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Mass Gatherings and Public Health The Experience of the Athens 2004 Olympic Games Edited by: Agis D. Tsouros and Panos A. Efstathiou Ministry of Health and Social Solidarity Mass Gatherings and Public Health Mass Gatherings and Public Health The Experience of the Athens 2004 Olympic Games Edited by: Agis D. Tsouros and Panos A. Efstathiou ABSTRACT Large-scale mass gatherings, such as the Olympic Games, represent significant challenges for the entire health sector of host countries. Emerging global public health threats of natural or deliberate nature increase considerably the health and safety vulnerability of mass gatherings. Major areas of public health responsibility include health care capacity and mass-casualty preparedness; disease surveillance and outbreak response; environmental health and food safety; public information and health promotion; public health preparedness and response to incidents potentially involving the deliberate use of explosives, biological and chemical agents or radionuclear material; and leadership, operations and unified command. This book comprehensively and systematically presents the experience of and lessons learned from the public health aspects of the preparations and conduct of the Athens 2004 Olympic Games. Documenting this experience can be a source of valuable information and knowledge for governments at all levels and communities in building their capacity for not only large-scale events but also preparing to deal with the avian influenza pandemic threat or other emergencies such as flooding and phenomena often associated with climate change. Keywords ANNIVERSARIES AND SPECIAL EVENTS PUBLIC HEALTH COMMUNICABLE DISEASE CONTROL DISEASE OUTBREAKS – PREVENTION AND CONTROL ENVIRONMENTAL HEALTH DISASTER PLANNING HOSPITAL PLANNING EPIDEMIOLOGIC SURVEILLANCE SPORTS GREECE EU/07/5062470 ISBN: 978 92 890 7288 5 All material displayed and not otherwise credited is reproduced with the permission of the Olympic Planning Unit, National School of Public Health, Greece. The publication design follows the original publication guidelines of the Athens 2004 Olympic Games. Front and back cover photos: ©INTIMEsports. Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). © World Health Organization 2007 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delim- itation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. CONTENTS Foreword . viii Marc Danzon Foreword . ix Dimitris L. Avramopoulos Foreword . x Jacques Rogge Special recognition . xi Acknowledgements . xi Contributors. xii Preface . xviii Part 1. International experience and framework of the Athens 2004 Olympic Games 1. Overview and framework . 3 Andy Stergachis and Agis D. Tsouros 2. Operational framework for health and for the national and subnational jurisdictions for public health for the Athens 2004 Olympic Games . 29 Athina Kirlessi, Agis D. Tsouros, Michael S. Sabatakakis, Ellie Tragakes, Theodora Stavrou and Panos A. Efstathiou Part 2. Epidemiological surveillance and response and public health preparedness for the Athens 2004 Olympic Games Introduction . 46 George Saroglou 3. Preparing epidemiological surveillance and response for communicable diseases . 49 Nikoletta Mavroidi, Takis Panagiotopoulos, Xanthi Dedoukou, Paraskevi Tsonou, Efthimios Kalabalikis, Evangelia Piperaki, Vasiliki Pityriga, Katerina Karageorgou, Sophia Hatzianastasiou, Agoritsa Baka, Olga Daligarou, Maria Tseroni, Georgia Nikolopoulou, Elpidophoros Sotiriades, Christopher Bartlett and George Saroglou 4. Experience of epidemiological surveillance and response for communicable diseases . 67 Takis Panagiotopoulos, Nikoletta Mavroidi, Georgia Spala, Johannes Schnitzler, Eleni Kalamara, Helen Triantafyllou, Asimoula Oikonomopoulou, Theano Georgakopoulou, Athina Spilioti, Kassiani Mellou, Ioanna Magaziotou, Stefanos Bonovas, Kostas Danis, Denis Coulombier and George Saroglou 5. Syndromic surveillance system . 