The association football World Cup 1998 began in France yesterday, and will attract many thousands of visitors to its ten venues ( for which 27 of the 97 local health departments in metropolitan France are responsible) until after the final whistle blows on 12 July. The concentration of people at mass gatherings provides an opportunity for the spread of communicable diseases (1) as well as for injury and the effects of exposure to the environment, causing - for example, heat related illness (likely to be a particular problem during day time games in the south of France (Montpellier, Toulouse, and Marseille)). Just as for the Atlanta Olympics (1,2), preparations for the World Cup have included considerable planning to create systems for the surveillance, prevention, and control of disease.
The objectives of the surveillance system are to detect outbreaks that may require investigation and intervention (e.g. foodborne outbreaks), unusual diseases that may require prevention or control measures (e.g. diphtheria), and clustering of disease events that may justify collective prevention measures (such as heat related illness).
Data will be collected from three main sources. Notifiable disease surveillance is being activated, with daily rather than weekly transmission of notifications to the Réseau National de Santé Publique in Paris. All health workers directly involved in the event (emergency rooms, health care providers in the stadiums, paramedics (SAMU), and the fire department) are collecting disease event data in a standard format. Apart from unusual diseases, health events under routine surveillance include gastroenteritis and foodborne outbreaks, heat related illness, acute respiratory infections, meningitis, and asthma. More than a thousand sentinel general practitioners, private pharmacists, laboratories, and a pharmaceutical drug distributor voluntarily report daily to health authorities.
A computer application has been designed to analyse data daily and produce an epidemiological report to the ministry of health and the public. In the absence of precise denominators, indicators will include proportional morbidity (e.g. the percentage of general practitioners’ workload attributable to gastroenteritis) and trends that make use of averaged data for the preceding three days. Data are accessible (in French) on the Internet site of the Réseau National de Santé Publique: http://www.b3e.jussieu.fr:80/rnsp/mondial/index.html
As well as enabling health authorities to monitor the situation, the surveillance system is increasing the awareness of health care providers for public health surveillance. The mobilisation of the resources described towards the goal of controlling disease spread is the key to ensuring a safe and healthy World Cup.