Eurosurveillance

ECDC

Activities Performed by the State Sanitary and Epidemiological Service of Ukraine in Control over Sanitary and Epidemiological Situation During EURO-2012

 Rediger
  Published: 10.01.13 Updated: 10.01.2013 12:00:48

A. Kravchuk,V. Liashko
State Sanitary and Epidemiological Service of Ukraine, Kiev

Citation: Kravchuk A, Liashko V. Activities Performed by the State Sanitary and Epidemiological Service of Ukraine in Control over Sanitary and Epidemiological Situation During EURO-2012. EpiNorth 2012;13:112-6.

Abstract
The State Sanitary and Epidemiological Service of Ukraine was responsible for ensuring the sanitary and epidemiological well-being of the population during the final part of the European football championship (EURO-2012) that was held in the country. Despite the ongoing reform of the state sanitary and epidemiological surveillance system in Ukraine, nearly 53 thousand specialists monitored the epidemiological situation in all parts of the country every day and provided rapid response to infection-related events.

Introduction
The European football championship is a major football event held once every four years under the auspices of the Union of European Football Associations (UEFA). The final part of the championship was hosted by Ukraine and Poland. The opening game took place on June 8, 2012 in Warsaw and the final game was played in Kiev on July 1, 2012. In Ukraine the EURO-2012 matches were held at stadiums in Kiev, Donetsk, Kharkov and Lvov (Fig. 1).



Methods
During the final part of EURO-2012, the major goal of the state sanitary and epidemiological service was to provide surveillance over the locations involved in the championship. In addition, the service implemented measures to ensure sanitary and epidemiological well-being of the population in host cities, to prevent from the onset and spread of various infections and to guarantee biological safety.
On June 1, 2012, the Chief State Sanitary Doctor of Ukraine approved Resolution No.12 on the prevention of onset and spread of mass infectious and non-infectious (e.g. poisoning) diseases among the population of the host cities of EURO-2012. The local executive authorities were recommended to implement the following measures:
- to equip the dwelling areas for championship participants and guests with proper services and utilities, and to provide due maintenance of such areas;
- to make provision for proper catering services and to guarantee the necessary conditions for personal hygiene for championship participants and guests in the places of residence;
- to organize water supply in accordance with hygienic norms.

Prior to the beginning of the championship, the construction and reconstruction sites in all host cities (Donetsk, Kiev, Lvov and Kharkov) involved in preparation for EURO-2012 were subject to regular checks for compliance to sanitary legislation requirements. Epidemiological surveillance was intensified for the sites vulnerable to epidemiological risks such as public catering establishments in hotels and recreation centers, as well as shops and restaurants located in railway stations, bus stations and along the highways. The sanitary and epidemiological conditions at these locations were continuously monitored for compliance to the sanitary legislation requirements. Based on the results of monitoring, adequate response measures were taken and necessary recommendations were given.
Before EURO-2012, all stadiums where football matches were expected to be held were inspected to ensure proper sanitary and epidemiological conditions. These preliminary inspections were conducted during the national football championship games that preceded EURO-2012. Healthcare workers in all host cities had proper theoretical training concerning various issues of epidemiology, diagnostics, treatment and prophylaxis of the infections covered by the Regulations for Sanitary Protection of the Territory of Ukraine. In 2011 the Regulations were harmonized with the International Health Regulations of 2005 in terms of prevention of importation and spread of the hazardous infections of international significance (1).
In accordance with Order No. 47, from June 5 to July 15, 2012 the State Sanitary and Epidemiological Service of Ukraine provided daily monitoring of the incidence of 64 infections in the country (2). Every day at 6 a.m. the EURO-2012 Strategic Headquarters of the State Sanitary and Epidemiological Service of Ukraine obtained the current infection incidence data, based on which the daily national report on sanitary and epidemiological situation in Ukraine during the championship was compiled. The report was sent directly to the Ministry of Health of Ukraine, the WHO/Europe country office in Ukraine, the Prosecutor General’s Office of Ukraine, the Sanitary Inspection of Poland and to the European Centre for Disease Prevention and Control.

The Strategic Headquarters received copies of all urgent messages regarding cases of infections, food poisonings and occupational poisonings (occupational hazards due to unfavorable or harmful work conditions), radiation accidents and any other emergency situations in the country.

