Mass gathering
● Objectives :
1- Define mass gathering.
2- List MG characteristics that represent public health risk.
3- List and understand the steps of MG risk assessment.
4- Identify risk based on event assessment .
5-Understand the components of risk identification and characterization.
6- Understand the components of risk management: surveillance and response.
7-Understand the role of WHO in MG.
Done by: Abdullah Alzahrani - Waleed Alanazi - Alanoud Alessa - Rahaf Alshunaiber
Team leader: Afnan Almustafa & Saif Almeshari
Reviewed by: Yazeed Al-Dossare
● Resources:
Slides.
Doctor’s notes.
[Colors index : Important | Notes | Note | Slides | Extra] [ Editing file | Share note ]
Mass Gathering
● Mass gatherings (MGs) are events attended by large numbers of individuals,
concentrated in a specific area for a specific purpose and over a limited
period of time.
● Number of participants: >1000 persons, although most literature suggests
>25000 persons
● The World Health Organization (WHO) definition also takes a broader view
of mass gatherings to include the public health dimensions and defines mass
gatherings as events attended by a sufficient number of people to potentially
strain the public health resources of the community, city, or nation hosting
the event.
● “Mass Gatherings Medicine” is an area of medicine that deals with health
aspects during mass gatherings including the health effects and risks of mass
gatherings and strategies for effective health services delivery during these
events.
● The formal discipline of mass gatherings medicine was launched at the
World Health Assembly of Ministers of Health in Geneva in May 2014. There
was not any field in medicine cared about mass gathering at that time.
Examples of MG
The London Olympics 2012
• 10,250 Olympic athletes and 4,000 Paralympic athletes
• 20,000 press and media
• 180,000 spectators/day
• 17,000 people living in the Olympic Village
• Estimates of 4.5 million visitors to London
• 26 Olympic sports in 30 venues
• 20 Paralympic sports in 21 venues
They are coming from different countries bringing different diseases.
Types of MG
Concerts, festivals
Fairs, exhibitions
(Riyadh season, Sports (Olympics)
(World Expo Shanghai)
Glastonbury, UK)
Religious (Hajj) Political (G20)
Categories of MG
Mass Gathering
Spontaneous Planned
Recurrent One-off
Unknown\
unplanned e.g. Same location E.g.
refugee camps, e.g pope's Changing
celebrations
protests funeral location Same location
royal
، اﻻﻧﻔﺠﺎرات e.g. olympics e.g. Hajj, exit
weddings,
and football music festival
world cup
world cup
winners
Where is the risk in MG?
❖ Mass gatherings can pose several significant public health challenges to the health
and security authorities both within the host country and abroad.
❖ They place additional pressures on health systems, which must operate for the
duration of the mass gatherings stretched to surge capacity.like what happened in Italy
and Iran facing the coronavirus their healthcare system collapsed.
❖ require intersectoral approaches to risk mitigation and coordination and
cooperation across multiple disciplines, agencies, sectors, and ministries.( like the
police…)
MG characteristics that represent public health risk
◆ Diversity of population characteristics It will
◆ Different communities/ parts of the world will
Higher population ◆ Imported diseases
concentration ◆ Epidemic prone diseases
◆ Different health-related behaviors
◆ Heat/ cold
Environmental conditions
◆ Vectors of diseases
Pressure on infrastructure ◆ Hotels
Not only the medical field will be ◆ Food sales
affected ◆ Healthcare system
◆ Terrorism/ bioterrorism the police should take care
Political attention
of it.
Outbreak
❏ The importation of infectious diseases during a mass gathering may result in
outbreaks (Even food poisoning).
