-2 in Scotland, 11 June to 7 July 2021.

Public Health Scotland used Scottish national contact tracing data to estimate the European football championship (EURO 2020) contributions to a third wave of SARS-CoV-2 infections. From 11 June to 7 July 2021, 2,632 (4%) of 63,874 SARS-CoV-2 cases self-reported attending a EURO 2020 event; 90% were male, of whom 73% were 20-39-year-olds. Most cases attended unofficial gatherings and averaged more contacts than the general population. Targeted guidance on celebrating safely in closed spaces is key.

Measuring the impact of suspending Umrah, a global mass gathering in Saudi Arabia on the COVID-19 pandemic.

Since the early days of the coronavirus (COVID-19) outbreak in Wuhan, China, Saudi Arabia started to implement several preventative measures starting with the imposition of travel restrictions to and from China. Due to the rapid spread of COVID-19, and with the first confirmed case in Saudi Arabia in March 2019, more strict measures, such as international travel restriction, and suspension or cancellation of major events, social gatherings, prayers at mosques, and sports competitions, were employed. These non-pharmaceutical interventions aim to reduce the extent of the epidemic due to the implications of international travel and mass gatherings on the increase in the number of new cases locally and globally. Since this ongoing outbreak is the first of its kind in the modern world, the impact of suspending mass gatherings on the outbreak is unknown and difficult to measure. We use a stratified SEIR epidemic model to evaluate the impact of Umrah, a global Muslim pilgrimage to Mecca, on the spread of the COVID-19 pandemic during the month of Ramadan, the peak of the Umrah season. The analyses shown in the paper provide insights into the effects of global mass gatherings such as Hajj and Umrah on the progression of the COVID-19 pandemic locally and globally.

Ban of Religious Gatherings during the COVID-19 Pandemic: Impact on Christian Church Leaders' Well-Being in Ghana.

This study was conducted during a period of lockdown and ban on social gatherings, including religious gatherings, in Ghana. The restrictions were instituted in response to the COVID-19 pandemic. The purpose of the study was to understand how the well-being of Christian church leaders was impacted during the prohibition in terms of aspects of their vocation and religious practices. Fourteen Christian church leaders located in urban and rural settings in Ghana, with 5 to 32 years of experience, discussed how they and their families were impacted by the ban on religious gatherings in Ghana. Findings revealed negative impacts of the COVID-19 restrictions, including spiritual slacking, loss of fellowship, disruption of normal routine, pandemic anxiety, and financial stress. Positive impacts included increased faith, relief/reduced stress, and increased family time. These findings are discussed from psychological trauma and disaster response perspectives.

Large Outbreak of Coronavirus Disease among Wedding Attendees, Jordan.

In March 2020, a wedding in Jordan led to a large outbreak of coronavirus disease (COVID-19). We collected data on 350 wedding attendees, 76 who of whom developed COVID-19. Our study shows high communicability of COVID-19 and the enormous risk for severe acute respiratory syndrome 2 virus transmission during mass gatherings.

Impact of patron saint festivities on cholera in three communes in Haiti.

BACKGROUND: Religious pilgrimages are among the anthropogenic factors known to be associated with the transmission of diarrheal diseases, such as cholera. This ecological study aimed to describe the evolution of cholera and assess the relationship between the implementation of the 'coup de poing' strategy during the patron saint festivities and the incidence of cholera in the three communes of Cabaret, Carrefour, and Croix-des-Bouquets in Haiti in 2017. METHODS: An epidemiological curve was produced to illustrate the evolution of cholera at the communal level. Generalized linear models assuming a Poisson distribution were used to weight the annual cholera incidence of communal sections against variables such as the number of patronal festivities, population density and annual precipitation rates. The number of cases in the week of the festivity as well as one and 2 weeks later was weighted against patronal festivities and weekly precipitation rates. RESULTS: In total, 3633 suspected cholera cases were continuously reported in three communes in Haiti (Cabaret, Carrefour, Croix-des-bouquets) during the 52-epidemiological week period in 2017. After controlling for rainfall and population density, the implementation of the 'coup de poing' strategy during the patron saint festivities was associated with a significant reduction in cholera incidence of 57.23% [PR = 0.4277 (97.5% CI: 0.2798-0.6193), p = 0.0000244]. The implementation of the strategy was associated with a reduction in cholera incidence of 25.41% 1 week following patronal festivities. CONCLUSION: This study showed a continuous presence of cholera in three communes in Haiti in 2017 and an association between the implementation of the 'coup de poing' strategy during patronal festivities and a reduction in cholera incidence. The findings imply that the multi-partner 'coup de poing' strategy may have contributed to the reduced cholera incidence following patron saint festivities and in Ouest department in Haiti in 2017.

