Monitoring wastewater and Internet chatter for a disease-free World Cup

Epidemiologists will be busy this summer examining wastewater and social media content, with the aim of protecting football fans and the public from contracting serious diseases during the World Cup, one of the largest and most diverse crowd gatherings the world has ever seen.

Organizers said the Washington, D.C.-based public health team plans to monitor wastewater and Internet conversations to detect and track infectious diseases if they appear in any of the American or Canadian cities that host World Cup players, their matches and millions of spectators.

The 39-day tournament begins in Mexico on Thursday, and more than 6.5 million fans from more than 100 countries are expected to travel to watch 104 matches in the United States, Canada and Mexico.

Health security experts say the scale of the event and the worldwide travel pose an increased risk of rapid disease transmission at a time when limited US public health resources are dealing with outbreaks of measles, Ebola and Hantavirus at home and abroad.

According to the organizers of the new disease tracking initiative, budget cuts and staff reductions under the administration of US President Donald Trump, in addition to the US withdrawal from the World Health Organization, have exacerbated these challenges.

Genetic threads
In a move to provide real-time data on potential threats, a newly formed team of public health experts has transformed a Georgetown University laboratory into an epidemiological command center. It includes academic institutions, non-profit organizations, and private companies that work to support government agencies.

The team is already preparing a daily situation report to inform hospital emergency managers and public health authorities at the local, state, federal and international levels, as well as FIFA, of emerging risks and any immediate need for action.

The operations center serves as a preliminary experience for future events, including the 2028 Olympic Games in Los Angeles. Rebecca Katz, director of the Georgetown Center for Health Sciences and Global Security and head of new disease surveillance efforts, said that advanced analysis of wastewater, using DNA and RNA sequencing to find genetic sequences from a range of microbes without the need for laboratory cultivation, is an essential element in monitoring infectious disease threats.

“It’s very powerful,” Katz said. Her team is currently receiving such data from data collection sites in the United States and Canada, as well as from various other health surveillance sources in all three World Cup host countries.

The discovery of disease-causing microorganisms in wastewater can indicate an upcoming disease outbreak, giving health officials time to warn clinicians to watch out for symptoms of diseases that may be misdiagnosed, and to urge the public to take precautions.

Katz said her team will pay special attention to the spread of measles, which is approaching a record number of cases in the United States this year — about 2,000 so far — and has resurfaced in parts of Mexico and Canada. Mosquito-borne diseases, such as dengue fever and its related chikungunya fever, pose additional risks. Both originate in tropical regions and can be carried by infected travelers and then transmitted by mosquitoes.

Katz noted that other key tools include tracking anonymized data from electronic health records, and searching open source social media platforms for information that indicates hotspots of infection transmission.

She cited a previous example of public health officials identifying an outbreak of a gastrointestinal illness through conversations on social media about a sudden spike in toilet paper sales.