81 Urania Dafni, Kassi Gkolfinopoulou, Aggeliki Lambrou, Dimitrios Papamichail, Giannis Karagiannis, Kostas Athanasakis, Georgios Ferentinos, Olga Adrami, George Kouvatseas, Zoi Tsourti, Demosthenes Panagiotakos, Vassilios Raftopoulos, Tracee Treadwell, Scott D. Williams, George Saroglou and Sotirios Tsiodras 6. Public health preparedness for incidents involving the potential deliberate use of biological and chemical agents or radionuclear material . 97 Agoritsa Baka, Petros Isaakidis, Georgios Ferentinos, Nikoletta Mavroidi, Vasiliki Panagiotopoulou, Dimitrios Iliopoulos, Kalliopi Papadima, Maurizio Barbeschi and George Saroglou Part 3. Addressing the environmental health challenges of the Athens 2004 Olympic Games Introduction . 128 Christos Hadjichristodoulou and Jenny Kourea-Kremastinou 7. Environmental health surveillance and management of food and water safety . 131 Christos Hadjichristodoulou, Varvara Mouchtouri and Jenny Kourea-Kremastinou 8. Food safety and the role of the Hellenic Food Authority . 161 Despina Vassiliadou, Christos Apostolopoulos, Dimitra Panteleaki, Konstantinos Barberis and Nikos Katsaros 9. Monitoring drinking-water quality in holding tanks at Olympic venues . 177 Nicholaos D. Katsiris, Olga I. Kavoura, Georgios A. Zervas, Ioanna P. Damikouka 10. Laboratory support in environmental health monitoring . 185 Emmanouil N. Velonakis, Seraphem Lukussias, Elias Papadopoulos, Anna Katsiafliaka, Sophia Vourli, Despina Perimeni and Alkiviadis Vatopoulos 11. Mosquito surveillance and control . 193 Nikolaos Vakalis, Eleni Patsoula and Anna Samanidou-Voyadjoglou Part 4. Prehospital and hospital preparedness and care and disease prevention and health promotion activities for the Athens 2004 Olympic Games Introduction . 210 12. Preparedness of emergency medical services . 211 Anastasia Zygoura, Michalis Syndos and Vasilios Kekeris 13. Olympic hospital preparedness and the case of Sismanogleion General Hospital . 225 Marianthi Vafeiadou and Adamantia Egglezopoulou 14. Health Services Department of the Athens 2004 Olympic Games Organizing Committee . 237 Costas Parisis, Demetrios Pyrros, Konstantinos Ditsios, Polydoros Chios, Spyros Spyrou, Eleftherios Thireos and Athanasios Papamichos 15. Disease prevention and health promotion activities . 253 Agis D. Tsouros, Maroulio Lekka, Panos Minogiannis and Andy Stergachis Part 5. Coordination, international cooperation and overall conclusions and lessons from the Athens 2004 Olympic Games 16. Health sector command, coordination and communication . 269 Panos A. Efstathiou, Agis D. Tsouros, Ann Knebel and Maurizio Barbeschi 17. International cooperation for public health . 285 Agis D. Tsouros, Panos A. Efstathiou, Agoritsa Baka, Maurizio Barbeschi and Ann Knebel 18. The Athens 2004 Olympic Games and public health: main conclusions and lessons learned . 303 Agis D. Tsouros, Andy Stergachis, Maurizio Barbeschi, Sotirios Tsiodras, Ann Knebel and Panos A. Efstathiou Annex 1. Standard operating procedures for reviewing public health signals and reports during the Athens 2004 Olympic Games . 311 Annex 2. Examples of daily situation reports for the Athens 2004 Olympic Games . 321 Annex 3. Sample daily report on the results of environmental health inspections and laboratory tests and of epidemiological surveillance at the Athens 2004 Olympic Games . 329 Annex 4. Outlines of five key operational plans for the Athens 2004 Olympic Games: health sector coordination; quarantine measures; mass-casualty management; mass prophylaxis planning; and crisis communication . 339 Panos A. Efstathiou, Ann Knebel and Agis D. Tsouros viii Foreword The World Health Organization (WHO) has a long-standing association with the Olympic Games. Most notably, the smoke-free Olympic Games (Seoul in 1988 and Barcelona in 1992) and a host of co-sponsored events to promote active living, physical activity and sports for all span a period of almost
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