Nurses' job satisfaction during the mass gathering of the Hajj 2018 in Saudi Arabia.

AIM: To explore job satisfaction of nurses during the Hajj season 2018 in Saudi Arabia, determine predictors of nurses' job satisfaction and inform future healthcare provision and policy. BACKGROUND: Mass gatherings of large numbers of people inevitably pose unique public health concerns and challenges for organizers. A mass gathering happens annually in Saudi Arabia during the Hajj pilgrimage. There was a paucity of evidence regarding nurses' experiences during Hajj. This gap in knowledge needed to be addressed. METHODS: A cross-sectional survey was conducted in 198 nurses across 12 healthcare settings along the Hajj pilgrimage route. A 24-item Nurses' Job Satisfaction Questionnaire was developed exploring six domains: supervision, nature of work, retention, communication, workload and co-workers. RESULTS: Nurses reported a high level of job satisfaction. All six domains were strong predictors of job satisfaction. Nurses reported the lowest level of job satisfaction when assessed against the items 'multiple policies and procedures that were perceived as complicating nursing work', 'incompetence of other people they work with' and 'too much burden at work'. CONCLUSION: Job satisfaction levels for nurses during Hajj 2018 appeared higher than during previous Hajj pilgrimages, probably influenced by the additional healthcare measures put in place during Hajj 2018, such as improved technology. IMPLICATIONS FOR NURSING POLICY AND PRACTICE: Hajj-specific skills training must be designed to enhance the knowledge, competencies and capabilities of nurses. Policies and procedures must prevent heavy workloads and avoid complicating nurses' work during Hajj. Improvements to the nurse work environment should focus on evidence-based interventions promoting effective resource planning, interprofessional relationships and communication, for instance via innovative, technological approaches. These findings can be shared with organizers of other mass gatherings worldwide.

Medication utilization pattern among outpatients during the Hajj mass gathering.

BACKGROUND: The Kingdom of Saudi Arabia (KSA) provides free healthcare, including medications, for the over 2 million Muslim pilgrims who attend Hajj every year. Information on drug utilization patterns at the Hajj is important to strengthen the supply chain for medicines, avert stock-outs, identify inappropriate use, and support public health planning for the event. METHOD: We investigated drug utilization pattern among outpatients in eight seasonal Holy sites hospitals in Makkah, KSA, during the 2018 Hajj. Data on medication prescribed and dispensed were retrieved from the hospitals' electronic records. Data were also used to calculate six of the WHO indicators for drug use at these facilities. RESULTS: A total of 99,117 medications were prescribed for 37,367 outpatients during 37,933 encounters. Outpatients were mainly older males and originated from 134 countries. Twenty medications accounted for 72.8% of the 323 different medications prescribed. These were mainly nonsteroidal anti-inflammatory drugs, analgesics and antipyretics, and antibacterial medicines for systemic use. Outpatients were prescribed an average of 2.6 (SD = 1.2) drugs per consultation and polypharmacy (≥5 medications) was observed in 4.8% of the encounters. Antibiotics and an injection were prescribed in 46.9% and 6.5% of encounters, respectively. Nearly 90% of the prescribed drugs were actually dispensed. On average, medications were dispensed 16.4 (SD = 119.8) minutes from the time they were prescribed for the patient. All hospitals had a copy of the essential drugs list available and all of the prescribed drugs appeared on that list. CONCLUSION: Nonsteroidal anti-inflammatory drugs, analgesics and antibiotics are the most common medications prescribed to outpatient during Hajj. Our results, including the calculated WHO drug use indicators, can form a basis for further investigations into appropriate drug use at the Hajj and for planning purposes. These results could also guide the development of reference values for medications prescribing and use indicators at mass gatherings.

Mass Gatherings and Diarrheal Disease Transmission Among Rural Communities in Coastal Ecuador.

Mass gatherings exacerbate infectious disease risks by creating crowded, high-contact conditions and straining the capacity of local infrastructure. While mass gatherings have been extensively studied in the context of epidemic disease transmission, the role of gatherings in incidence of high-burden, endemic infections has not been previously studied. Here, we examine diarrheal incidence among 17 communities in Esmeraldas, Ecuador, in relation to recurrent gatherings characterized using ethnographic data collected during and after the epidemiologic surveillance period (2004-2007). Using distributed-lag generalized estimating equations, adjusted for seasonality, trend, and heavy rainfall events, we found significant increases in diarrhea risk in host villages, peaking 2 weeks after an event's conclusion (incidence rate ratio, 1.21; confidence interval, adjusted for false coverage rate of ≤0.05: 1.02, 1.43). Stratified analysis revealed heightened risks associated with events where crowding and travel were most likely (2-week-lag incidence rate ratio, 1.51; confidence interval, adjusted for false coverage rate of ≤0.05: 1.09, 2.10). Our findings suggest that community-scale mass gatherings might play an important role in endemic diarrheal disease transmission and could be an important focus for interventions to improve community health in low-resource settings.

