title: An Observational Study Using English Syndromic Surveillance Data Collected During the 2012 London Olympics - What did Syndromic Surveillance Show and What Can We Learn for Future Mass-gathering Events?
abstract: Introduction In preparation for the London 2012 Olympic Games, existing syndromic surveillance systems operating in England were expanded to include daily general practitioner (GP) out-of-hours (OOH) contacts and emergency department (ED) attendances at sentinel sites (the GP OOH and ED syndromic surveillance systems: GPOOHS and EDSSS). Hypothesis/Problem The further development of syndromic surveillance systems in time for the London 2012 Olympic Games provided a unique opportunity to investigate the impact of a large mass-gathering event on public health and health services as monitored in near real-time by syndromic surveillance of GP OOH contacts and ED attendances. This can, in turn, aid the planning of future events.
  
  
  METHODS
  The EDSSS and GPOOHS data for London and England from July 13 to August 26, 2012, and a similar period in 2013, were divided into three distinct time periods: pre-Olympic period (July 13-26, 2012); Olympic period (July 27 to August 12); and post-Olympic period (August 13-26, 2012). Time series of selected syndromic indicators in 2012 and 2013 were plotted, compared, and risk assessed by members of the Real-time Syndromic Surveillance Team (ReSST) in Public Health England (PHE). Student's t test was used to test any identified changes in pattern of attendance.
  
  
  RESULTS
  Very few differences were found between years or between the weeks which preceded and followed the Olympics. One significant exception was noted: a statistically significant increase (P value = .0003) in attendances for "chemicals, poisons, and overdoses, including alcohol" and "acute alcohol intoxication" were observed in London EDs coinciding with the timing of the Olympic opening ceremony (9:00 pm July 27, 2012 to 01:00 am July 28, 2012).
  
  
  CONCLUSIONS
  Syndromic surveillance was able to provide near to real-time monitoring and could identify hourly changes in patterns of presentation during the London 2012 Olympic Games. Reassurance can be provided to planners of future mass-gathering events that there was no discernible impact in overall attendances to sentinel EDs or GP OOH services in the host country. The increase in attendances for alcohol-related causes during the opening ceremony, however, may provide an opportunity for future public health interventions. Todkill D , Hughes HE , Elliot AJ , Morbey RA , Edeghere O , Harcourt S , Hughes T , Endericks T , McCloskey B , Catchpole M , Ibbotson S , Smith G . An observational study using English syndromic surveillance data collected during the 2012 London Olympics - what did syndromic surveillance show and what can we learn for future mass-gathering events? Prehosp Disaster Med. 2016;31(6):628-634.
authors.affiliation: 1Public Health England,Centre for Infectious Disease Surveillance,Real-time Syndromic Surveillance Team,Birmingham,United Kingdom.
authors.forename: Dan
authors.initials: D
authors.lastname: Todkill
authors.affiliation: 1Public Health England,Centre for Infectious Disease Surveillance,Real-time Syndromic Surveillance Team,Birmingham,United Kingdom.
authors.forename: Helen E
authors.initials: HE
authors.lastname: Hughes
authors.affiliation: 1Public Health England,Centre for Infectious Disease Surveillance,Real-time Syndromic Surveillance Team,Birmingham,United Kingdom.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Elliot
authors.affiliation: 1Public Health England,Centre for Infectious Disease Surveillance,Real-time Syndromic Surveillance Team,Birmingham,United Kingdom.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Morbey
authors.affiliation: 1Public Health England,Centre for Infectious Disease Surveillance,Real-time Syndromic Surveillance Team,Birmingham,United Kingdom.
authors.forename: Obaghe
authors.initials: O
authors.lastname: Edeghere
authors.affiliation: 1Public Health England,Centre for Infectious Disease Surveillance,Real-time Syndromic Surveillance Team,Birmingham,United Kingdom.
authors.forename: Sally
authors.initials: S
authors.lastname: Harcourt
authors.affiliation: 3Royal College of Emergency Medicine,London,United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Hughes
authors.affiliation: 4Public Health England,WHO Collaborating Centre for Mass Gatherings and Global Health Security,London,United Kingdom.
authors.forename: Tina
authors.initials: T
authors.lastname: Endericks
authors.affiliation: 4Public Health England,WHO Collaborating Centre for Mass Gatherings and Global Health Security,London,United Kingdom.
authors.forename: Brian
authors.initials: B
authors.lastname: McCloskey
authors.affiliation: 5European Centre for Disease Control,Office of the Chief Scientist,Stockholm,Sweden.
authors.forename: Mike
authors.initials: M
authors.lastname: Catchpole
authors.affiliation: 6Public Health England,Centre Director,West Midlands,United Kingdom.
authors.forename: Sue
authors.initials: S
authors.lastname: Ibbotson
authors.affiliation: 1Public Health England,Centre for Infectious Disease Surveillance,Real-time Syndromic Surveillance Team,Birmingham,United Kingdom.
authors.forename: Gillian
authors.initials: G
authors.lastname: Smith
mesh_terms: D000846:Anniversaries and Special Events; D004196:Disease Outbreaks; D004739:England; D006801:Humans; D008131:London; D062486:Public Health Surveillance / Q000379:methods*; D013177:Sports; D013577:Syndrome
keywords:  ED emergency department;  EDSSS Emergency Department Syndromic Surveillance System;  GP general practitioner;  GPOOHS General Practitioner Out-Of-Hours Syndromic Surveillance System;  HPA Health Protection Agency;  NHS National Health Service;  OOH out-of-hours;  PHE Public Health England;  ReSST Real-time Syndromic Surveillance Team;  SitRep situation report;  WHO World Health Organization; health protection; mass gatherings; syndromic surveillance