Mass Gathering

In 2016, the BioSense Platform for national syndromic surveillance made substantial enhancements including data processing changes, a national ESSENCE instance, and management tools to support diverse data sharing needs. On August 21, 2017, a total solar eclipse occurred over much of the United States. The event resulted in large gatherings over multiple days to areas in the Path of Totality (PoT). In the days leading up to the event, public health and emergency preparedness included syndromic surveillance in their monitoring plans. To support this effort, Illinois (IL), Kentucky (KY), and Tennessee (TN) established inter-jurisdictional aggregate data sharing to get a more inclusive view of cause-specific illness or injury in Emergency Department (ED) visits before, during, and after the eclipse.

Objective:

Describe cross-jurisdictional data sharing practices using ESSENCE and facilitated by the BioSense Platform for a national mass gathering event, and the dashboard views created to enhance local data for greater situational awareness.

Oregon’s statewide syndromic surveillance system (Oregon ESSENCE) has been operational since 2012. Non-federal emergency department data (and several of their associated urgent care centers) are the primary source for the system, although other data sources have been added, including de-identified call data from OPC in 2016. OPHD epidemiologists have experience monitoring mass gatherings and have a strong relationship with OPC, collaborating on a regular basis for routine and heightened public health surveillance. Nevertheless, surveillance for the Great American Solar Eclipse (August 2017) presented a challenge due to the 107 reported simultaneous statewide eclipse-watching events planned for the day of the eclipse (some with estimated attendance of greater than 30,000 people and most in rural or frontier regions of the state). Scientific literature is limited on mass gathering surveillance in the developed world, particularly in rural settings, so OPC and OPHD worked together to develop a list of health conditions of interest, including some that would warrant both an ED visit and a call to OPC (e.g., snake bites). Monitoring visits in both data sources in would allow for assessment of total burden on the healthcare system, especially in the case of snake bites where only specific bites require administration of anti-venom.

Objective:

Identify surveillance priorities for emergency department (ED) and Oregon Poison Center (OPC) data ahead of the 2017 Great American Solar Eclipse gatherings in Oregon and create a suite of queries for use in the Health Intelligence Section of the Oregon Public Health Division (OPHD) Incident Management Team (IMT).

The massive flow of people to mass gathering events, such as festivals or sports events like EURO 2016, may increase public health risks. In the particular context of several terrorist attacks that took place in France in 2015, the French national Public Health agency has decided to strengthen the population health surveillance systems using the mandatory notification disease system and the French national syndromic surveillance SurSaUD®. The objectives in terms of health surveillance of mass gathering are: 1/ the timely detection of a health event (infectious cluster, environmental exposure, collective foodborne disease…) 2/ the health impact assessment of an unexpected event such as a terrorist attack. In collaboration with the Regional Emergency Observatory (ORU), a procedure for the labeling of emergencies has been tested to identify the ED records that could be considered as linked to the event.

Objective:

To access the potential health impact on the population during mass gathering over time using labelling procedure in emergency department (ED).

Global Mass gatherings (MGs) such as Olympic Games, FIFA World Cup, and Hajj (Muslim pilgrimage to Makkah), attract millions of people from different countries. The gathering of a large population in a proximity facilitates transmission of infectious diseases. Attendees arrive from different geographical areas with diverse disease history and immune responses. The associated travel patterns with global events can contribute to a further disease spread affecting a large number of people within a short period and lead to a potential pandemic. Global MGs pose serious health threats and challenges to the hosting countries and home countries of the participants. Advanced planning and disease surveillance systems are required to control health risks in these events. The success of computational models in different areas of public health and epidemiology motivates using these models in MGs to study transmission of infectious diseases and assess the risk of epidemics. Computational models enable simulation and analysis of different disease transmission scenarios in global MGs. Epidemic models can be used to evaluate the impact of various measures of prevention and control of infectious diseases.

Objective:

To develop a computational model to assess the risk of epidemics in global mass gatherings and evaluate the impact of various measures of prevention and control of infectious diseases.

