Public health surveillance during the XVII Central American and Caribbean Games - Puerto Rico, November 1993

Morbidity and Mortality Weekly Report, July 12, 1996

To provide medical services at mass gatherings for scheduled special events (e.g., world fairs, music festivals, and athletic competitions such as the Olympics), organizers must have information to anticipate both routine and uncommon situations. In November 1993, approximately 9500 athletes and staff from 31 countries participated in the XVII Central American and Caribbean Games in San Juan, Puerto Rico. To monitor injury- and illness-related morbidity among participants, the schools of public health and medicine at the University of Puerto Rico and the Puerto Rico Olympic Committee established a public health surveillance system designed specifically for this event. This report summarizes selected results from the system, which underscore the usefulness of this approach in planning prevention, medical, and emergency services for similar events.

During the games, 4400 athletes competed in 28 sports at venues located in multiple sites around San Juan; the 5000 staff members included 500 trainers, judges, and delegates, and 4500 volunteers who were support personnel. The athletes lived at the Central American Village of the Caribbean at Camp Santiago in Salinas. Physicians provided medical care at the athletic village hospital, where an epidemiology unit conducted surveillance while the village was open. Staff in the epidemiology unit analyzed data daily and shared reports with games officials.

From November 14 through December 2, a total of 458 (58%) of 794 consultations at the hospital were for athletes, and 336 (42%) were for staff members. The largest numbers of patients were from Puerto Rico (249), Guatemala (49), and Jamaica (46). Most (444 156%!) of the visits occurred during November 20-25, the peak of competition, when a daily average of 74 patients were evaluated. Among all 794 patients, the most common diagnosis was musculoskeletal injuries (302 138%1). Among the 229 athletes treated for injuries, the most frequent injury-related diagnoses were contusion (38), sprain (27), strain (27), tendinitis (25), abrasion (15), and myositis (15). The sports accounting for the largest number of injuries were field hockey (25), softball (22), soccer (21), and tae kwon do (21). Other diagnoses among all of those treated included respiratory (180 123%!), skin (85 111%!), gastrointestinal (56 17%!), genitourinary (25 13%!), and other (146 118%!) problems.

Of 180 patients with respiratory diagnoses, 71 (39%) were athletes whose most frequent diagnoses were upper respiratory tract infection (33) and pharyngitis (23). During the games, acute infectious conjunctivitis was diagnosed in 12 persons, including nine support staff and three athletes. Because of concern about the potential for spread, the nine support staff were provided treatment and asked to leave the games; the three athletes were treated and interviewed by epidemiologists to detect additional cases. Of the 15 cases of acute gastroenteritis, eight occurred in athletes, including three in members of one team. These three and their teammates were monitored by medical personnel for additional cases among teammates.

Of the 794 consultations, 727 (92%) persons received medication, the most common of which were nonsteroidal anti-inflammatory agents (199), analgesics (162), antihistamines (58), and antibiotics (52). A total of 128 procedures were performed, including 26 clinical laboratory tests, 70 radiographic studies, and 32 procedures requiring suturing and local wound care. Reported by: RV Perez Perdomo, MD, CA Morell Rivera, AM Mayor Becerra, MD, RA Serrano Rodriguez Graduate School of Public Health, Univ of Puerto Rico; WR Frontera, MD, School of Medicine, Univ of Puerto Rico, San Juan. E Martin, J Cantwell, MD, Atlanta Committee for the Olympic Games, Atlanta; D Blumenthal, MD, Fulton County Health Dept, Atlanta; P Wiesner, MD, DeKalb County Board of Health, Decatur; K Toomey, MD, State Epidemiologist, P Meehan, MD, Div of Public Health, Georgia Dept of Human Resources. J Clinton, MD, HHS Region IV Office of the Director, Public Health Practice Program Office; Div of Surveillance and Epidemiology, Epidemiology Program Office, CDC.

Editorial Note: International sports events and other organized mass gatherings bring together large numbers of competitors and support staff from geographically widespread regions into sports venues and lodging facilities. Persons planning such events should recognize the data requirements of health-care and public health officials for providing necessary services during the events (1-3). The public health surveillance system established for the XVII Central American and Caribbean Games was simple and flexible and provided useful information on a timely basis (4). For example, information about patients treated at the hospital was used by the organizing committee's Division of Health Services for daily planning, and the system detected two conditions (conjunctivitis and gastroenteritis) with potential for spread.

Outbreaks of infectious diseases associated with competitive sports events may be transmitted by several modes, including person-to-person, common source, and airborne or droplet spread (5). Basic measures for preventing infectious diseases among athletes participating in such events include diagnosis and follow-up, prevention (e.g., vaccination), education about risk behaviors, and public health surveillance (e.g., prompt disease recognition and reporting). Health-care workers who provide medical care in these settings should recognize the potential risks for transmission of infectious diseases at three levels: the individual athlete, the team and support staff (as a group of individuals in close contact), and spectators or others exposed through viewing or related activities (5). In addition, members of these groups may be at risk for exposure to infectious diseases present among persons in the general community. Although the overall likelihood of transmission during competitive sports events is low, understanding of the levels for potential spread of infectious diseases facilitates rapid detection and intervention by medical and public health officials.