surveillance at mass gatherings: vancouver 2010 · surveillance sources • routine o bccdc alert...
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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
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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
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Outline
• Disease surveillance • Public health concerns at mass gatherings • Risk assessment • Where it all fits in mass gathering
organization • What happened in Vancouver
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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)
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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
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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
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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?
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2010 Winter Olympics
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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)
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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
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Whistler 2010 Games 2010 Paralympic
Games – 1350 athletes from 40
countries – 1500 team officials – 60 medal events – 1300 media – 6500 volunteers
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*
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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
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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
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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
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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
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Sentinel Physicians: Influenza-Like Illness
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Laboratory Reports – Norovirus Outbreaks
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Respiratory specimens submitted to BC Provincial Laboratory and positive for Influenza Virus by week, BC,
2009-2010
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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?
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Number of calls for ambulance services for Overdose / Ingestion Poisoning (February 28 to
March 6, 2010)
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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
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Emergency Department Visits. FHA Hospitals, Selected VIHA Hospitals, and BC Children’s Hospital
(September 6, 2009 to March 21, 2010)
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Illicit Drug-Related Calls to the Drug and Poison Information Centre, by week (January, February, and March. 2008 – 2010)
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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
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Illicit Drug Overdose Deaths in British Columbia, by month January, February, and March 2008 – 2010
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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
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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
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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
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Measles in BC: a post party problem?
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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
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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
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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
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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)
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Luck favours the prepared mind
Louis Pasteur
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Thank you
Merci