In preparation for mass gathering events, DPH conducts enhanced syndromic surveillance activities to detect potential cases of anthrax, tularemia, plague, and other potentially bioterrorism-related communicable diseases. While preparing for Saint Louis to host a Presidential Debate on October 9, 2016, DPH was asked by a partner organization whether we could also detect emergency department (ED) visits for injuries (e.g., burns to the hands or forearms) that could possibly indicate bomb-making activities.

Objective:

To describe a novel application of ESSENCE by the Saint Louis County Department of Public Health (DPH) in preparation for a mass gathering and to encourage discussion about the appropriateness of sharing syndromic surveillance data with law enforcement partners.

The Great American Solar Eclipse of 2017 provided a rare opportunity to view a complete solar eclipse on the American mainland. Much of Oregon was in the path of totality and forecasted to have clear skies. Ahead of the event, OPHD aggregated a list of 107 known gatherings in mostly rural areas across the state, some with estimated attendance of up to 30,000 attendees. Temporary food vendors and a range of sanitation solutions (including open latrines) were planned. International travelers were expected, along with large numbers of visitors traveling by car on the day of the eclipse. The potential for multiple simultaneous mass gatherings across the state prompted OPHD to activate an incident management team (IMT) and to create a Health Intelligence Section to design a mass gathering surveillance strategy. Statewide syndromic surveillance (Oregon ESSENCE) has been used to monitor previous mass gatherings (1) and captures statewide emergency department (ED), urgent care, Oregon Poison Center, and reportable disease data.

Objective:

Develop a public health surveillance plan for the Oregon Public Health Division (OPHD) in anticipation of the expected influx of visitors for the 2017 Great American Solar Eclipse.

Final Four-associated events culminated in four days of intense activity from 3/31/17-4/3/17, which attracted an estimated 400,000 visitors to Maricopa County (population 4.2 million). Field teams of staff and volunteers were deployed to three days of Music Fest, four days of Fan Fest, and three Final Four games (Games) as part of an enhanced epidemiologic surveillance system.

Objective:

To describe and present results of field-based near-real time syndromic surveillance conducted at first aid stations during the 2017 National Collegiate Athletic Association Division I Men’s College Basketball Championship (Final Four) events, and the use of field team data to improve situational awareness for Mass Gathering events.

Panchkroshi yatra is an annual ritual of circumambulation (yatra) of temples (Mahadevs) and 100,000 devotees walk for around 15 miles per day for six days and cover a total of 73 miles to worship important Mahadevs. The festival is held every year at the city of Ujjain, Madhya Pradesh, Central India. The yatra attracts large number of pilgrims especially from rural areas and usually women outnumber men. During the yatra, the pilgrims halt at several places and prepare their food in outdoors. We described the public health preparedness, implemented a tablet-based participatory syndromic surveillance among pilgrims of the yatra and reviewed satisfaction of the pilgrims regarding implementation of public health measures, Ujjain during 21-26, April, 2017.

Objective:

To study operation feasibility and prepadness of a a tablet-based participatory syndromic surveillance among pilgrims during annual ritual circumbulation (Panchkroshi Yatra) coveirng 15 miles daily in Ujjain, Madhya Pradesh India

Final Four-associated events culminated in four days of intense activity from March 31st through April 3rd, and added an estimated 400,000 visitors to Maricopa County's 4.2 million residents.

Objective:

To describe and present results for the enhanced epidemiologic surveillance system established during the 2017 National Collegiate Athletic Association Division I Men’s College Basketball Championship (Final Four) events.

Infectious disease surveillance for generating early warnings to enable a prompt response during mass gatherings has long been a challenge in India as well as in other parts of the world. Ujjain, Madhya Pradesh in Central India hosted one of the largest religious festival in the world called ‘Simhasth kumbh mela’ on the banks of River Kshipra, where more than 50 million attendees came for holy dip during April 22 to May 21, 2016. The attendees included pilgrims (residents and visitors), observers, officials and volunteers. We developed an android application with automated summary reports and an interactive dashboard for syndromic surveillance during the gathering.

Objective:

To develop, test and study tablet-based participatory syndromic surveillance system for common infectious disease conditions at community level in Simhashta religious mass gathering in Ujjain, India, 2016.