The XXXIIIrd Paris Summer Olympics followed by the XVIIth Paralympics Games will take place in France, predominantly in and around Paris, from July 26 to September 8, 2024. Public health stakeholders and decision-makers are called upon to set up or strengthen surveillance systems in areas hosting Olympic or Paralympic Games (OPGs) or large-scale international competitions, the objective being to detect and manage outbreaks should they occur during that period. We undertook a narrative review of the literature so as to identify major reported infectious disease outbreaks linked with or during OPGs / international sporting events during warm seasons. Our review found that since 1992, Summer Olympic and Paralympic games and international football competitions have been associated with sporadic cases of infectious diseases, principally respiratory, gastrointestinal/foodborne, but not with any major communicable or other infectious disease outbreak. Communicable disease risks should be assessed for the population taken as a whole, an integrated ecosystem with several population compartments potentially exchanging pathogens among one another. Although the Games afford an opportunity to federate or invent new surveillance systems to fill a gap, surveillance should be based on existing medical and laboratory systems, proven tools reinforced with the necessary human and financial resources. The performance of the public health surveillance system is ultimately predicated on trust on the part of participating clinicians, policymakers and international partners.

BACKGROUND: Mass gatherings are events where many people come together at a specific location for a specific purpose, such as concerts, sports events, or religious gatherings, within a certain period of time. In mass-gathering studies, many rates and ratios are used to assess the demand for medical resources. Understanding such metrics is crucial for effective planning and intervention efforts. Therefore, this systematic review aims to investigate the usage of rates and ratios reported in mass-gathering studies.
METHODS: In this systematic review, the PRISMA guidelines were followed. Articles published through December 2023 were searched on Web of Science, Scopus, Cochrane, and PubMed using the specified keywords. Subsequently, articles were screened based on titles, abstracts, and full texts to determine their eligibility for inclusion in the study. Finally, the articles that were related to the study\'s aim were evaluated.
RESULTS: Out of 745 articles screened, 55 were deemed relevant for inclusion in the study. These included 45 original research articles, three special reports, three case presentations, two brief reports, one short paper, and one field report. A total of 15 metrics were identified, which were subsequently classified into three categories: assessment of population density, assessment of in-event health services, and assessment of out-of-event health services.
CONCLUSIONS: The findings of this study revealed notable inconsistencies in the reporting of rates and ratios in mass-gathering studies. To address these inconsistencies and to standardize the information reported in mass-gathering studies, a Metrics and Essential Ratios for Gathering Events (MERGE) table was proposed. Future research should promote consistency in terminology and adopt standardized methods for presenting rates and ratios. This would not only enhance comparability but would also contribute to a more nuanced understanding of the dynamics associated with mass gatherings.

UNASSIGNED: 1.Mass gathering events have resumed with the availability of SARS-CoV-2 vaccines. However, the pandemic is ongoing and such events potentially contribute to upsurges in COVID-19 cases. There is mounting evidence that public health mitigation strategies such as mask requirements, capacity restrictions, and physical distancing reduce transmission risk. However, evidence suggests imperfect compliance with these strategies. This study aimed to quantify spectators\' masking behaviors and identify correlates of mask-wearing during a major sporting event.
UNASSIGNED: 2.This study used a repeated cross-sectional design, in which trained observers used a web-based application to record counts of mask-wearing.
UNASSIGNED: 3.Overall, 74% of spectators observed correctly wore masks. Mask-wearing behavior was associated with presumed sex, location of the spectator, game competitiveness, and whether the teams playing originated from a state with an active mask mandate.
UNASSIGNED: 4.Understanding the factors associated with masking behavior may help venues prepare for future events and identify innovative and targeted strategies to promote compliance with public health mitigation measures.
UNASSIGNED: 5.This study makes contributions to understanding how to manage public health risks during a high-profile sporting event, specifically by identifying spectator-, game-, venue-, and state-level factors associated with mask-wearing.

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.

