Presented by Sharon O’Regan
Environmental Health Officer
South Western Sydney Local Health District
Public Health UnitOctober 2016
Co-authors: Dr Stephanie Fletcher-Lartey, John Birkett
Public Health Preparedness and Surveillance : Australian Scouts Jamboree 2016
Photo credit: SWSLHD PHU/Dr Stephanie Fletcher-Lartey
Outline of Presentation:
This presentation outlines the actions taken by a
multidisciplinary Public Health Unit team to proactively
develop and implement an early warning system at a mass
gathering event in NSW. The event, namely the National
Scouts Jamboree 2016 (AJ2016) was held at Cataract
Scout Park, Appin, NSW between the 3-13 January 2016.
The presentation emphasizes the importance of public
health preparedness and demonstrates how inter-sectoral
collaboration remains a valuable principle for effective
delivery of public health actions in an industrialized setting.
Video: AJ2016 Leap into Adventure
https://www.youtube.com/watch?v=da0_pURmnKw
Aim: To develop and implement a syndromic surveillance system
and environmental monitoring to provide early warnings of
outbreaks and other incidents at a mass gathering event,
(Australian Scouts Jamboree 2016, AJ2016), to enable a
timely response.
Source of image: www.pinterest.com
Introduction: Scouts Jamboree
Audience:
– Scouts aged between
11 and 14 years of age
(8354),
– Leaders 18 years and
older (2639)
– Junior Service Leaders
(198).
– Family and friends on
visitor’s day (10154).
AJ 2016 was held at Cataract
Scout Park, Appin between
January 3-13, 2016.
Drinking Water Supply:
Private drinking water supply from
a header tank on the property.
Extra water supply from nearby
Cataract Dam.
Private Drinking Water Supply
Quality Assurance Program was
provided to the Public Health Unit
(PHU) for the event.
Jamboree Activities:
Onsite activities
included:
– abseiling, water sliding, high
ropes course, rock climbing;
– challenge valley with water
and mud obstacles;
Offsite activities:
– tours of Sydney and
– visits to theme parks.
Multi-Agency Emergency Preparedness Pre-
Jamboree Meetings:
Campbelltown Council
Wollondilly Council
Transport NSW
Rural Fire Service
State Emergency Services
NSW Police (REMO,
LEOCON)
NSW Ambulance
NSW Fire Brigade
NSW Health (SWSLHD):
PHU, HSFAC, Disaster
Management
Public Health Preparedness and
Surveillance:
PHU internal multidisciplinary team convened, including Medical
Staff, Environmental Health, Communicable Disease and Bio-
preparedness Epidemiologist;
Risk assessment criteria for AJ2016 based on WHO Toolbox for
Implementation of Surveillance at Mass Gatherings1 including:
– magnitude of the event, duration, age groups involved and time
of year (Southern Hemisphere Summer);
– AJ2016 classified as a medium risk mass gathering event.
Source: 1. Zielinski A, Pawlak BJ, React project. Toolbox for implementation of surveillance at mass gatherings. WP 4: Surveillance during mass gatherings. 2011. Accessed 22/5/2016
http://www.rki.de/EN/Content/Prevention/React/Work/wp4/WP_4_ToolBox.pdf?__blob=publicationFile Available at https://www.pdffiller.com/en/project/56381294.htm?form_id=15448845
Risk Assessment Template from: Zielinski A, Pawlak BJ, React project. Toolbox for implementation of surveillance at mass gatherings. WP 4: Surveillance
during mass gatherings. 2011.
Public Health Preparedness and
Surveillance: Syndromic surveillance for key
syndromes informed by global
mass gathering events and best
practice.
– Daily Syndromic Surveillance
reporting form with definitions
developed.
Environmental Health Monitoring
for key indicators developed.
– Daily EH reporting form developed.
Daily reporting endorsed by multi-
agency emergency management
committee.
Event organisers agreed to adapt
PHU’s recommendations.
Roles of Public Health Unit:
Environmental
Health Officer
o Evaluate/risk assessment of
services, area, numbers of
people.
o Emergency management –
water, sewage, waste disposal,
food, electricity, shelter,
hygiene, vector control.
o Monitor risks to environment –
pool/drinking water testing.
Epidemiology
o Provide advice on infectious
disease control.
o Carry out surveillance of cases
presenting to temporary on-site
medical facility.
EHO visits to the campsite:
o Assess the site, determine
hazards and to implement any
risk management strategies.
Feedback to site management
and event organisers on:
o Management of waste water
o Enhanced treatment of potable
water and recreational water
facilities, and
o Communicable disease
prevention and control.
Environmental Health Monitoring:
EH Monitoring: Potable Water Quality.
Chlorine automatically dosed into inlet of
the tank containing water from the
reservoir,
Dosing unit purposefully installed close to
the tank.
Generally test results were good for
chlorine levels throughout the system.
Chlorinator knocked out on the second
last day due to power failure associated
with freak storm the previous night
– Detected by EHOs during site visit;
– Issue rectified by on-site volunteers
immediately.
EH Monitoring: Potable Water Quality.
Drinking water quality test
results reported to the PHU
usually on the same day as
the testing.
Samples tested once a day,
by qualified on-site
volunteers:
– point near the inlet of the
header tank
– Point at most extreme outlet.
EH Monitoring: Recreational Water Activities.
Water slide;
– Participants required to shower
before using the water slide.
– activities staggered over the event
to prevent scouts entered the slide
after involvement in a dirty activity.
– A secondary water slide used
potable water and disinfected
between each group of scouts (a
low risk activity).
Testing of the pool at bottom of the
water slide 3 times daily.
ORP was good throughout the
duration of the event.
Pool results met standards with a
few minor variants.
