Mass-gathering events (MGEs) occur regularly throughout the world. As people congregate at MGEs, there is an increased risk of transmission of communicable diseases. Novel respiratory viruses, such as Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Influenza A Virus Subtype H1N1 Strain 2009 (H1N1pdm09), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), or Coronavirus Disease 2019 (COVID-19), may require specific infection prevention and control strategies to minimize the risk of transmission when planning MGEs. This literature review aimed to identify and analyze papers relating to novel respiratory viruses with pandemic potential and to inform MGE planning.

This paper used a systematic literature review method. Various health care databases were searched using keywords relating to MGEs and novel respiratory viruses. Information was extracted from identified papers into various tables for analysis. The analysis identified infection prevention and control strategies used at MGEs to inform planning before, during, and following events.

In total, 27 papers met the criteria for inclusion. No papers were identified regarding SARS-CoV-1, while the remainder reported on H1N1pdm09 (n = 9), MERS-CoV (n = 15), and SARS-CoV-2 (n = 3). Various before, during, and after event mitigation strategies were identified that can be implemented for future events.

This literature review provided an overview of the novel respiratory virus epidemiology at MGEs alongside related public health mitigation strategies that have been implemented at these events. This paper also discusses the health security of event participants and host communities in the context of cancelling, postponing, and modifying events due to a novel respiratory virus. In particular, ways to recommence events incorporating various mitigation strategies are outlined.

Our study of informal networks aimed to explore information-sharing environments for the management of disaster medicine and public health preparedness. Understanding interagency coordination in preparing for and responding to extreme events such as disease outbreaks is central to reducing risks and coordination costs.

We evaluated the pattern of information flow for actors involved in disaster medicine through social network analysis. Social network analysis of agencies can serve as a basis for the effective design and reconstruction of disaster medicine response coordination structures. This research used new theoretical approaches in suggesting a framework and a method to study the outcome of complex inter-organizational networks in coordinating disease outbreak response. We present research surveys of 70 health professionals from different skill sets and organizational positions during the swine influenza A (H1N1) PDM09 2009 pandemic. The survey and interviews were designed to collect both qualitative and quantitative data in order to build a comprehensive and in-depth understanding of the dynamics of the inter-organizational networks that evolved during the pandemic.

The degree centrality of the informal network showed a positive correlation with performance, in which the ego’s performance is related to the number of links he or she establishes informally—outside the standard operating structure during the pandemic. Informal networks facilitate the transmission of both strong (ie, infections, confirmed cases, deaths in hospital or clinic settings) and weak (ie, casual acquaintances) ties.

The results showed that informal networks promoted community-based ad hoc and formal networks, thus making overall disaster medicine and public health preparedness more effective. (Disaster Med Public Health Preparedness. 2017;11:343–354)

To examine their implementation, we analyzed World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) guidelines from 2005 to 2008 for risk communication during an emerging infectious disease outbreak, WHO and CDC reports on implementing the guidelines worldwide after the 2009 H1N1 pandemic; and a case study of a member state.

A qualitative study compared WHO and CDC guidelines from 2005 to 2008 with WHO and CDC reports from 2009 to 2011, documenting their implementation during the H1N1 outbreak and assessed how these guidelines were implemented, based on the reports and Israeli stakeholders (n=70).

Eight risk communication subthemes were identified: trust, empowerment, uncertainty, communicating the vaccine, inclusion, identification of subpopulations and at-risk groups, segmentation, and 2-way communication. The reports and case study disclosed a gap between international guidelines and their local-level implementation. The guidelines were mostly top-down communications, with little consideration for individual member-state implementation. The WHO and CDC recommendations were not always based on formative evaluation studies, which undermined their validity.

In formulating effective communication strategies, the first step is to define the goal of a vaccination program. We recommend implementing conceptual elements from the most current theoretical literature when planning communication strategies and increasing organizational involvement in implementing guidelines in future health crises. (Disaster Med Public Health Preparedness. 2014;0:1–12)

The USS George Washington (GW) and the USS Ronald Reagan (RR), 2 US Navy aircraft carriers, experienced almost simultaneous outbreaks of novel H1N1 influenza A in the summer of 2009. We compared the respective epidemic control measures taken and subsequent lessons learned.

Data were collated from both outbreaks to assess various elements including attack rate, isolation/quarantine protocols, and treatment methods. The respective duration of each outbreak was compared with survival curve analysis. The number of personnel affected in each outbreak was compared using χ2 analysis.

Differences were found in the protocols used on the 2 ships. The GW treated about two-thirds of the patients with oseltamivir through day 14 and quarantined all patients meeting case definition throughout the outbreak. Face masks were used throughout. The RR used oseltamivir and quarantined many fewer patients (through days 5 and 3, respectively). No face masks were used after day 5. The outbreaks were similar in duration (GW = 25 days, RR = 27 days, P = .38), but the RR had significantly more cases (n = 253 vs 142, P < .0001). A portion of each group had samples that were confirmed H1N1 by polymerase chain reaction.

