Global perspectives for prevention of infectious diseases associated with mass gatherings.

We assess risks of communicable diseases that are associated with mass gatherings (MGs), outline approaches to risk assessment and mitigation, and draw attention to some key challenges encountered by organisers and participants. Crowding and lack of sanitation at MGs can lead to the emergence of infectious diseases, and rapid population movement can spread them across the world. Many infections pose huge challenges to planners of MGs; however, these events also provide an opportunity to engage in public health action that will benefit host communities and the countries from which participants originate.

[1]  A. Mankertz,et al.  Spotlight on measles 2010: Measles outbreak among travellers returning from a mass gathering, Germany, September to October 2010. , 2010, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[2]  R. Gold Epidemiology of meningococcal disease in light of recent Hajj-associated outbreaks. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[3]  Mary E. Wilson,et al.  Chikungunya fever: an epidemiological review of a re-emerging infectious disease. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[4]  H. Artsob,et al.  Update: outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000--Borneo, Malaysia, 2000. , 2001, MMWR. Morbidity and mortality weekly report.

[5]  I. Barr,et al.  Influenza Outbreaks during World Youth Day 2008 Mass Gathering , 2010, Emerging infectious diseases.

[6]  J. Swann,et al.  The impact of mass gatherings and holiday traveling on the course of an influenza pandemic: a computational model , 2010, BMC public health.

[7]  M. Lim,et al.  Sexual-risk behaviour, self-perceived risk and knowledge of sexually transmissible infections among young Australians attending a music festival. , 2007, Sexual health.

[8]  M. Issack,et al.  Hajj-Related Neisseria Meningitidis Serogroup W135 in Mauritius , 2002, Emerging infectious diseases.

[9]  A. Eltahawy,et al.  A fatal non-01 Vibrio cholerae septicemia in a patient with liver cirrhosis. , 2004, Saudi medical journal.

[10]  C. Woods,et al.  Outbreak of leptospirosis among triathlon participants and community residents in Springfield, Illinois, 1998. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  S. Fagbo The Evolving Transmission Pattern of Rift Valley Fever in the Arabian Peninsula , 2002, Annals of the New York Academy of Sciences.

[12]  H. Hussain,et al.  Pattern of skin diseases among pilgrims during Hajj season in Makkah, Saudi Arabia , 2000, International journal of dermatology.

[13]  Nalin Rastogi,et al.  Proposal for Standardization of Optimized Mycobacterial Interspersed Repetitive Unit-Variable-Number Tandem Repeat Typing of Mycobacterium tuberculosis , 2006, Journal of Clinical Microbiology.

[14]  Philippe Brouqui,et al.  Common health hazards in French pilgrims during the Hajj of 2007: a prospective cohort study. , 2009, Journal of travel medicine.

[15]  R. Booy,et al.  Hazards of hepatitis at the Hajj. , 2009, Travel medicine and infectious disease.

[16]  R. Hancock,et al.  Outbreak of Escherichia coli O157 Infection Associated with a Music Festival , 1999, European Journal of Clinical Microbiology and Infectious Diseases.

[17]  H. Foo,et al.  Laboratory test performance in young adults during influenza outbreaks at World Youth Day 2008. , 2009, Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology.

[18]  A. Lenglet,et al.  Mumps outbreak in young adults following a village festival in the Navarra region, Spain, August 2006. , 2006, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[19]  M. Achtman,et al.  Serogroup W135 meningococcal disease in Hajj pilgrims , 2000, The Lancet.

[20]  P. Fine,et al.  Global poliomyelitis eradication: status and implications , 2007, The Lancet.

[21]  A. Sheikh,et al.  Vaccinations for Hajj , 2006, The journal of the Royal Society for the Promotion of Health.

[22]  S. Malik,et al.  Spectrum of malaria in Hajj pilgrims in the year 2000. , 2002, Journal of Ayub Medical College, Abbottabad : JAMC.

[23]  A. Wilder-Smith,et al.  Acquisition of W135 meningococcal carriage in Hajj pilgrims and transmission to household contacts: prospective study , 2002, BMJ : British Medical Journal.

[24]  R. Booy,et al.  Viral respiratory infections at the Hajj: comparison between UK and Saudi pilgrims , 2008, Clinical Microbiology and Infection.

[25]  M. Richter,et al.  Serious soccer, sex (work) and HIV - will South Africa be too hot to handle during the 2010 World Cup? , 2010, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[26]  V. Novelli,et al.  EPIDEMIC GROUP A MENINGOCOCCAL DISEASE IN HAJ PILGRIMS , 1987, The Lancet.