Challenge Valley:
Challenge Valley had a
number of water obstacles,
but because of high rainfall
at the start of the Jamboree,
it was closed for several
days.
Photo credit: Scouts Australia NSW
EH Monitoring:
Challenge Valley Risk Management.
o Prevent access to Challenge Valley water
obstacles to those with gastroenteritis
symptoms (vomiting or diarrhoea) in the previous
24 hours.
o Water elements regularly checked for animal
faeces before daily filling.
o Water elements filled daily with chlorinated
water.
o Participants not to dunk their head underwater
unless instructed to do so.
o Participants to close mouth and hold nose when
dunking heads on water pipe obstacle.
o Compulsory shower at end of course.
Photo credit: Scouts Australia NSW
Camp Hygiene:
Each campsite provided with:
• Hand wash facilities and sanitiser at entry to sub campsite.
• Waste water disposal facilities.
Syndromic Surveillance:
The syndromic surveillance
system;
– designed to provide early warning
of outbreaks and other events of
public health importance.
– Facilitate immediate action and
response.
Voluntary participation from
onsite medical centre;
However still required to
report notifiable conditions in
accordance with
Communicable Disease
Control Guidelines.
Syndromic Surveillance: Seven core syndromes were monitored under this syndromic
surveillance system;
o Acute febrile illness with rash.
o Acute respiratory infection with fever.
o Acute viral hepatitis (suspected).
o Gastrointestinal illness.
o Meningitis/Encephalitis.
o Undifferentiated Fever.
o Temperature-related illness.
o Death.
Detailed data collected on line lists required for individual
patients, only if an outbreak was suspected.
Medical facilities consisted of;
o Triage tent.
o Consulting rooms.
o Male and Female wards.
o Medical dispensary.
o X-ray facility.
o Separate toilet and shower
facilities.
o Separate computer room.
Onsite Medical
Facilities:
Generally incident free from a public health perspective.
34 cases reported to the PHU over the period.
Small outbreak of gastroenteritis in the second week -
mainly males ≤16 years.
Collaboration between Event management and PHU to
contain the outbreak (confirmed norovirus case).
– Isolation of gastroenteritis cases.
– Enhanced hand hygiene and sanitation.
– Monitoring of food safety and waste management.
Implementation of daily reporting:
Results of Syndromic Surveillance:
The Scouts implemented daily syndromic reporting from January 3rd until January 15th, 2016.
Table 1: Summary of Syndromes reported by AJ 2016, January 4-14, 2016
Male Female Overall
≤ 16 yrs ≥ 17yrs Total
Males
≤ 16 yrs ≥ 17yrs Total
Females
Acute febrile illness with rash 0 0 0 0 0 0 0
Acute respiratory infection
with fever
0 0 0 1 0 1 1
Acute viral hepatitis (suspected) 0 0 0 0 0 0 0
Gastrointestinal illness 24 2 26 1 3 4 30
Meningitis/Encephalitis 0 0 0 0 0 0 0
Undifferentiated fever 0 0 0 0 0 0 0
Temperature-related illness 2 0 2 0 0 0 2
Death 0 0 0 0 0 0 0
Other unspecified Conditions*
Mesenteric adenitis 1 0 1 0 0 0 1
What was done well…
Proactive preparedness of Syndromic Surveillance provided
effective early warning of gastroenteritis outbreak that averted
catastrophic public health events at AJ2016.
Presence of a fully equipped onsite medical centre and ability
to isolate and triage cases helped to avert a wider spread of
the outbreak across camps.
Having direct contact person at AJ 2016 and PHU liaison
person made communication relatively seamless.
What was done well…
A de-brief session was organised by the
PHU following the event.
The scouts felt that ‘syndromic
surveillance was a good effort, was
worth doing and facilitated transparency
between the event organisers and the
PHU’.
A team of incredibly talented clinical
volunteers helped to prevent any major
medical emergencies.
Staff felt that having a direct point of
contact in the PHU was helpful.
Having environmental health monitoring
separate to syndromic surveillance
reporting helped the respective teams to
keep both activities under control.
What needed improvement….
Very high workload for
volunteer staff limited same
day reporting of the
syndromic surveillance.
More delegation of tasks to
a less senior staff members
needed to ensure
timeliness of reporting.
What needed
improvement… There was no photometer on site for testing
of pool water. Test strips were used for the
event. Photometric method is
recommended for best practice.
Pool is to be regularly tested in accordance
with NSW Public Health Regulation 2012
requirements.
Limited access to Challenge Valley during
the event. PHU have since returned to the
site with Scouts Australia NSW staff to
carry out a health risk assessment.
No automated chlorination of water held in
drinking water header tank during normal
operations.
A Quality Assurance Program is required
for the private drinking water supply outside
of event mode.
Initial communications with AJ 2016 event organisers was weak, but
improved once discussions began with the event management team,
and the team was responsive and responded to requests in a timely
fashion.
Daily reports were initially requested to be submitted on the evening of
the same day, but these were submitted by email mainly on the next
morning. Once the outbreak was detected it was notified to the PHU by
telephone immediately.
Strong collaboration across PHU teams to develop protocol.
Syndromic surveillance protocol is easy to use and can be useful in
other similar Scout events.
Limitations are to be addressed by Site Management Team prior to any
future events.
Lessons Learned:
Acknowledgements:
Dr Stephanie Fletcher-Lartey, Epidemiologist, PHU
John Birkett, Senior Environmental Health Officer, PHU
Peter Cavagnino, Environmental Health Officer, PHU
Tracey Hansford, Administration Officer, Scouts Australia
NSW
Dr Allan Kirkpatrick, Director Health Services, AJ2016
Michael Wright, Director Sites and Services, AJ2016
