Communicable diseases as health risks at mass gatherings other than Hajj: what is the evidence?

Abstract

Mass gatherings are characterized by the concentration of people temporally and spatially, and may lead to the emergence of infectious diseases due to enhanced transmission between attendees. This is well-demonstrated in the context of the Hajj and Umrah pilgrimages in Saudi Arabia. The goal of this review was to present the available evidence on outbreaks associated with a variety of pathogens, or also the lack thereof, as assessed by thorough surveillance at any mass gatherings with the exception of those in Saudi Arabia. A systematic search for relevant articles in the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Sixty-eight studies were identified. Although outbreaks have not been reported frequently in or after mass gatherings outside the Hajj and Umrah pilgrimages, they have sometimes occurred at Muslim, Christian, and Hindu religious events, at sports events, and at large-scale open air festivals. In this review it was found that the most common outbreaks at these mass gatherings involved vaccine preventable diseases, mainly measles and influenza, but also mumps and hepatitis A. Meningococcal disease has rarely been recorded. Additionally it was found that the transmission of various communicable diseases that may not be prevented by vaccination has been recorded in association with mass gatherings. These were mainly gastrointestinal infections, caused by a variety of pathogens. It was also noted that some outbreaks occurring at mass gatherings have resulted in the international spread of communicable diseases.

Summer music and arts festivals as hot spots for measles transmission: experience from England and Wales, June to October 2016

“…Music and arts festivals present the ideal environment for the transmission of infections like measles, given the large crowds and close prolonged interpersonal contact between individuals [5,6]. The popularity of these events [7] enhances the potential for outbreaks in this type of setting, and it is therefore important to advise festival goers, as well as individuals working or performing at such events, to be fully vaccinated.…”

Risks threatening the health of people participating in mass gatherings: A systematic review

“…This fact further illustrates the importance of efforts on water and food health of the participants. [58] In addition, it was observed that the outbreak of waterborne disease with various pathogens (parasites, bacteria, and viruses) occurred due to the lack of personal and public hygiene and insufficient vaccination coverage. [58] Further, in addition to water sanitation, similar supervision should be considered for ice sources as well.…”

“…[58] In addition, it was observed that the outbreak of waterborne disease with various pathogens (parasites, bacteria, and viruses) occurred due to the lack of personal and public hygiene and insufficient vaccination coverage. [58] Further, in addition to water sanitation, similar supervision should be considered for ice sources as well. [56] Due to the provision of safe drinking water during the Hajj, the risk of waterborne diseases is low.…”

“…[67] In music festivals involving alcohol consumption, there is an increased risk of sexually transmitted disease risks. [58]…”

“…The provisions include recommendations and different standard plans for participants[454648577172] and vaccination according to approved protocols. [5454648565867717273]…”