Risk factors for developing acute gastrointestinal, skin or respiratory infections following obstacle and mud run participation, the Netherlands, 2017.

BackgroundIn the Netherlands, obstacle, mud and survival runs are increasingly popular. Although outbreaks of gastroenteritis have been reported following these events, associated health risks have not been systematically assessed.AimTo investigate the incidence of acute gastrointestinal infections (AGI), skin infections (SI) and respiratory infections (RI) among obstacle run participants, as well as risk factors.MethodsBetween April and October 2017, we conducted a retrospective cohort study among 2,900 participants of 17 obstacle runs in the Netherlands. Demographic, symptomatic and behavioural data were collected from participants via an online questionnaire 1 week after participation in an obstacle run. Stool specimens were obtained from respondents for microbiological tests. Adjusted relative risks (aRR) and 95% confidence intervals (CI) using multilevel binomial regression analysis were calculated.ResultsOf 2,646 respondents (median age: 33 years; 53% male), 76 had AGI after the obstacle run; ingesting mud was associated with AGI (aRR: 1.7; 95% CI: 1.2-4.9) and 38 respondents had AGI during or in the week before the obstacle run. Overall, 103 respondents reported SI and 163 RI. Rinsing off in a hot tub was associated with SI (aRR: 2.2; 95% CI: 1.7-2.8). Of 111 stool specimens, 13 tested positive for six different pathogens. No clusters were found.ConclusionThe reported incidence of AGI, SI and RI was low. Risk of these infections could be decreased by informing participants on preventive measures, e.g. showering vs rinsing in the hot tub, avoiding ingesting mud and not participating with symptoms of AGI.

Leading interagency planning and collaboration in mass gatherings: public health and safety in the 2012 London Olympics.

OBJECTIVES: Planning and implementing public health initiatives in mass gatherings such as the Olympic Games pose unique challenges for interorganizational collaboration, which involves interaction among multiple and diverse agencies. Nonetheless, there is limited empirical evidence to support interagency collaboration and public health planning decisions in mass gatherings and how leadership can shape such interactions. We empirically explored these topics in the 2012 London Olympics to identify lessons to inform planning for future mass gatherings. STUDY DESIGN: This is a qualitative case study. METHODS: Data comprised 39 semistructured interviews with key informants conducted before, during, and after the games; in addition, direct observations of field exercises and documentary analysis were also used. Open coding and thematic analysis was used to analyze the data. RESULTS: We identified two main leadership challenges that influenced interagency collaboration: organizational public health leadership and coordinating collaborative decision-making. Two facilitative conditions helped overcome the previous challenges: nurturing interorganizational linkages and creating shared understanding by activating codified frameworks at the organizational level. CONCLUSIONS: Our study highlights leadership issues in interagency collaboration in mass gatherings. Practical implications arising from this study may inform the ways the organizers of mass gatherings, public health and safety agencies, and professionals can engage in effective partnerships and joint working.

Syndromic surveillance and its utilisation for mass gatherings.

Tremendous advancements in syndromic surveillance strategies over the last two decades, and specifically from prior mass gatherings, have been incorporated into day-to-day healthcare analysis worldwide and have left a lasting indirect impact since their inception. Mass gatherings are a daily occurrence worldwide and provide a scenario ripe for public health aims and objectives utilising syndromic surveillance. Europe is less than a decade away from hosting a colossal worldwide gathering (2024 Summer Olympics) in likely a time when the global agreement is in flux. A call to arms is needed for additional surveillance strategies incorporating mobile application symptom checker data, telemedicine, social media and social data sensing. There remains a need for an optimal combination of real-time data sensing that captures the whole population, but to reach that goal we must incorporate new advancements into baseline epidemiologic data monitoring, otherwise we will be tracking real-time mass gathering events on top of inaccurate baseline epidemiologic data.

Novel public health risk assessment process developed to support syndromic surveillance for the 2012 Olympic and Paralympic Games.