UNASSIGNED: Hajj is a series of rituals that are done in specific areas and periods in Mecca. Performing Hajj requires a great amount of physical demand which may result in musculoskeletal pain (MSP) in different age groups.
UNASSIGNED: To estimate the prevalence of MSP and understand its pattern via exploring the factors that could be associated with muscular pain among pilgrims in the 2022 Hajj.
UNASSIGNED: A web-based survey was distributed during the annual Hajj mass gathering. Pilgrims were recruited from Hajj ritual sites. The collected data included demographics, musculoskeletal pain at ten anatomical body sites, and physical activity (PA) level. Descriptive and inferential statistics were used to analyze the data at a 0.05 significance level.
UNASSIGNED: A total of 248 pilgrims participated in the study. The mean age of the sample was 43.49±12.70 years. Of all pilgrims, 78.6% had reported MSP in at least one anatomical body site during performing Hajj. Results revealed that Pilgrims were more likely to have MSP in the lower limb while performing Hajj rituals where the most prevalent reported pain was in the legs (46% ), followed by the lower back (45% ), knees (37% ), and ankles/feet (30% ). Age, sex, and PA were not significantly associated with MSP except the BMI was found to be a significant factor related to MSP among pilgrims (p <0.05).
UNASSIGNED: Many pilgrims exhibited pain in at least one body part. Although physical fitness recommendations are published in the Saudi Ministry of Health, MSP preventative measures need to be disseminated by organizations and interested parties worldwide.

OBJECTIVE: Influenza is frequent among pilgrims participating in the Grand Magal de Touba (GMT), in Senegal, with a potential to spread to contacts when they return home.
METHODS: Ill pilgrims consulting at a health care center in Mbacké city close to Touba during the 2021 GMT, pilgrims returning to Dielmo and Ndiop villages, and patients who did not travel to Touba and consulted at health care centers in these two villages in 2021 were tested for the influenza virus by polymerase chain reaction on nasopharyngeal samples. Next-generation sequencing and comparative and phylogenetic analyses of influenza A virus genomes were performed.
RESULTS: A total of 62 of 685 patients tested positive for influenza A virus, including 34 of 53 who were consulted in Mbacké in late September, six of 129 pilgrims who returned home in early October, and 20 of 42 villagers from October 3 to 29. A total of 27 genomes were obtained. Four clusters were observed based on the phylogenetic analyses, suggesting that Mbacké patients and returned pilgrims may have shared closely related viral strains with patients inhabiting the villages who did not participate in the GMT.
CONCLUSIONS: Villagers in Ndiop and Dielmo may have been infected with viral strains originating from the GMT and possibly imported by pilgrims who returned from the GMT.

BACKGROUND: The annual Islamic pilgrimage of Hajj attracts millions of pilgrims from around the world, necessitating the involvement of healthcare professionals, including nurse volunteers, to ensure the safety and well-being of attendees. This study aims to explore the experiences, motivations, and skillsets of nurse volunteers during the Hajj pilgrimage, focusing on the personal, professional, and spiritual dimensions of volunteering, and providing insights to enhance volunteer programs.
METHODS: The demographic data shows that the majority of nurse volunteers during Hajj 2022 fell in the 30-39 age group and were predominantly women. The study provides insights into the interest, experience, and motives for volunteering, with spiritual motives cited as a primary driver. An overview of volunteer hours, perceived benefits, and pre-existing skills reveals diverse commitments and skillsets among the volunteers.
RESULTS: Nurse volunteers during Hajj 2022 show diverse age and gender composition, strong commitment, spiritual motives, varied engagement, and professional skills. Team dynamics, skills development, and positive experiences are crucial. A potential gap exists in preparatory education. Significant associations are found between age, volunteer hours, training, skill practice, and gender.
CONCLUSIONS: This study highlights the multifaceted benefits of volunteering during Hajj and underscores the need for decision-makers to devise strategies that cater to diverse needs, foster collaboration, and enhance the preparedness of nurse volunteers. Further research is suggested to examine the long-term impact of volunteering during Hajj on nurses\' professional development and personal well-being and to evaluate the effectiveness of various recruitment strategies, training programs, and support initiatives.

