Surveillance at Mass Gatherings: Vancouver 2010 - Dr Bonnie Henry Medical Director, CD Prevention and Control and Public Health Emergency Programs ...

Surveillance at Mass
Gatherings: Vancouver
         2010
Dr Bonnie Henry
Medical Director, CD Prevention and Control and
Public Health Emergency Programs
BC Centre for Disease Control

COI declaration
• I have no conflicts to declare, specifically
• Relationships with commercial interests:
   – Grants/Research Support: none
   – Speakers Bureau/Honoraria: none
   – Consulting Fees: none
• Other: I am an employee of the BC Centre for
  Disease Control and Faculty at UBC, School of
  Population and Public Health
  – In this role I do provide advice to government
    on surveillance programs in BC

Outline

• Disease surveillance
• Public health concerns at mass gatherings
• Risk assessment
• Where it all fits in mass gathering
  organization
• What happened in Vancouver

What is a “Mass gathering”?

                  Mass gatherings

 Spontaneous                                   Planned
 (e.g. Pope's Funeral)

                    Recurrent events                     Recurrent event
                    different locations                   same location
                  (e.g. Olympics, World Cup)             (e.g. Hajj, Wimbledon)

Mass gathering population
    Public Health concerns

Communicable                     Adverse-effects of
  diseases                        environmental
                                    exposures

Investigations, Prevention,            Prevention
 Interventions     Control          ex : temperature
ex : Foodborne ex : meningitis     related illness, air
   outbreaks                              quality

Why are we worried?
• Mass gatherings
  – Increase the demand on existing services
  – Increase the potential for public health events
    due to changes in population dynamics,
    changes in services and changes in
    behaviours
  – Provide a platform for terrorist events
  – Attract media attention
• Therefore require more public health
  attention

Mass Gathering Preparedness
3 main areas:

• Risk Assessment: What might
  happen?
• Surveillance: How will we know when
  it happens?
• Response: What will we do when it
  happens?

2010 Winter Olympics

Vancouver 2010: the Dates
• 27 days of sport
• 60 days of celebration
• January 2010
   – Five week Olympic and Paralympic arts festival began
• Olympic Village opened Jan 15 and closed March 24

• February 12 to 28, 2010
   Olympic Winter Games (17 days of sport, 15 sports, 86
     medal events)
• March 12 to 21, 2010
   Paralympic Winter Games (10 days of sport, 5 sports,
     64 medal events)

Vancouver 2010 Games
            2010 Olympic Games
              – 2600 athletes
              – 3800 team officials
              – 83 countries; 86 medal
                events
              – 18,500 volunteers
              – 10,800 registered
                media
              – 14,500 security
                personnel
              – 1.6 million tickets

Whistler 2010 Games
          2010 Paralympic
            Games
            – 1350 athletes from 40
              countries
            – 1500 team officials
            – 60 medal events
            – 1300 media
            – 6500 volunteers

*

Overall Objective
• To detect increases in communicable diseases
  and syndromes of interest in BC between
  February 5 - March 22, 2010
• To document the absence of activity of the
  above and dispel rumours
• To develop expertise in surveillance
• To promote effective communication and
  collaboration with cross-border and other
  partners

What were we worried about?
 • Influenza, influenza, influenza
 • Gastrointestinal illness (especially in
   ‘accommodation vessels’)
 • Protests and tear gas

 • Injuries from cold
 • Anti-Olympic protestors
 • Terrorism events: very low risk

Surveillance Sources
• Routine
  o   BCCDC Alert Analysis system
       ! Reportable communicable disease in the province,
         daily Monday-Friday
  o   BCCDC Laboratory
       ! Daily report posted at 10:30
  o   Influenza surveillance
       ! Weekly bulletin (Wednesdays)
  o   Enteric
       ! Monthly report

Surveillance Sources
• Enhanced
  o   BC Ambulance Service
  o   BC HealthLink
  o   Sentinel Emergency Departments (ED)
       ! BC Children’s Hospital
       ! Fraser Health Authority
       ! Vancouver Island Health Authority
  o   Drug and Poison Information Centre (DPIC)
  o   Medical Services Plan
  o   Coroner’s Office
  o   Vital Statistics

Sentinel Physicians: Influenza-Like
              Illness

Laboratory Reports –
Norovirus Outbreaks

Respiratory specimens submitted to BC Provincial
Laboratory and positive for Influenza Virus by week, BC,
                      2009-2010

Other
• Global Public Health Intelligence Network
  (GPHIN)
     ! Identifies events of public health importance reported in
       the global media
     ! Fusion Report: weekly until Olympics; then daily
• Pacific Northwest Partners teleconference
      1) Did anything unusual happen in your area
      yesterday?
      2) Are you monitoring anything in particular?
      3) Is there anything that will hit the media tomorrow?

Number of calls for ambulance services for
Overdose / Ingestion Poisoning (February 28 to
                March 6, 2010)

Percentage of BC HealthLink Calls for Enteric Illness among
 all callers in BC(compared to seven day moving average)
                 February 14 to March 20, 2010

Emergency Department Visits. FHA Hospitals, Selected VIHA
          Hospitals, and BC Children’s Hospital

          (September 6, 2009 to March 21, 2010)

Illicit Drug-Related Calls to the Drug and Poison Information
Centre, by week (January, February, and March. 2008 – 2010)

Specific Enteric Illness codes as a Percentage of Total
Medical Service Plan Claims (7 day moving average) by date,
 South Vancouver Island, December 15 2009 to March 22,
                            2010

Illicit Drug Overdose Deaths in British Columbia, by month
          January, February, and March 2008 – 2010

Reporting cycle
• 0800 team briefing
• 0900 PREOC call
• 1100 IHEP call
• 1300 internal review
• 1430 draft report for MD
  review
• 1500 PNW partners call
• 1600 daily wrap-up
• 1630 daily report posted

What Happened?
• GI illness in RCMP week before the Games
• Noro OB in Workers accommodation
• ‘poisoning’ reports at skytrain station
• Increased ED visits for assaults/overdose Feb
  20/21 and 26/27
• Leprosy
• Apparent STI on
accommodation ship
• No influenza!
• 15 Gold medals

What worked?
• Situational awareness
  valued
• Strengthening of existing
  relationships
• Build new partnerships
• Increased connectivity,
  information flow
• Cross training opportunity
• Team building
• Working with new data
  sources

Measles in BC: a post party
        problem?

Introduction
• 3 co-primary cases with dates of onset 9-11
  March, 2010 may have been infected by same
  source, suspected to be 1 or more visitors to
  Vancouver
• 3 different genotypes identified (from 18
  samples): 15-H1 and 3-D8
  – 1 D8 from a traveler returning from India; no
    secondary cases
  – 2 H1 co-primary cases associated with transmission
    in extended unimmunized family
  – 1 H1 co-primary case California resident

Introduction
• 71 confirmed, 4 clinical cases (April 30)
• Highest number in a decade: 42 cases in
  2000; 2002-2009 0-4 reported cases per
  year
• Age range: 5mos-64 years (mean 22
  years)
• Rash onsets: 9 March-18 April, 2010

Impact
• 46 cases attended EDs (61%)
• 16 cases were hospitalized (21%)
• One person hospitalized for 6 days and
  required ventilatory support.

• Hundreds of HCWs screened and some
  furloghed

What did we learn about disease
         surveillance?
• The health sector is complex
• Role for medical intelligence
• What is the added value:
  – Builds capacity
  – Builds connections
  – Builds confidence
  (Don’t underestimate the importance of
    rumour control)

Luck favours the
 prepared mind

Louis Pasteur

Merci

        Thank you