[27]  K. Goh,et al.  Hajj-associated outbreak strain of Neisseria meningitidis serogroup W135: estimates of the attack rate in a defined population and the risk of invasive disease developing in carriers. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[28]  J. Brownstein,et al.  Preparing for infectious disease threats at mass gatherings: the case of the Vancouver 2010 Olympic Winter Games , 2010, Canadian Medical Association Journal.

[29]  F. Mahoney,et al.  Establishment of public health security in Saudi Arabia for the 2009 Hajj in response to pandemic influenza A H1N1 , 2009, The Lancet.

[30]  W. T. Dyer,et al.  THE CHOLERA AND HAGAR'S WELL AT MECCA. , 1883 .

[31]  Laura C Rodrigues,et al.  Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance , 1999, BMJ.

[32]  A. Mangili,et al.  Review Transmission , 2022 .

[33]  Abdolvahab Alborzi,et al.  Viral etiology of acute respiratory infections among Iranian Hajj pilgrims, 2006. , 2009, Journal of travel medicine.

[34]  Ziad A Memish,et al.  Health risks at the Hajj , 2006, The Lancet.

[35]  A. Sheikh,et al.  Hajj and risk of blood borne infections , 2001, Archives of disease in childhood.

[36]  Alipasha Meysamie,et al.  Comparison of mortality and morbidity rates among Iranian pilgrims in Hajj 2004 and 2005. , 2006, Saudi medical journal.

[37]  D. Gunnell,et al.  An outbreak ofCampylobacter infection associated with the consumption of unpasteurised milk at a large festival in England , 1994, European Journal of Epidemiology.

[38]  Adi V. Gundlapalli,et al.  Influenza, Winter Olympiad, 2002 , 2006, Emerging infectious diseases.

[39]  A. Baleta South Africa prepares for the football World Cup. , 2010, Lancet. Infectious Diseases (Print).

[40]  G. Iliyasu,et al.  Anti-retroviral therapy among HIV infected travelers to Hajj pilgrimage. , 2010, Journal of travel medicine.

[41]  A. Wilder-Smith,et al.  High incidence of pertussis among Hajj pilgrims. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[42]  D. Coleman,et al.  A multi-jurisdictional outbreak of hepatitis A related to a youth camp--implications for catering operations and mass gatherings. , 2004, Communicable diseases intelligence quarterly report.

[43]  S. Abdo-Salem,et al.  Can environmental and socioeconomic factors explain the recent emergence of Rift Valley fever in Yemen, 2000-2001? , 2011, Vector borne and zoonotic diseases.

[44]  K. Stark,et al.  Outbreak of leptospirosis among triathlon participants in Germany, 2006 , 2010, BMC infectious diseases.

[45]  J. Benzler,et al.  Preparations for infectious disease surveillance during the football World Cup tournament, Germany 2006. , 2006, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[46]  Z. Memish,et al.  Influenza vaccine in Hajj pilgrims: policy issues from field studies. , 2008, Vaccine.

[47]  Z. Memish Meningococcal disease and travel. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[48]  Onishchenko Gg,et al.  Cholera in the Republic of Dagestan , 1995 .

[49]  M. Hellard,et al.  Home-based chlamydia testing of young people attending a music festival - who will pee and post? , 2010, BMC public health.

[50]  A. Pollard,et al.  Quadrivalent meningococcal conjugate vaccines. , 2009, Vaccine.

[51]  J. Wells,et al.  A large outbreak of antibiotic-resistant shigellosis at a mass gathering. , 1990, The Journal of infectious diseases.

[52]  D. Coulombier,et al.  Public health preparedness for two mass gathering events in the context of pandemic influenza (H1N1) 2009--Serbia, July 2009. , 2009, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[53]  N. Ravenscroft,et al.  Epidemic meningitis due to Group A Neisseria meningitidis in the African meningitis belt: a persistent problem with an imminent solution. , 2009, Vaccine.

[54]  Nigerian states again boycott polio-vaccination drive , 2004, The Lancet.

[55]  F. Allerberger,et al.  Mumps outbreak in young adults following a festival in Austria, 2006. , 2008, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[56]  J. Gaudart,et al.  Incidence of Hajj-associated febrile cough episodes among French pilgrims: a prospective cohort study on the influence of statin use and risk factors , 2009, Clinical Microbiology and Infection.

[57]  S. Salmaso,et al.  Autochthonous chikungunya virus transmission may have occurred in Bologna, Italy, during the summer 2007 outbreak. , 2008, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[58]  M. Mendelson,et al.  The 2010 FIFA World Cup: communicable disease risks and advice for visitors to South Africa. , 2010, Journal of travel medicine.

[59]  R. Charrel,et al.  Alkhurma haemorrhagic fever--a viral haemorrhagic disease unique to the Arabian Peninsula. , 2010, International journal of antimicrobial agents.

[60]  M Gross,et al.  Oswego County revisited. , 1976, Public health reports.

