Emergency Preparedness and Response

Improved public health surveillance systems to be a legacy of London Olympics

The scale of the challenge the London 2012 summer Olympic and Paralympic Games pose for public health, occupational and public safety, and emergency planning is unprecedented and a multiplicity of national public bodies have been involved, including the Home Office, Department of Health, Metropolitan Police, the Health and Safety Executive and the HPA.

Arrangements for public/visitor/participant health and emergency preparedness are being coordinated by the HPA. At a recent Chilton seminar, Dr Brian McCloskey, HPA regional director for London, who has been leading this work since the London bid was submitted seven years ago, presented a review of the advanced state that preparations have reached [1]. The task was formidable, he said, not only because of the unprecedented scale of the event but also because of the associated international media focus and the fact that contingency planning has to encompass the possibility of terrorist attack, which was less of a risk for either Beijing or Athens. By the time of the opening ceremony on 27 July next year, approximately 180,000 people will be working on the project, including 10,000 employed by the London Organising Committee of the Olympic Games (LOCOG), up to 70,000 volunteers and 100,000 contractors.

McCloskey was a member of a WHO advisory group that studied and codified public health lessons learned from past mass gatherings following consultations and contributions from international experts from a wide range of fields including bio-surveillance, emergency response, mass gatherings, medicine, epidemiology and pharmacology [2]. These guidelines provide a framework within which lessons learned from past public health alerts are being assimilated and carried forward for the benefit of the London games and future host cities, a legacy aspect of the Olympics that has been neglected in the past, McCloskey said.

The biggest test of the HPA's preparations lies ahead, during the period surrounding the main games fortnight (27/7 to 12/8). In the week ahead of the opening ceremony, for example, the simultaneous migration of athletes (10,250 for the main games, 4000 for the paralympics) from 200 training camps around the country, has the potential to trigger an unusually high number of infectious disease outbreaks and other increased public health risks associated with mass gatherings [2]. Existing infectious disease surveillance systems are being enhanced to take account of this possibility.

This includes existing syndromic surveillance systems [3]. The HPA Real-time Syndromic Surveillance Team (ReSST) has been preparing an enhanced syndromic surveillance service for the 2012 Games including the strengthening of existing systems and the development of new ones. Two of the major enhancements in this area have been the development of a GP out-of-hours (OOH) system, which will provide near-real time (daily) reports of patients presenting to OOH services, and an emergency department (ED) surveillance system, which will enable real-time monitoring of attendance data from a sentinel network of EDs.

Each system provides novel aspects of syndromic surveillance which is advantageous for the Games:

• GP OOH surveillance data cover evenings, nights, weekends and bank holidays, complementing the ‘in-hours' data already monitored through the HPA/QSurveillance GP system [4];
• ED surveillance data will provide more effective monitoring of more severe presentations of acute disease than is currently possible through the GP or HPA/NHS Direct systems.

ReSST, which is based in Birmingham but provides a national surveillance service, piloted both of these systems during 2010 to assess the feasibility of using these syndromic data for surveillance purposes. Both systems are now being rolled out to ensure representative coverage across London, and the rest of England. They will complement the existing syndromic package to ensure that the public health impacts of any infectious disease outbreak or related incident (eg heatwave) are detected as soon as possible. These and related developments are described in the latest edition of the HPA 2012 Games Newsletter [5].

References

1. “London 2012 – are we prepared?” presentation given by Dr McCloskey in February 2011, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Oxon.

2. “Communicable disease alert and response for mass gatherings: key considerations”, WHO, June 2008.

3. Syndromic surveillance is the real-time (or near real-time) collection, analysis, interpretation and dissemination of health-related data to enable the early identification of the impact (or absence of impact) of potential human or veterinary public-health threats which require effective public health action. See, the Syndromic Surveillance Systems in Europe (“Triple S” project) website at: http://www.syndromicsurveillance.eu/.

4. See HPR Primary Care webpage, http://www.hpa.org.uk/hpr/infections/primarycare.htm.

5. HPA website: http://www.hpa.org.uk/Topics/EmergencyResponse/2012Olympics/.