Wednesday, 27 July 2011

Them foreign germs? Comin’ over here?

This post first appeared on the 21st Floor site

So, the Olympics are one year away, running from 27 July to 12 August 2012 . The Paralympics (29 August to 9 September) run soon afterwards.
That’s a lot of people coming to London. Many of them foreign, so cue the Daily Mail getting into a froth about nasty foreigners and their nastier germs.
Anyway, I digress. Lots of people in one place (otherwise known as a mass gathering) means there is potential for outbreaks of infectious diseases. The authorities have to be as prepared as possible, and this would include liaison between dozens of institutions and offices, including local and national government, healthcare bosses, the police, the Mayor’s office, and also the Health Protection Agency (HPA).
The HPA (soon to be reformed into a Department of Health entity called Public Health England) are the body responsible for disease surveillance in England (Health Protection Scotland, and Public Health Wales seeing to the rest of Great Britain). They are key to the monitoring and confirmation of potential outbreaks, and providing advice and support for the containment of the outbreaks. They have reference laboratories all over the country, with the main site being in Colindale, in north-west London.
According to the specific pages on the HPA website, during the period of the Olympics, they will be ‘producing a daily public health report’ that will be disseminated to appropriate partners and collaborators. They have also carried out training exercises (codenamed Exercise Bucephalu), identifying best practice in situations of mass casualties and evacuations. As well as infectious disease outbreaks, they will also monitor other public health concerns, such as bioterrorism, fires, radiation, chemical attacks etc.
But back to infection – what does happen during mass gatherings? The risk of an outbreak does of course increase. More people around in crowded areas, perhaps with unusual strains and serotypes of interesting bacteria and viruses. But this does not mean that half the Olympic stadium will be charging towards some overcrowded toilets immediately after the opening ceremony, nor does it mean the equestrian events will be tarnished with a hefty bout of equine flu. Let’s look at what happens in previous mass gatherings.
The Hajj is perhaps the world’s largest mass gathering. Somewhere near 2 million pilgrims attend this 5-day Muslim festival in Mecca every year, which poses significant crowd-control and public health issues. This festival has experienced outbreaks of meningitis, and pilgrims are considered at high risk of tuberculosis and other respiratory infections. The World Health Organisation now publish guidance on vaccination requirements before visas to Saudi Arabia are issued.
With sporting events, and in relation to the dynamics of infection, they tend to play out a little differently. People are in close proximity to each other for maybe a couple of hours, then disperse. The 1998 football world cup was held in France, and the network of surveillance systems set up to capture health-related data suggested that there was no significant increase in cases of communicable diseases. Fast forward to Portugal and the 2004 European Championships – during the tournament, there were ten foodborne outbreaks, seven cases of meningococcal disease and one case of legionnaires disease. Visitors were not affected, and cases numbers among residents were not unduly affected by the presence of thousands of extra tourists. During the 2006 world cup in Germany, a norovirus outbreak was picked up through the enhanced surveillance systems, but nothing of great impact beyond that.
A further paper also suggests that, on the whole, there is no great increase in incidence of infectious diseases during large sporting events. But preparation and surveillance, as described above, here for the Beijing Olympics, and here for the Vancouver Winter Olympics, is absolutely key.  Because despite the risks rarely playing out into a worst-case scenario, we certainly don’t want them foreign germs (or the good old-fashioned British ones with union jack-themed flagellae) spreading freely about the capital...

Michael Head