[61]  S. Z. Bukhari,et al.  Pyoderma among Hajj Pilgrims in Makkah. , 2002, Saudi medical journal.

[62]  S M El-Sheikh,et al.  Bacteria and viruses that cause respiratory tract infections during the pilgrimage (Haj) season in Makkah, Saudi Arabia , 1998, Tropical medicine & international health : TM & IH.

[63]  Anne Perrocheau,et al.  Outbreak of Serogroup W135 Meningococcal Disease after the Hajj Pilgrimage, Europe, 2000 , 2002, Emerging infectious diseases.

[64]  S. Loewenberg Fears of World Cup sex trafficking boom unfounded , 2006, The Lancet.

[65]  N. Hamajima,et al.  Food poisoning by Staphylococcus aureus at a university festival. , 2009, Japanese journal of infectious diseases.

[66]  P. Hunter,et al.  Foreign travel, casual sex, and sexually transmitted infections: systematic review and meta-analysis. , 2010, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[67]  M. Abdel-Fattah,et al.  Acute respiratory tract infections among Hajj medical mission personnel, Saudi Arabia , 2006, International Journal of Infectious Diseases.

[68]  T. Heggie Traveling to Canada for the Vancouver 2010 Winter Olympic and Paralympic Games. , 2009, Travel medicine and infectious disease.

[69]  C. Hadjichristodoulou,et al.  Evaluation of standardized scored inspections for Legionnaires' disease prevention, during the Athens 2004 Olympics , 2006, Epidemiology and Infection.

[70]  G. Jamjoom,et al.  Tuberculosis is the commonest cause of pneumonia requiring hospitalization during Hajj (pilgrimage to Makkah). , 1998, The Journal of infection.

[71]  R. Bercion,et al.  Recent Increase in Meningitis Caused by Neisseria meningitidis Serogroups A and W135, Yaoundé, Cameroon , 2002, Emerging infectious diseases.

[72]  Z. Memish,et al.  Sexually transmitted diseases and travel. , 2003, International journal of antimicrobial agents.

[73]  A. Wilder-Smith,et al.  Persistence of W135 Neisseria meningitidis Carriage in Returning Hajj Pilgrims: Risk for Early and Late Transmission to Household Contacts , 2003, Emerging infectious diseases.

[74]  J. Cutter,et al.  The influenza A (H1N1-2009) experience at the inaugural Asian Youth Games Singapore 2009: mass gathering during a developing pandemic , 2010, British Journal of Sports Medicine.

[75]  I. Abubakar,et al.  Tuberculosis and air travel: a systematic review and analysis of policy. , 2010, The Lancet. Infectious diseases.

[76]  M. Zambon,et al.  Influenza among U.K. Pilgrims to Hajj, 2003 , 2004, Emerging infectious diseases.

[77]  N. Crowcroft,et al.  W135 meningococcal disease in England and Wales associated with Hajj 2000 and 2001 , 2002, The Lancet.

[78]  Paul Armstrong,et al.  Should cities hosting mass gatherings invest in public health surveillance and planning? Reflections from a decade of mass gatherings in Sydney, Australia , 2009, BMC public health.

[79]  Hisham O Akbar,et al.  Pattern of admission to hospitals during muslim pilgrimage (Hajj). , 2003, Saudi medical journal.

[80]  T. Popović,et al.  Outbreak of W135 meningococcal disease in 2000: not emergence of a new W135 strain but clonal expansion within the electophoretic type-37 complex. , 2002, The Journal of infectious diseases.

[81]  R. Charrel,et al.  Travel-related influenza A/H1N1 infection at a rock festival in Hungary: one virus may hide another one. , 2010, Journal of travel medicine.

[82]  N. Othman,et al.  The prevalence of acute respiratory symptoms and role of protective measures among Malaysian hajj pilgrims. , 2010, Journal of travel medicine.

[83]  J. R. Evans,et al.  Prevalence of meningococcal serogroups and description of three new groups. , 1968, American journal of epidemiology.

[84]  J. Sejvar,et al.  Leptospirosis in “Eco-Challenge” Athletes, Malaysian Borneo, 2000 , 2003, Emerging infectious diseases.

[85]  G. Hasçelik,et al.  Neisseria meningitidis W135, Turkey , 2004, Emerging Infectious Diseases.

[86]  N. Bean,et al.  An outbreak of shigellosis at an outdoor music festival. , 1991, American journal of epidemiology.

[87]  A. Wilder-Smith,et al.  High risk of Mycobacterium tuberculosis infection during the Hajj pilgrimage , 2005, Tropical medicine & international health : TM & IH.

[88]  Z. Memish,et al.  Pandemic H1N1 influenza at the 2009 Hajj: understanding the unexpectedly low H1N1 burden , 2010, Journal of the Royal Society of Medicine.