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 (e.g. Pope's Funeral)

Planned

Recurrent events different locations

(e.g. Olympics, World Cup)

Recurrent event same location

(e.g. Hajj, Wimbledon)

Communicable diseases

Adverse-effects of environmental

exposures

Investigations, Interventions

ex : Foodborne outbreaks

Prevention, Control

ex : meningitis

Prevention ex : temperature

related illness, air quality

Mass gathering population Public Health concerns

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

Thank you

Merci