Epidemiologists will be busy this summer sifting through sewage and social media with the goal of keeping soccer fans and the public safe from severe illness during the World Cup, one of the largest and most globally diverse mass gatherings ever anticipated.
A public health squad based in Washington, D.C., plans to monitor wastewater and internet chatter to detect and track infectious diseases should they emerge in any of the US or Canadian cities hosting World Cup players, their matches, and millions of spectators, organisers said.
The 39-day event kicks off in Mexico on Thursday. More than 6.5 million soccer fans are expected to travel from over 100 countries to witness 104 games in the US, Canada and Mexico.
The scale of the event and the globe-spanning travel involved pose a heightened risk of rapid disease transmission at a time when strained US public health resources are coping at home and abroad with outbreaks of measles, Ebola and hantavirus, health security experts say.
Budget and staffing cuts under the Trump administration, along with the US withdrawal from the World Health Organization, have exacerbated those challenges, according to organisers of the new disease-tracking initiative.
Stepping in to provide real-time data about potential threats, the newly formed team of public health experts has converted a Georgetown University laboratory into an epidemiological command post. The facility brings together academic institutions, non-profit organisations and private companies working in support of government agencies.
The team is already preparing a daily status report to flag emerging risks and any immediate need for action to hospital emergency managers and public health authorities at the local, state, federal and international level, as well as FIFA, soccer's governing body and organiser of the World Cup.
The operations centre, launched in collaboration with the MedStar Health regional hospital chain, is also a trial run for future events, including the 2028 Summer Olympics in Los Angeles. MedStar hosts one of the nation's 13 biocontainment units.
Advanced wastewater analysis, using DNA and RNA sequencing to find genetic strands from a range of microbes without requiring laboratory culture, is a key element in monitoring infectious disease threats, said Rebecca Katz, director of Georgetown's Center for Global Health Science and Security and head of the new disease surveillance effort.
"It's incredibly powerful," Katz said. Her team is currently receiving such data from collection sites in the US and Canada, as well as from various other health monitoring sources in all three World Cup host countries.
Detecting disease-causing microorganisms in wastewater can signal an outbreak in the making, giving health officials time to warn medical clinicians to look out for symptoms of diseases that might otherwise be misdiagnosed, and to urge the public to take precautions.
Considerable media attention has focused on the current Ebola crisis in Africa. But Katz said the often-fatal hemorrhagic fever poses a "very low risk to the general public" in North America. The World Cup team and support staff from the Democratic Republic of Congo, the country at the epicenter of the Ebola outbreak, have been undergoing a precautionary quarantine in Belgium before traveling to the United States, although most of the players were in Europe at the time of the outbreak.
Katz said her team would be paying special attention to the spread of measles, which is approaching a record for US case numbers this year - around 2,000 so far - and has resurged in parts of Mexico and Canada.
Additional risks are posed by mosquito-borne diseases such as dengue, also known as "breakbone fever," and a close cousin, chikungunya. Both originate in the tropics and can be carried by infected travelers and then be transmitted by mosquitoes.
Katz enlisted 20 colleagues along with pro bono support and assistance from 30 other entities for her operations center. They include several wastewater surveillance companies that are collecting and screening sewage samples and sharing their data with Katz's team without charge.
Other key tools include tracking anonymised data from electronic health records and scouring open-source social media platforms for information pointing to transmission clusters, Katz said.
She cited a past example of public health officials pinpointing an outbreak of gastrointestinal illness from social media chatter about a sudden uptick in sales of toilet paper.
The Georgetown team will augment the work of several US agencies, including the Centers for Disease Control and Prevention and the Administration for Strategic Preparedness and Response, Katz said.
Financial support for the centre has come from a small family foundation and Georgetown, along with in-kind contributions from such partners as the University of Nebraska.