❏ Mass gatherings health deals with the diverse health risks associated with mass
gatherings including transmission of infectious disease, non-communicable
disease, trauma and injuries (occupational or otherwise), environmental effects
(such as, heat-related illnesses, dehydration, hypothermia), illnesses related to the
use of drugs and alcohol and deliberate acts, such as terrorist attacks
Outbreak
The aim is to:
❖ Know the risk Risk assessment>identification
❖ Know when it happens Surveillance
❖ Know what to do when it happens Response
Steps of risk assessment:
❖ Risk identification (depending on event assessment)
◇ Host country context assessment:
❏ Systems: need for enhancement in surveillance,
testing, reporting, response and command, control
and communication
❏ Training: responsibilities
❏ Population factors: immunity (hosts, visitors)
❏ Baseline status for CD
❖ Risk characterization (impact high? Low? , likelihood) to arrange the priorities.
❖ Risk management (surveillance if you don't have the equipment you will not be
able to respond > and response)
MG event assessment characteristics
MG event assessment characteristics
Based on the above
Risk identification based on event assessment
Event assessment Risk identification
Type: Religious event Older population with NCD, in-site medical care
Season: summer Risk of dehydration, heat stroke
International Imported diseases
Venue: indoor Poor air circulation
Venue: temporary Poor infrastructure
Catering: informal Risk of food-born illnesses
Hygiene:hand washing stations Decreased risk of infections
Risk characterization
• Impact on MG, impact on PH (minimal-severe)
• Risk likelihood
We should cancel the event
Why risk characterization?
If the risk estimate that a particular event will
occur is highly uncertain, risk management
decisions might be more conservative than in the
case of an event deemed to be highly likely.
Then what?
● Once the risks have been mapped on the risk
matrix, the objective of public health planning
for the MG will be to reduce the likelihood of a
threat occurring and to reduce the consequences
of each threat: risk management.
Risk management
➢ What mitigation measures can be put into place to manage the risk and
reduce either the probability or impact?
➢ Could include:
Initiating new surveillance programmes (if you don't have it in the host country).
Implementing a range of special prevention (risk of food-borne, waterborne,
airborne and person-to-person spread of diseases).
Developing plans for immediate acquisition of additional human and material
resources should a crisis occur.
Surveillance in MG
When planning surveillance for the MG, the questions that public health
authorities are likely to ask are:
1) What diseases or syndromes should surveillance be conducted for and
what is the risk of these?
2) What is the best type of public health surveillance system(s) to use?
(timeliness and sensitivity)
3) What are the special considerations for outbreak or public health
response?
Diseases with the following characteristics should be considered for surveillance:
• Have outbreak potential
• Have modes of transmission enhanced in the MG (e.g. respiratory spread)
• Are known to be of particular potential use as bioterrorism agents
• May cause severe illness and require investigation and / or the application
of control measures even for a single case
• Imported diseases not usually seen in the host country (especially
drug-resistant organisms and unusual serotypes)
• Endemic diseases for which event attendees may have no immunity
• Highly infectious diseases (e.g., norovirus or measles)
• Diseases or events that need to be reported under the IHR (2005).
Surveillance Problems posed by MGs
• Short time –problem for collecting information –systems sensitive and
responsive
• Large, diffuse and highly varied population
• Include diseases not normally surveyed? New for the host country.
• People arrive from/return to many locations
• Multiple opportunities for exposure:
• –air travel –food –water –physical contact
• Varying health surveillance capabilities of –host nation
• –originating nation(s)
• Tracking (time/location) and notification –not just in location, but after
returning Spread diseases in their own country.
Preparing a surveillance plan
Identify monitoring Define conditions to Establish priorities
resources at all levels look for the top/the bottom.
Identify mechanism for
Link notification and Set threshold / alert
prompt investigation &
response plan levels
feedback
MG Planning
A safe and healthy MG requires:
✓ Early multi-sectoral preparation involving:
local hospital public health authority
event organizers
emergency departments representatives
first-aid health emergency other sectoral partners (e.g. police,
personnel managers emergency services, security services)
Depends on risk assessment and risk identification
✓ Medical care needs to be offered at the mass gathering but local care needs
to be maintained as usual:
Response
Establish a major incident response system
Well rehearsed multi-agency and cross government response systems
● Effective liaison across health sector
● Public health engagement with:
1. Police & other emergency services (threat assessment, incident response)
2. Central government (threat assessment, preparedness, response)
3. Intelligence services (threat assessment)
Incident command
Command Staff:
Public information officer Provide information,
safety, and liaison
Safety officer services for the entire
organization.
