Reducing the risk of public health emergencies for the world’s largest mass gathering: 2010 World Exposition, Shanghai China

Mass Gatherings and Public Health Mass gatherings are highly visible events with the potential for serious health and political consequences if not managed carefully and effectively.(1)(-)(4) Mass gatherings have been reported to have significant impact upon public health systems throughout the world.(5)(-)(10) International mass gathering events, such as those associated with the Olympic Games, often carry high political significance and have a historical risk for terrorist attacks.(2) Mass gatherings ranging from the subnational level to international the level have also been associated with outbreaks and subsequent spread of communicable diseases. These events have included outbreaks of foodborne shigellosis occurring at an outdoor music festival in the United States.(5)(,)(6) The annual Hajj pilgrimage in Saudi Arabia has been plagued by public health threats such as fires, stampedes and an outbreak of meningitis.(7)(,)(9) Influenza outbreaks were also reported during the 2008 World Youth Day mass gathering in Australia.(10) Local, provincial and national public health and medical agencies are frequently involved before, during and after a major event. Therefore, disaster risk reduction is a key element for the effective management of mass gatherings. Disaster Risk Reduction Throughout the world, the overall approach to emergencies and disasters has recently shifted from post-impact activities (i.e., ad hoc relief and reconstruction) to a more systematic and comprehensive process of risk management.(11) Disaster risk management includes pre-impact disaster risk reduction (i.e., prevention, preparedness and mitigation) as well as post-impact response and recovery).(12) While planners may not always have the ability to prevent health hazards from occurring at mass gathering events, the health sector can play an important role in preventing the public health impact of such hazards. This manuscript describes a comprehensive approach for disaster risk reduction as implemented by those entities responsible for health security associated with the 2010 Shanghai World Exposition (Shanghai Expo).