Background: Syndromic surveillance aims to provide early warning and real time estimates of the extent of incidents; and reassurance about lack of impact of mass gatherings. We describe a novel public health risk assessment process to ensure those leading the response to the 2012 Olympic Games were alerted to unusual activity that was of potential public health importance, and not inundated with multiple statistical 'alarms'. Methods: Statistical alarms were assessed to identify those which needed to result in 'alerts' as reliably as possible. There was no previously developed method for this. We identified factors that increased our concern about an alarm suggesting that an 'alert' should be made. Results: Between 2 July and 12 September 2012, 350 674 signals were analysed resulting in 4118 statistical alarms. Using the risk assessment process, 122 'alerts' were communicated to Olympic incident directors. Conclusions: Use of a novel risk assessment process enabled the interpretation of large number of statistical alarms in a manageable way for the period of a sustained mass gathering. This risk assessment process guided the prioritization and could be readily adapted to other surveillance systems. The process, which is novel to our knowledge, continues as a legacy of the Games.

Using mobile technology to optimize disease surveillance and healthcare delivery at mass gatherings: a case study from India's Kumbh Mela.

Background: Planning for mass gatherings often includes temporary healthcare systems to address the needs of attendees. However, paper-based record keeping has traditionally precluded the timely application of collected clinical data for epidemic surveillance or optimization of healthcare delivery. We evaluated the feasibility of harnessing ubiquitous mobile technologies for conducting disease surveillance and monitoring resource utilization at the Allahabad Kumbh Mela in India, a 55-day festival attended by over 70 million people. Methods: We developed an inexpensive, tablet-based customized disease surveillance system with real-time analytic capabilities, and piloted it at five field hospitals. Results: The system captured 49 131 outpatient encounters over the 3-week study period. The most common presenting complaints were musculoskeletal pain (19%), fever (17%), cough (17%), coryza (16%) and diarrhoea (5%). The majority of patients received at least one prescription. The most common prescriptions were for antimicrobials, acetaminophen and non-steroidal anti-inflammatory drugs. There was great inter-site variability in caseload with the busiest hospital seeing 650% more patients than the least busy hospital, despite identical staffing. Conclusions: Mobile-based health information solutions developed with a focus on user-centred design can be successfully deployed at mass gatherings in resource-scarce settings to optimize care delivery by providing real-time access to field data.

Hepatitis A outbreak among men who have sex with men (MSM) predominantly linked with the EuroPride, the Netherlands, July 2016 to February 2017.

Between July 2016 and February 2017, 48 male cases of hepatitis A were notified in the Netherlands. Of these, 17 identified as men who have sex with men (MSM). Ten of the 13 cases for whom sequencing information was available, were infected with a strain linked with the EuroPride that took place in Amsterdam in 2016. This strain is identical to a strain that has been causing a large outbreak among MSM in Taiwan.

The Effect of Sporting Events on Medical Transport Time at a Level 1 Trauma Center: a Retrospective Cohort Study.

OBJECTIVE: We investigate how West Virginia University football games affect transport to Ruby Memorial Hospital, which shares a parking lot with Milan Puskar Football Stadium. METHODS: A retrospective chart review of a trauma registry from a level 1-trauma center was conducted from 2007 to 2011 for all home and away football games. Home games served as time period of interest and away games served as a control time period. Patient charts were collected for a 36-hour time window surrounding the game. 250 patient charts were complete for home games and 185 patient charts for away games. Data analyzed were time from scene to arrival at hospital, use of air transport, transport time in relation to kick-off, and comparison between demographic and emergency department disposition of patients arriving during home games vs. patients arriving during away games. RESULTS: No statistically significant differences were found for demographic data or emergency department disposition between groups. For ground transport directly from scene, the average time to arrival at the hospital was 44.9 minutes for home games and 45.1 minutes for away games. For air transport directly from the scene, the average time to arrival at the hospital was 44.9 minutes for home games and 44.0 minutes for away games. For ground transfer from another facility, the average time to arrival at the hospital was 76.4 minutes for home games and 52.9 minutes for away games. For air transport from another facility, the average time to arrival at the hospital was 37.4 minutes for home games and 24.0 minutes for away games. Air transportation utilization was increased in inter-facility transfers during home games (5/16, 31.3% vs. 4/20, 22.2%), and helicopters traveled a further distance (avg. 66.6 vs. 50.25 air miles). For patients coming from the scene during a home game, if the start of the game occurred after the trauma but before arrival to the trauma center, the average time of ground transport increased from 44.9 minutes to 120 minutes (p<0.0001). CONCLUSION: A mass gathering in close proximity to a rural trauma center does affect transport patterns and transport times for trauma patients. Further investigation is warranted in order to improve patient care during mass gathering events.