Mass gatherings include a diverse range of events such as sporting competitions, religious ceremonies, entertainment activities, political rallies and cultural celebrations, which have important implications for population well-being. However, if not managed properly, these events can amplify health risks including those related to communicable diseases, and place undue strain on health systems in host countries and potentially in attendees\' home countries, upon their return. The coronavirus disease 2019 (COVID-19) pandemic has provided a unique opportunity to evaluate the risk factors associated with mass gatherings and the effectiveness of applying mitigation measures during infectious disease emergencies. The pandemic has also allowed event organizers and health officials to identify best practices for mass gathering planning in host countries. To guide decisions about whether to hold, postpone, modify or cancel a mass gathering during the COVID-19 pandemic, the World Health Organization and its partners developed normative guidance and derivative tools promoting a risk-based approach to mass gathering planning. This approach involves three steps to guide decision-making around mass gatherings: risk evaluation, risk mitigation and risk communication. The approach was applied in the planning and execution of several mass gathering events, including the Tokyo 2020 and Beijing 2022 Olympic and Paralympic Games. Lessons identified from these large-scale international events offer insights into the planning and implementation of mass gathering events during a pandemic, and the broader impacts of such events on society. These lessons may also further inform and refine planning for future mass gatherings.
Les rassemblements de masse désignent un large éventail d\'événements tels que des compétitions sportives, cérémonies religieuses, activités de divertissement, manifestations politiques et fêtes culturelles. Tous ont un impact considérable sur le bien-être de la population. Toutefois, s\'ils ne sont pas gérés correctement, ils peuvent augmenter les risques sanitaires, notamment concernant les maladies transmissibles, et exercer une pression excessive sur les systèmes de santé des pays hôtes, voire sur ceux des pays d\'origine des participants après leur retour. La pandémie de maladie à coronavirus 2019 (COVID-19) a offert une occasion unique d\'évaluer les facteurs de risque associés aux rassemblements de masse, ainsi que l\'efficacité des mesures visant à limiter la propagation dans des situations d\'urgence liées à des maladies infectieuses. Cette pandémie a également permis aux organisateurs d\'événements et responsables de santé d\'identifier les bonnes pratiques à appliquer dans les pays hôtes pendant les rassemblements de masse. Afin de guider les décisions relatives au maintien, au report, à la modification ou à l\'annulation d\'un rassemblement de masse durant la pandémie de COVID-19, l\'Organisation mondiale de la Santé et ses partenaires ont mis au point des orientations normatives et des outils dérivés favorisant une approche tenant compte des risques au moment de la planification. Cette approche comprend trois étapes contribuant à la prise de décision: l\'évaluation, la réduction et la communication des risques. Elle a été déployée lors de la planification et de l\'exécution de nombreux rassemblements de masse, comme les Jeux olympiques et paralympiques de Tokyo 2020 et Beijing 2022. Les leçons tirées de ces événements internationaux à grande échelle fournissent des informations sur leur organisation et leur mise en œuvre en cas de pandémie, ainsi que les impacts de tels événements sur la société. Elles sont en outre susceptibles de faciliter et d\'améliorer la planification des futurs rassemblements de masse.
Las concentraciones masivas incluyen una gran variedad de eventos, como competiciones deportivas, ceremonias religiosas, actividades de entretenimiento, mítines políticos y celebraciones culturales, que tienen importantes implicaciones para el bienestar de la población. Sin embargo, si no se gestionan adecuadamente, estos eventos pueden amplificar los riesgos para la salud, incluidos los relacionados con las enfermedades transmisibles, y suponer una carga excesiva para los sistemas sanitarios de los países anfitriones y, potencialmente, de los países de origen de los participantes a su regreso. La pandemia de la enfermedad por coronavirus de 2019 (COVID-19) ha brindado una oportunidad única para evaluar los factores de riesgo asociados a las concentraciones masivas y la eficacia de aplicar medidas de mitigación durante las emergencias por enfermedades infecciosas. La pandemia también ha permitido a los organizadores de eventos y a las autoridades sanitarias identificar las mejores prácticas para la planificación de concentraciones masivas en los países anfitriones. Para orientar las decisiones sobre la celebración, el aplazamiento, la