Liaison officer They listen to the problem.
General Staff: Delegated functional responsibilities. They report.
Operation section Planning section Logistics section Finance/Admin section
Legacy and Evaluation
• The wealth of knowledge and expertise generated from mass gatherings can drive
best health promotion, education, and risk mitigation strategies and optimize the
planning and delivery of effective health services during future mass gathering events
Saudi Arabia has the experience from Hajj and Umrah.
WHO and MG
❖ What is WHO’s role in mass gatherings?
• WHO provides advice and technical support to host governments preparing for mass
gathering events. The give them the advice from other experts in other countries.
❖ How does WHO provide support to Member States for mass gatherings?
• To provide advice and technical support to Member States that are hosting mass
gatherings, WHO draws on 5 WHO Collaborating Centres for Mass Gatherings and a
Virtual Interdisciplinary Advisory Group (VIAG). VIAG is an informal network of
mass gathering experts. Their role is to share expertise on public health requirements
and best practices with any organization considering hosting a mass gathering event.
Activities to support host governments of mass gatherings often include:
• Prior to the event: all-hazard risk assessment, travel medicine and activities to
encourage increased physical activity, cessation of tobacco use and avoidance of
excess alcohol.
• During the event: international monitoring of potential disease spread and risk
assessment, emergency medical services and hospitals and plans to manage fan
zones.
• After the event: capture lessons learnt and share expertise ( to WHO) with future
mass gathering hosts.
❖ What governs WHO’s work on mass gatherings?
• The decision states that the WHO "Director-General should, where appropriate,
work closely with Member States that are planning and conducting mass gatherings to
support cooperation and communication between the concerned health authorities in
each country, and help Member States strengthen capacities to better utilize the
International Health Regulations (2005)".
❖ Does WHO have the power to cancel or move mass gatherings?
• WHO may provide advice and technical guidance to host countries on public health
risks, but has no decision power to uphold, cancel or postpone mass gatherings
hosted by Member States.
MCQs
1- Mass gatherings (MGs) are events attended by large numbers of individuals,
concentrated in a specific area for a specific purpose and over a limited period of
time. What is the required number of participants for it to be a mass gathering ?
A- >1000 persons
B- <1000 persons
C- >100 persons
2- you were asked to do a risk identification for a sport event which will be held
outdoors in summer :
A- High risk of participants with existing medical conditions which may increase the need
for on site medical care, risk of waterborne diseases , drowning and flood related injuries.
B- Risk of STDs, hypothermia and non-communicable diseases . poor air circulation,
unknown immunity of participants.
C- Risk of injuries and cardiovascular events , collapse of infrastructure if inadequate to
support attendees , potential for inadequate sanitation, food and water preparations.
3- Does WHO have the power to cancel or move mass gatherings?
A- WHO may provide advice and decision power to uphold, cancel or
postpone mass gathering
B-WHO may provide advice,but has no decision power to uphold, cancel or
postpone mass gathering
C-WHO doesn’t provides advice and technical support to host governments preparing for
mass gathering events.
4- Do a risk assessment for Hajj 1440 ,the weather is expected to be Hot , sunny and
dry
A- risk of dehydration and hypothermia, risk of injuries, fatigue and crushes , increase
need of on-site medical care
B- excessive reliance on previously used systems, risk of drowning, flood related injuries,
risk of delayed detection of pathogens by inexperienced health care system
C- risk of allergies ,risk of communicable diseases , increase the need for on site medical
care , risk for crushes , risk for dehydration, heat stroke / hyperthermia
5- Which of the following disease characteristics should be considered for
surveillance:
5- C
A-Have an outbreak potential 4- C
B-Are known to be of particular potential use as bioterrorism agents 3- B
2- C
C-Both A and B 1- A