A crowded vegetable market serves as a mass gathering, posing a potential risk for infection transmission. In this study, we isolated a multidrug-resistant Acinetobacter baumannii strain, VRL-M19, from the air of such a market and conducted comparative genomics and phenotypic characterization. Antimicrobial susceptibility testing, genome sequencing using Illumina HiSeq X10, and pan-genome analysis with 788 clinical isolates identified core, accessory, and unique drug-resistant determinants. Mutational analysis of drug-resistance genes, virulence factor annotation, in vitro pathogenicity assessment, subsystem analysis, Multilocus sequence typing, and whole genome phylogenetic analysis were performed. VRL-M19 exhibited multidrug resistance with 69 determinants, and analysis across 788 clinical isolates and 350 Indian isolates revealed more accessory genes (52 out of 69) in the Indian isolates. Multiple mutations were observed in drug target modification genes, and the strain was identified as a moderate biofilm-former with 55 virulence factors. Whole genome phylogenetics indicated a close relationship between VRL-M19 and clinical A. baumannii strains. In conclusion, our comprehensive study suggests that VRL-M19 is a multidrug-resistant, potential pathogen with biofilm-forming capabilities, closely associated with clinical A. baumannii strains.

The risk of transmission of respiratory tract infections is considerably enhanced at mass gathering (MG) religious events. Hajj is an annual Islamic MG event with approximately 3 million Muslim pilgrims from over 180 countries concentrated in Makkah, Saudi Arabia. This study aimed to investigate the genetic diversity of influenza viruses circulating among pilgrims during the Hajj pilgrimage. We performed a cross-sectional analytical study where nasopharyngeal swabs (NPs) from pilgrims with respiratory tract illnesses presenting to healthcare facilities during the 2019 Hajj were screened for influenza viruses. Influenza A subtypes and influenza B lineages were determined by multiplex RT-PCR for positive influenza samples. The phylogenetic analysis was carried out for the hemagglutination (HA) gene. Out of 185 nasopharyngeal samples, 54 were positive for the human influenza virus. Of these, 27 were influenza A H1N1 and 19 H3N2, 4 were untypable influenza A, and 4 were influenza B. Phylogenetic analysis revealed that the H1N1 and H3N2 strains differentiated into different and independent genetic groups and formed close clusters with selected strains of influenza viruses from various locations. To conclude, this study demonstrates a high genetic diversity of circulating influenza A subtypes among pilgrims during the Hajj Season. There is a need for further larger studies to investigate in-depth the genetic characteristics of influenza viruses and other respiratory viruses during Hajj seasons.

This study aimed to explore emergency pharmacy workforce perspectives and experiences in providing pharmaceutical care during mass gathering events (i.e., FIFA World Cup Qatar 2022™).
A qualitative methodology was employed using focus groups discussions. Emergency pharmacists across Hamad Medical Corporation were invited to participate using a combination of purposive and snowball sampling. Focus groups were audio-recorded, transcribed verbatim, and validated. Inductive thematic analysis was undertaken to generate key themes and subthemes.
Four focus groups were conducted which included 21 participants and generated five major themes. Whilst participants had mixed opinions in relation to their preparedness to practice during the World Cup, they perceived their experience as successful and smooth. The primary perceived facilitators were management support, mobile medical units, and high public health awareness. The main highlighted barriers were related to staff insufficiency, medications availability, and cultural and language challenges. Participants recommended pharmacist\'s role identification in mass gatherings, development of pharmacy action plan, and offering simulation training and pharmacy-specific training.
Despite the perceived barriers, pharmacists reported positive views in relation to their experience in providing pharmaceutical care during mass gatherings. Future research should focus on the development of theory-driven action framework for pharmacy departments to adopt during mass gatherings.