modificación o la cancelación de una concentración masiva durante la pandemia de la COVID-19, la Organización Mundial de la Salud y sus asociados elaboraron orientaciones normativas y herramientas derivadas que promueven un enfoque de la planificación de concentraciones masivas basado en los riesgos. Este enfoque consta de tres pasos para orientar la toma de decisiones en torno a las concentraciones masivas: la evaluación, la mitigación y la comunicación de riesgos. El enfoque se aplicó en la planificación y ejecución de varias concentraciones masivas, incluidos los Juegos Olímpicos y Paralímpicos de Tokio 2020 y Pekín 2022. Las conclusiones extraídas de estos eventos internacionales a gran escala permiten comprender mejor la planificación y ejecución de concentraciones masivas durante una pandemia, así como las repercusiones más generales de estos eventos en la sociedad. Estas lecciones también pueden informar y perfeccionar la planificación de futuras concentraciones masivas.
تشمل التجمعات الغفيرة مجموعة متنوعة من الأحداث مثل المسابقات الرياضية، والاحتفالات الدينية، والأنشطة الترفيهية، والمسيرات السياسية، والاحتفالات الثقافية، وهي ذات انعكاسات مهمة على رفاهية السكان. ومع ذلك، فإنه إذا لم تتم إدارة هذه الأحداث بشكل صحيح، فإنها يمكن أن تؤدي إلى تضاعف المخاطر الصحية بما في ذلك تلك المتعلقة بالأمراض المعدية، وتضع ضغوطًا بلا حدود على النظم الصحية في الدول المضيفة، ومن المحتمل كذلك في دول الحاضرين الأصلية، عند عودتهم لها. أتاحت جائحة مرض فيروس كورونا 2019 (كوفيد 19) فرصة فريدة لتقييم عوامل الخطر المرتبطة بالتجمعات الغفيرة، وفعالية تطبيق تدابير التخفيف أثناء حالات الطوارئ الخاصة بالأمراض المعدية. كما سمح الوباء لمنظمي الأحداث ومسؤولي الصحة بالتعرف على أفضل الممارسات للتخطيط التجمعات الغفيرة في الدول المضيفة. لتوجيه القرارات المتعلقة بعقد تجمع غفير، أو تأجيله، أو تعديله، أو إلغائه أثناء جائحة كوفيد 19، قامت منظمة الصحة العالمية (WHO) وشركاؤها بوضع توجيهات معيارية، وأدوات مشتقة تعزز الأسلوب القائم على المخاطر في التخطيط للتجمعات الغفيرة. يتضمن هذا الأسلوب ثلاث خطوات لتوجيه عملية صنع القرار بخصوص التجمعات الغفيرة، ألا وهي: تقييم المخاطر، وتخفيف المخاطر، والإبلاغ عن المخاطر. وتم تطبيق هذا الأسلوب أثناء تخطيط العديد من أحداث التجمعات الغفيرة وتنفيذها، بما في ذلك دورتي الألعاب الأولمبية والبارالمبية في طوكيو 2020 وبكين 2022. إن الدروس المستفادة من هذه الأحداث الدولية واسعة النطاق تقدم نظرات متعمقة على تخطيط أحداث التجمعات الغفيرة وتنفيذها أثناء الجائحة، والانعكاسات الأوسع لمثل هذه الأحداث على المجتمع. كما أن هذه الدروس قد تؤدي أيضًا إلى التوعية والتحسين المستقبلي بشكل أكبر للتخطيط للتجمعات الغفيرة.
大型集会包括对民众福祉具有重要影响的体育比赛、宗教仪式、娱乐活动、政治集会和文化庆典等各种活动。然而，如果管理不当，这些活动可能会增加卫生风险（包括与传染病有关的风险），并对东道国的卫生系统造成过大压力，甚至可能会在参与者回国后对其本国造成过大压力。2019 冠状病毒病 (COVID-19) 大流行为我们提供了评估与大型集会相关的风险因素以及在传染病突发情况下采取缓解措施的有效性的独特机会。大流行还有助于活动组织者和卫生官员找出在东道国策划大型集会的最佳做法。为指导在 COVID-19 大流行期间决定是否举行、推迟、变更或取消大型集会，世界卫生组织及其合作伙伴制定了规范性指南和衍生工具，从而提出了策划大型集会的风险管理方法。这一方法涉及就大型集会进行决策指导的三个步骤：风险评估、风险缓解和风险沟通。该方法已被应用于多项大型集会活动的策划和执行过程中，包括 2020 年东京奥运会和 2022 年北京冬季奥运会和残奥会。从这些大型国际活动中吸取的经验教训为大流行期间策划和实施大型集会活动以及了解此类活动会对社会造成的更广泛影响提供了见解。这些经验教训还可为未来完善大型集会的策划提供更多的依据。.
В число массовых мероприятий входит целый ряд событий, таких как спортивные соревнования, религиозные церемонии, развлекательные мероприятия, политические митинги и культурные праздники, которые оказывают важное влияние на благосостояние населения. Однако при отсутствии надлежащего управления эти мероприятия могут усилить риски для здоровья, в том числе связанные с инфекционными заболеваниями, а также создать чрезмерную нагрузку на системы здравоохранения в принимающих странах и, возможно, в странах проживания участников после их возвращения. Пандемия коронавирусной инфекции в 2019 году (COVID-19) предоставила уникальную возможность оценить факторы риска, связанные с массовыми мероприятиями, и эффективность применения мер по снижению риска во время чрезвычайных ситуаций, связанных с инфекционными заболеваниями. Пандемия также позволила организаторам мероприятий и сотрудникам органов здравоохранения определить оптимальные методы планирования массовых мероприятий в принимающих странах. Для принятия решений о проведении, переносе, изменении или отмене массовых мероприятий во время пандемии COVID-19 Всемирная организация здравоохранения и ее партнеры разработали нормативное руководство и производные инструменты, способствующие применению подхода к планированию массовых мероприятий на основе рисков. Этот подход предполагает три этапа принятия решений о массовых мероприятиях: оценку рисков, снижение рисков и информирование о рисках. Подход применялся при планировании и проведении нескольких массовых мероприятий, включая Олимпийские и Паралимпийские игры 2020 года в Токио и 2022 года в Пекине. Уроки, извлеченные из этих крупномасштабных международных событий, позволяют понять, как планировать и проводить массовые мероприятия во время пандемии и как они влияют на общество в целом. Эти выводы также могут послужить основой для планирования массовых мероприятий в будущем.

