title: Novel public health risk assessment process developed to support syndromic surveillance for the 2012 Olympic and Paralympic Games.
abstract: Syndromic surveillance aims to provide early warning and real time estimates of the extent of incidents; and reassurance about lack of impact of mass gatherings. We describe a novel public health risk assessment process to ensure those leading the response to the 2012 Olympic Games were alerted to unusual activity that was of potential public health importance, and not inundated with multiple statistical 'alarms'.
  
  
  
  Statistical alarms were assessed to identify those which needed to result in 'alerts' as reliably as possible. There was no previously developed method for this. We identified factors that increased our concern about an alarm suggesting that an 'alert' should be made.
  
  
  
  Between 2 July and 12 September 2012, 350 674 signals were analysed resulting in 4118 statistical alarms. Using the risk assessment process, 122 'alerts' were communicated to Olympic incident directors.
  
  
  
  Use of a novel risk assessment process enabled the interpretation of large number of statistical alarms in a manageable way for the period of a sustained mass gathering. This risk assessment process guided the prioritization and could be readily adapted to other surveillance systems. The process, which is novel to our knowledge, continues as a legacy of the Games.
authors.affiliation: Real-Time Syndromic Surveillance Team, Public Health England, 5 St Philip's Place, Birmingham B3 2PW, UK.
authors.forename: Gillian E
authors.initials: GE
authors.lastname: Smith
authors.affiliation: Real-Time Syndromic Surveillance Team, Public Health England, 5 St Philip's Place, Birmingham B3 2PW, UK.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Elliot
authors.affiliation: Public Health England Centre, West Midlands, Public Health England, 5 St Philip's Place, Birmingham B3 2PW, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Ibbotson
authors.affiliation: Real-Time Syndromic Surveillance Team, Public Health England, 5 St Philip's Place, Birmingham B3 2PW, UK.
authors.forename: Roger
authors.initials: R
authors.lastname: Morbey
authors.affiliation: Field Epidemiology Service, Public Health England, 5 St Philip's Place, Birmingham B3 2PW, UK.
authors.forename: Obaghe
authors.initials: O
authors.lastname: Edeghere
authors.affiliation: Field Epidemiology Service, Public Health England, 5 St Philip's Place, Birmingham B3 2PW, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Hawker
authors.affiliation: Public Health England Centre for Infectious Disease Surveillance and Control, 61 Colindale Avenue, London NW9 5EQ, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Catchpole
authors.affiliation: Department of Global Health, Wellington House, 133 to 155 Waterloo Road, London SE1 8UG, UK.
authors.forename: Tina
authors.initials: T
authors.lastname: Endericks
authors.affiliation: Real-Time Syndromic Surveillance Team, Public Health England, 5 St Philip's Place, Birmingham B3 2PW, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Fisher
authors.affiliation: Department of Global Health, Wellington House, 133 to 155 Waterloo Road, London SE1 8UG, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: McCloskey
mesh_terms: D003441:Crowding; D006801:Humans; D015980:Public Health Practice; D018570:Risk Assessment; D018571:Sentinel Surveillance; D013177:Sports
keywords: mass gatherings, risk assessment process, syndromic
                      surveillance