title: Burden of vaccine preventable diseases at large events.
abstract: BACKGROUND
  Large events or mass gatherings (MGs) are known to amplify the risk of infectious diseases, many of which can be prevented by vaccination. In this review we have evaluated the burden of vaccine preventable diseases (VPDs) in MGs.
  
  
  METHODS
  Major databases like PubMed and Embase, Google Scholar and pertinent websites were searched by using MeSH terms and text words; this was supplemented by hand searching. Following data abstraction, the pooled estimate of the burden of VPDs was calculated when possible; otherwise a narrative synthesis was conducted.
  
  
  RESULTS
  In the past, at religious MGs like Hajj and Kumbh Mela, cholera caused explosive outbreaks; but currently respiratory infections, notably influenza, are the commonest diseases not only at Hajj but also at World Youth Day and Winter Olympiad. The recent cumulative attack rate of influenza at Hajj is 8.7% (range 0.7-15.8%), and the cumulative prevalence is 3.6% (range: 0.3-38%). Small outbreaks of measles (13-42 cases per event) have been reported at sport, entertainment and religious events. A sizeable outbreak (>200 cases) was reported following a special Easter Festival in Austria. An outbreak of hepatitis A occurred following the 'Jam bands' music festival. Other VPDs including pneumococcal disease, pertussis and tuberculosis have been reported in relation to MG attendance.
  
  
  CONCLUSIONS
  VPDs not only affect the participants of MGs but also their contacts; vaccine uptake is variable and vaccine implementation is likely to have beneficial effects. Research to address the knowledge gaps surrounding VPDs at MGs is needed.
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; School of Public Health, The University of Sydney, Sydney, NSW, Australia. Electronic address: amani.alqahtani@health.nsw.gov.au.
authors.forename: Amani S
authors.initials: AS
authors.lastname: Alqahtani
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Saudi Arabia.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Alfelali
authors.affiliation: Flinders University World Health Organisation Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Adelaide, SA, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Arbon
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Booy
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia.
authors.forename: Harunor
authors.initials: H
authors.lastname: Rashid
mesh_terms: D002771:Cholera / Q000453:epidemiology / Q000517:prevention & control; D003140:Communicable Disease Control; D003141:Communicable Diseases / Q000453:epidemiology* / Q000635:transmission; D017281:Cost of Illness; D004196:Disease Outbreaks / Q000191:economics / Q000517:prevention & control / Q000706:statistics & numerical data; D006693:Holidays; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D007514:Islam; D008457:Measles / Q000453:epidemiology / Q000517:prevention & control; D014195:Travel; D014611:Vaccination; D014917:Whooping Cough / Q000453:epidemiology / Q000517:prevention & control
keywords: Cholera; Influenza; Mass gathering; Measles; Respiratory infections; Vaccine preventable diseases