As the world steadily recovers from the COVID-19 pandemic, managing large gatherings becomes a critical concern for ensuring crowd safety. The crowd-crush disaster in Seoul in 2022 highlights the need for effective predictive crowd management techniques. In this study, an empirical analysis of this incident is conducted using data from various sources, and model-based simulations are created to replicate hazardous crowd conditions in high-risk areas. In the empirical analysis, mobile device data indicates a significant increase in population above normal levels in the disaster area just hours before the incident occurred. In the simulations, a hydrodynamic model is employed to simulate a bidirectional collision, which quantitatively demonstrates that the average density during the crush reached 7.57 ped/m2 (with a maximum of (9.95)ped/m2). Additionally, the average crowd pressure peaked at 1,063 N/m (with a maximum of 1,961 N/m), and the maximum velocity entropy was 10.99. Based on these findings, it can be concluded that the primary causes of the disaster were the substantial population, bidirectional collision, and escalating panic. The results of controlled simulations under various management strategies are then presented. By implementing effective crowd management techniques, crowd safety can be enhanced through quantitative comparisons of these key indicators.

Monkeypox (mpox), a zoonotic disease caused by the monkeypox virus (MPXV), poses a significant public health threat with the potential for global dissemination beyond its endemic regions in Central and West Africa. This study explores the multifaceted aspects of monkeypox, covering its epidemiology, genomics, travel-related spread, mass gathering implications, and economic consequences. Epidemiologically, mpox exhibits distinct patterns, with variations in age and gender susceptibility. Severe cases can arise in immunocompromised individuals, underscoring the importance of understanding the factors contributing to its transmission. Genomic analysis of MPXV highlights its evolutionary relationship with the variola virus and vaccinia virus. Different MPXV clades exhibit varying levels of virulence and transmission potential, with Clade I associated with higher mortality rates. Moreover, the role of recombination in MPXV evolution remains a subject of interest, with implications for understanding its genetic diversity. Travel and mass gatherings play a pivotal role in the spread of monkeypox. The ease of international travel and increasing globalization have led to outbreaks beyond African borders. The economic ramifications of mpox outbreaks extend beyond public health. Direct treatment costs, productivity losses, and resource-intensive control efforts can strain healthcare systems and economies. While vaccination and mitigation strategies have proven effective, the cost-effectiveness of routine vaccination in non-endemic countries remains a subject of debate. This study emphasizes the role of travel, mass gatherings, and genomics in its spread and underscores the economic impacts on affected regions. Enhancing surveillance, vaccination strategies, and public health measures are essential in controlling this emerging infectious disease.