GW's protocol, including aggressive oseltamivir treatment of two-thirds of the cases and quarantine throughout the duration decreased the overall number of personnel affected, likely reducing the overall control reproduction number. Both outbreaks were similar in duration. Even though the GW expended significantly more resources than the RR, if the 2009 pandemic H1N1 strain had been as clinically severe as the 1918 pandemic, a more stringent treatment protocol may have been the only way to prevent significant operational impact.(Disaster Med Public Health Preparedness. 2013;7:29-35)

We compared attack rates for novel H1N1 influenza A (H1N1) among various groups aboard an aircraft carrier as influenced by characteristics of their living arrangements.

During an outbreak of H1N1 on board the USS George Washington (GW), group affiliation (department or squadron membership) data were obtained on all patients who were placed in respiratory isolation based on their diagnosis with presumptive H1N1. Because berthing spaces are assigned by department and various characteristics of each department's berthing spaces are known, analysis of attack rates in comparison to these characteristics was possible. Attack rates were compared with the square feet of living space per sailor, occupancy rate of the berthing areas, and size of the berthing areas. These results were further correlated with the mission of the various departments or squadrons.

The average attack rate was 3%, with the highest rates occurring in departments or squadrons whose mission required ongoing contact with civilian populations ashore. The attack rate among officers was 2.04 versus 3.19 among enlisted personnel; this difference was not significant (P = .21). The attack rate for women was 1.90 versus 3.09 for men, which was significant (P = .05). Although attack rates varied considerably based on organizational mission, no correlation was found between attack rate and square feet of living space per person or occupancy rate or size of berthing spaces.

The attack rate of the outbreak overall was limited to 3%. Smaller and more crowded berthing configurations did not contribute to higher attack rates, suggesting that transmission occurs most frequently elsewhere while engaged in other activities such as working, eating, or relaxing. Further studies are necessary to filter out potential correlations or variables not identified in this study, such as the difference between the number of men and women isolated. (Disaster Med Public Health Preparedness. 2012;0:1-5)

The first decade of the 21st century has witnessed three major influenza public health emergencies: (1) the severe acute respiratory syndrome of 2002-2003; (2) the avian flu of 2006; and (3) the 2009 H1N1 pandemic influenza. An effective public health response to an influenza public health emergency depends on the majority of uninfected health care personnel (HCP) continuing to report to work. The purposes of this study were to determine the state of the evidence concerning the willingness of HCP to work during an influenza public health emergency, to identify the gaps for future investigation, and to facilitate evidence-based influenza public health emergency planning.

A systemic literature review of relevant, peer-reviewed, quantitative, English language studies published from January 1, 2001 through June 30, 2010 was conducted. Search strategies included the Cochrane Library, PubMed, PubMed Central, EBSCO Psychological and Behavioral Sciences Collection, Google Scholar, ancestry searching of citations in relevant publications, and information from individuals with a known interest in the topic.

Thirty-two studies met the inclusion criteria. Factors associated with a willingness to work during an influenza public health emergency include: being male, being a doctor or nurse, working in a clinical or emergency department, working full-time, prior influenza education and training, prior experience working during an influenza emergency, the perception of value in response, the belief in duty, the availability of personal protective equipment (PPE), and confidence in one's employer. Factors found to be associated with less willingness were: being female, being in a supportive staff position, working part-time, the peak phase of the influenza emergency, concern for family and loved ones, and personal obligations. Interventions that resulted in the greatest increase in the HCP's willingness to work were preferential access to Tamiflu for the HCP and his/her family, and the provision of a vaccine for the individual and his/her family.

Understanding the factors that contribute to the willingness of HCP to report to work during an influenza public health emergency is critical to emergency planning and preparedness. Information from this review can guide emergency policy makers, planners, and implementers in both understanding and influencing the willingness of HCP to work during an influenza public health emergency.

DevnaniM. Factors Associated with the Willingness of Health Care Personnel to Work During an Influenza Public Health Emergency: An Integrative Review. Prehosp Disaster Med. 2012;27(6):1-16.

The H1N1 influenza virus has been described by the World Health Organization (WHO) and the media as a disease that could rival the 1918 Spanish Influenza epidemic in deaths. During the spring of 2009, emergency departments across the world saw a spike in the number of influenza cases and by June 2009, the WHO had declared H1N1 a pandemic. In order to prevent emergency department staff from becoming ill and to provide upto-date medical care to patients, information had to be disseminated quickly to emergency department staff.

An anonymous Internet survey was utilized to query emergency department staff regarding communication methods and overall attitudes regarding safety and treatment during the spring of 2009.

The majority of emergency department staff (263; 88.3%) used multiple sources to obtain information about the H1N1 virus. There were 258 respondents (88.9%) that felt that the hospital was supplying them with the necessary information to protect themselves and their families and 280 (98.5%) felt confident that their emergency department was treating patients by the government-recommended guidelines. Statistically significant differences were noted in communication patterns between direct and indirect patient care providers.

In general, H1N1 communication to emergency department staff was perceived as good during the initial H1N1 outbreak. However, because of the limitations associated with an online survey, these results do not allow for generalization to the total emergency department staff population. Hospital administrators may need to consider the differences in communication preferences of direct patient care providers and indirect patient care providers when distributing important information to emergency department staff during crisis and emergency situations.