A measles outbreak, heat events and food-borne illnesses are among the potential health hazards at the FIFA World Cup that public health officials in Toronto, Vancouver and cities in the U.S. and Mexico aim to mitigate by sifting through wastewater and social media.
The 39-day event kicked off on Thursday in Mexico, and matches will be played on Friday in Toronto and Saturday in Vancouver.
More than 6.5 million soccer fans from around the world are expected to attend games in the three host nations — a scale of travel that boosts the risk of rapid disease spread just as outbreaks of measles, Ebola and the Andes strain of hantavirus, which was recently linked to an outbreak on a cruise ship, have hit globally.
Dr. Michelle Murti, medical officer of health for Toronto Public Health, said the city turned to laboratory staff at the University of Toronto and Toronto Metropolitan University to step up surveillance at the stadium, fan festival and training facility as it welcomes visitors from around the world who might bring different infectious disease threats.
The tournament’s Canadian host cities of Toronto and Vancouver routinely test wastewater for respiratory viruses like COVID infection, influenza and respiratory syncytial virus, or RSV, which affects the airways and lungs.
“Through that extra surveillance, we’re looking for norovirus, measles infection and mpox infection,” Murti said. “We chose these three particular infections in addition to what we have in the respiratory side because we know we would do something very different if we found them.”
The advantage of wastewater sampling is it can give an early signal without people having to seek testing, she said.
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Advanced wastewater analysis, using DNA and RNA sequencing to find microbes without waiting for them to grow in a lab dish, is a key way to monitor infectious disease threats, said Rebecca Katz, director of Georgetown University’s Center for Global Health Science and Security in Washington, D.C., and head of new disease surveillance efforts for all sites in North America.
“One of the cool things about the wastewater surveillance data is it looks like it can pick up measles in the wastewater five to seven days before the first patient actually shows up in the emergency department,” Katz said. “It’s really powerful.”
If the measles virus is detected, Toronto Public Health would put out messages to reinforce how highly contagious it is.
“Measles is the kind of infection that you don’t get sick with until maybe 10 or 12 days after,” Murti said. Making visitors aware of potential exposures before they travel reduces the risk.
“Of course, the best thing for measles is to be vaccinated before you arrive.”
Katz said her team would be paying special attention to the spread of measles, which is approaching a record for U.S. case numbers this year at about 2,000. The virus has resurged in parts of Mexico and Canada, with the most recent new cases in Alberta and Manitoba.
For norovirus, which causes severe vomiting and diarrhea, Murti said it’s likely to be in wastewater already. But if it starts to appear at higher levels, the city will remind people who are sick to stay home and fans to practise good hand hygiene.
The third viral infection, mpox, spreads through close physical contact, skin to skin, including through sexual activities. Mpox can cause painful rashes, fever, enlarged lymph nodes and respiratory symptoms.
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People can also get the virus when handling personal items used by an infected person, including towels, clothing and bedding, or when sharing utensils, toothbrushes, razors, needles or sex toys, according to the Public Health Agency of Canada’s website.
Ongoing cases of mpox have been occurring in Toronto, which is a reminder to visitors to consider vaccination and safer sex practices to reduce the risk of spread, Murti advised.
Elsewhere, the World Health Organization (WHO) has declared an outbreak of the rare Bundibugyo strain of the Ebola virus a public health emergency of international concern. WHO points to more than 500 confirmed cases and 100 deaths from the outbreak that was declared last month in the eastern Democratic Republic of Congo.
Canada has never seen an Ebola case, and the federal government said its measures reduce the risk of cases entering and spreading. These include a temporary suspension of certain immigration documents for residents of the D.R.C., Uganda and South Sudan as Canada hosts the World Cup.
Katz said the hemorrhagic fever poses a “very low risk to the general public” in North America. That’s one of the reasons why Ebola is excluded from wastewater testing. Instead, Murti pointed to the federal border-screening measures to prevent cases.
Katz’s team is currently receiving data from collection sites in the U.S. and Canada, as well as from various other health monitoring sources in all three World Cup host countries.
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Other ways to monitor for spread of infectious diseases involve tracking anonymized data from electronic health records and scouring open-source social media platforms for information pointing to transmission clusters, she said.
Katz gave a previous example of public health officials pinpointing an outbreak of gastrointestinal illness from social media chatter about a sudden uptick in sales of toilet paper.
To prevent outbreaks of foodborne illnesses, Murti highlighted a new food vendor portal where stallholders need to register before serving at Toronto’s World Cup fan sites.
The potential advantage of registering vendors came to light at the Canadian National Exhibition in 2013, when the cronut burger, which consisted of a cheeseburger on a croissant-donut bun, made at least 150 people sick. Staphylococcus aureus bacteria were present in lab tests of the burger.
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Meanwhile, in Vancouver, 350,000 fans are expected to attend seven soccer matches at BC Place, and thousands of others are expected to turn out for the city’s fan festival.
To prepare, British Columbia’s Centre for Disease Control has been working with Vancouver Coastal Health and the Office of the Provincial Health Officer to mitigate risks, which also include illnesses associated with food handling.
Other risks flagged as moderate in B.C. during the World Cup include harms from substance use, including toxic drug overdoses and injuries related to alcohol consumption; heat events; and transportation-related injuries as more people move across Vancouver and surrounding areas.
It helps that Vancouver has a good understanding of how many people are coming, where the venues are and the security considerations on top of the public health risks, said Dr. Mark Lysyshyn, deputy chief medical health officer at Vancouver Coastal Health.
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The stadium will have dedicated paramedic teams with ambulances, and emergency departments are prepared for surges in volumes, he said.
The Pan American Health Organization issued public health recommendations this week for travellers and people attending the World Cup.
To reduce risks, it recommends simple preventive actions, such as frequent handwashing, drinking safe water, choosing properly cooked foods and ensuring proper ventilation in enclosed spaces.
In some host cities, particularly in Mexico, mosquitoes can transmit such diseases as dengue, Zika and chikungunya, the agency said. Travellers are encouraged to use insect repellent and wear protective clothing.