Shared social identity and social norms are often un(der)recognized within mass gatherings health literature, yet they can increase infectious disease transmission by motivating people to engage in risk-taking behaviours. Across three experiments (Ntotal = 1551), we investigated how shared social identities, perceived norms of resource-sharing, and perceived riskiness of sharing interact to shape decisions that can lead to disease transmission. In Experiment 1 (N = 528), we examined how shared social identity and perceived descriptive norms affect the likelihood of crowd members sharing resources that may contribute to disease spread. We then replicated this in Experiment 2 (N = 511) using perceived injunctive norms. In Experiment 3 (N = 512), we explored how high shared social identity, perceived norms, and perceived health risks of resource-sharing impact the likelihood of sharing that may, in turn, increase infectious disease transmission at mass gatherings. We found that high shared social identity interacts with perceived descriptive and injunctive norms, and low health risk perceptions, to increase the likelihood of accepting resources and giving resources at mass gatherings. We discuss the theoretical and practical implications for researchers, practitioners, and policymakers to build effective strategies to mitigate infectious disease transmission at mass gatherings.

BACKGROUND: Large gatherings often involve extended and intimate contact among individuals, creating environments conducive to the spread of infectious diseases. Despite this, there is limited research utilizing outbreak detection algorithms to analyze real syndrome data from such events. This study sought to address this gap by examining the implementation and efficacy of outbreak detection algorithms for syndromic surveillance during mass gatherings in Iraq.
METHODS: For the study, 10 data collectors conducted field data collection over 10 days from August 25, 2023, to September 3, 2023. Data were gathered from 10 healthcare clinics situated along Ya Hussein Road, a major route from Najaf to Karbala in Iraq. Various outbreak detection algorithms, such as moving average, cumulative sum, and exponentially weighted moving average, were applied to analyze the reported syndromes.
RESULTS: During the 10 days from August 25, 2023, to September 3, 2023, 12202 pilgrims visited 10 health clinics along a route in Iraq. Most pilgrims were between 20 and 59 years old (77.4%, n=9444), with more than half being foreigners (58.1%, n=7092). Among the pilgrims, 40.5% (n=4938) exhibited syndromes, with influenza-like illness (ILI) being the most common (48.8%, n=2411). Other prevalent syndromes included food poisoning (21.2%, n=1048), heatstroke (17.7%, n=875), febrile rash (9.0%, n=446), and gastroenteritis (3.2%, n=158). The cumulative sum (CUSUM) algorithm was more effective than exponentially weighted moving average (EWMA) and moving average (MA) algorithms for detecting small shifts.
CONCLUSIONS: Effective public health surveillance systems are crucial during mass gatherings to swiftly identify and address emerging health risks. Utilizing advanced algorithms and real-time data analysis can empower authorities to improve their readiness and response capacity, thereby ensuring the protection of public health during these gatherings.

BACKGROUND: Mass gatherings (MGs) usually represent significant challenges for the public health and safety sector of the host cities. Organizing a safe and successful mass event highly depends on the effective collaboration among different public and private organizations. It is necessary to establish successful coordination to ensure that all the key stakeholders understand their respective roles and responsibilities. The inconsistency between the variety of participating agencies because of their different culture can result in delays in decision making. Interorganizational knowledge transfer can improve the success of the event; however, knowledge transfer among professionals and agencies in MGs is not well-documented.
OBJECTIVE: This study used the 2018 Athens Marathon as the empirical setting to examine how interorganizational knowledge transfer was perceived among the multiple public health and safety professionals during the planning stage of the event.
METHODS: Data comprised 18 semi-structured, in-depth interviews with key informants, direct observations of meetings, and documentary analysis. Open coding and thematic analysis were used to analyze the data.
RESULTS: Findings indicated that sharing the acquired knowledge was a necessary and challenging step to create an enabling collaborative environment among interacting organizations. Experiential learning was identified as a significant factor, which helped promote joint understanding and partnership work. Informal interpersonal exchanges and formal knowledge transfer activities facilitated knowledge sharing across organizational boundaries, helping to break down silos.
CONCLUSIONS: Interorganizational knowledge transfer is a necessary step to achieve joint understanding and create an environment where interaction among agencies can be more effective. The study findings can be beneficial for organizers of marathons and other mass sporting events to support valuable interorganizational collaboration and conduct a safe event.

OBJECTIVE: To map the current evidence about the health concerns and the potential solutions related to the Islamic pilgrimage to Mecca.
METHODS: A scoping review was applied. Papers published in English between 2012 and 2023 were included but non-human research and sources without any related data were excluded. Data charting and extraction were used to map the current evidence.
RESULTS: The total of 36 papers were included with the total number of pilgrims of 17,075,887. The majority of studies were published in the Asia Pacific region (36.11%) as original articles (88.89%). The health concerns were grouped into five main aspects. There were 7603 deaths recorded or about 44 incidences of deaths per 100,000 pilgrims during the pilgrimage. There were recorded 11,018; 6178; 3393; and 17,810 cases for communicable diseases; non-communicable diseases; injuries and trauma; and health services (i.e., cardiac catheterization) and vaccination, respectively.
CONCLUSIONS: Relating to the five health concerns, this study identified the top seven issues in each category (i.e., hypertension, influenza vaccination), except for the death record. Moreover, there were three solutions (for general health, non- and communicable-diseases) presented. Stakeholders could use this evidence to improve healthcare quality particularly related to the annual Islamic pilgrimage to Mecca.

BACKGROUND: The mass gathering event (MGE) industry is growing globally, including in countries such as Canada. MGEs have been associated with a greater prevalence of injury and illness when compared with daily life events, despite most participants having few comorbidities. As such, adequate health, safety, and emergency medical planning is required. However, there is no single entity regulating these concerns for MGEs, resulting in the responsibility for health planning lying with event organizers. This study aims to compare the legislative requirements for MGE medical response systems in the 13 provinces and territories of Canada.
METHODS: This study is a cross-sectional descriptive analysis of Canadian legislation. Lists of publicly available legislative requirements were obtained by means of the emergency medical services directors and Health Ministries. Descriptive statistics were performed to compare legislation.
RESULTS: Of the 13 provinces and territories, 10 responded. For the missing 3, a law library review confirmed the absence of specific legislation. Most (n = 6; 60%) provinces and territories referred to provisions in their Public Health laws. Four confirmed that MGE medical response was a municipal or local concern to be addressed by the event organizers.
CONCLUSIONS: No provinces could list specific legislation guiding safety, health, and medical response for an MGE.

BACKGROUND: Global temperatures are on the rise, leading to more frequent and severe heatwaves with associated health risks. Heat-related illnesses (HRIs) are an increasing threat for travellers to hot climate destinations. This study was designed to elucidate the interplay between increasing ambient temperatures, incidence of HRIs and the effectiveness of mitigation strategies during the annual Hajj mass gathering over a 40-year period.
METHODS: An observational study was conducted utilizing historical records spanning four decades of meteorological data, and the rates of heat stroke (HS) and heat exhaustion (HE) during the Hajj pilgrimage in Mecca, Saudi Arabia. With an annual population exceeding 2 million participants from over 180 countries, the study analysed temporal variations in weather conditions over two distinct Hajj hot cycles and correlated it with the occurrence of HS and HE. The effectiveness of deployed mitigation measures in alleviating health vulnerabilities between the two cycles was also assessed.
RESULTS: Throughout the study period, average dry and wet bulb temperatures in Mecca escalated by 0.4°C (Mann-Kendall P < 0.0001) and 0.2°C (Mann-Kendall P = 0.25) per decade, respectively. Both temperatures were strongly correlated with the incidence of HS and HE (P < 0.001). Despite the intensifying heat, the mitigation strategies including individual, structural and community measures were associated with a substantial 74.6% reduction in HS cases and a 47.6% decrease in case fatality rate.
CONCLUSIONS: The study underscores the escalating climate-related health risks in Mecca over the study period. The mitigation measures\' efficacy in such a globally representative setting emphasizes the findings\' generalizability and the importance of refining public health interventions in the face of rising temperatures.

The 14th National Games was the first sporting mass gathering to be held in China in the context of the COVID-19 pandemic. It may increase the risk of severe acute respiratory syndrome coronavirus 2 transmission. In order to reduce the spread of the virus during the 14th National Games, the Chinese government took a series of public health measures, and ultimately no confirmed cases were found in the 14th National Games venues.
This study aimed to discuss preventive and control measures used to respond to the COVID-19 pandemic during the 14th National Games.
Five experts were selected for this study using a snowball sampling method, and semistructured and in-depth interviews were conducted. Based on grounded theory, the transcriptions were analysed and coded using Nvivo 12 software.
A theoretical model of the COVID-19 prevention and control measures at the 14th National Games of China was constructed. The model contains seven main components: the health risks of mass gatherings, crowd management, emergency medical care, allocation of emergency medical resources, pandemic emergency drills, the pandemic prevention and control management platform (Quanyuntong app), and emergency response plans.
The study showed that the deployment of emergency medical resources was the most important for mass gatherings. This study not only expanded the applications of grounded theory but also serves as a reference for future scholars when conducting more in-depth empirical studies on public health countermeasures for mass gatherings and can inform organizers when holding mass gatherings.