During the championship, the State Sanitary and Epidemiological Service undertook the following activities:
- the state sanitary and epidemiological control over activities of basic hospitals and other healthcare institutions was intensified;
- facilities where participants and guests of EURO-2012 resided were subject to regular sanitary and epidemiological control;
- the public catering establishments, fan zones (places where football matches were watched by crowds of people outside the stadiums) and recreation zones were also checked for compliance with sanitary and epidemiological regulations and proper sanitization etc. was ensured.
To prevent the onset and spread of infections in Ukraine, the most up-to-date system of epidemiological surveillance used in the country was implemented. The system consists of the following three subsystems that are functionally dependent from each other:
- information subsystem (responsible for collection, systematization and transfer of information);
- decision-making subsystem (responsible for determining a management goal, planning of events and taking managerial decisions);
- diagnostic subsystem (responsible for current and retrospective data analysis, forecasts of future development tendencies and determination of the burden of disease, also economical).

During EURO-2012, the structural subdivision of the State Sanitary and Epidemiological Service of Ukraine providing surveillance over air transport controlled the sanitary conditions at airports in Donetsk, Lvov, Kharkov, Kiev (Zhulyany and Borispol). The airports were checked for correspondence to the sanitary legislation regarding safety for tourists. The catering company in the international airport of Borispol was subject to daily epidemiological surveillance with laboratory control. This company provided food for UEFA clubs in the stadiums of Lvov, Kharkov, and Kiev and in the Olympic stadium in the capital of Ukraine. The service also controlled the activity of the company that transported food to the VIP zones at stadiums and encampments.
The State Sanitary and Epidemiological Service for Railway Transport provided sanitary and epidemiological control over all railway stations, including the public catering establishments and food sales points. Daily laboratory testing of food and drinking water was also performed. The Sanitary And Epidemiological Service For Water Transport intensified activities in ports, especially when foreign ships docked.

During EURO–2012, a round-the-clock telephone hotline was organized to provide more information about sanitary and epidemiological issues. The hotline service was available in Ukrainian, in English and in Russian.
The EURO-2012 Strategic Headquarters of the State Sanitary and Epidemiological Service of Ukraine took timely measures in response to notifications received from colleagues in Poland, from the WHO Regional Office for Europe and from the ECDC. The active interaction with ECDC was possible due to assistance from the EpiNorth project. Colleagues from the EpiNorth project provided daily epidemic intelligence in the project area. Official information sources and mass media reports in Russian, Ukrainian, Polish, Lithuanian, and English were screened for relevant topics, daily reports on infectious threats issued by ECDC were translated into Russian and the relevant information was sent to the State Sanitary and Epidemiological Service of Ukraine.
The information exchange model practiced previously at preparatory meetings before EURO-2012 was effectively used during the championship.

Results
During EURO-2012, 26 sporadic infections were identified among foreign citizens including 12 cases of acute intestinal infections, 4 cases of acute respiratory viral infections, 2 cases of scarlet fever, 2 cases of chickenpox, 1 case of measles, 1 case of viral hepatitis A, 1 case of infectious mononucleosis, 1 case of brucellosis, 1 case of bacterial meningitis and 1 case of malaria.
Of the 64 monitored infections, 34 were registered during the championship. Six foreign patients with infectious diseases were not allowed to come ashore in Ukraine.
The large number of sports fans visiting the country did not have much influence on the epidemiological well-being of the population of Ukraine. During the championship host cities were primarily affected by acute respiratory infections, but the incidence level including influenza and acute respiratory viral infections was at expected level for the summer period and posed no risk for EURO-2012.
To control and improve the sanitary and epidemiological situation in the country, specialists from the state sanitary and epidemiological service conducted more than 3.5 thousand checks and inspections of the sites involved in the organization of EURO-2012 and services for the guests. Approximately 16.5 thousand laboratory tests were performed of which more than half were related to the quality of food.
Public establishments did their best to get ready for EURO-2012. However, inspections indicated that one out of three of the establishments violated sanitary legislation. Results of laboratory tests showed minor deviations from the hygienic norms (up to 2.5%).
One thousand three hundred employees were held administratively liable for the violations, over 400 people were suspended from their tasks and 186 sites and establishments were temporary closed for visitors because they failed to comply with the sanitary legislation requirements.

Discussion
The commitment of specialists from the state sanitary and epidemiological service, authorities and businessmen of Ukraine to provide professional advice and service to the organization and implementation of EURO-2012 helped to ensure the well-being of the country’s population and foreign guests during the EURO-2012 championship. The activities of the State Sanitary and Epidemiological Service of Ukraine were acknowledged by WHO, UEFA and the ECDC.
The organizers of EURO-2012 benefitted from the experiences of epidemiological surveillance in countries that hosted previous world and European football championships. This helped to guarantee sanitary and epidemiological safety during EURO-2012. We studied the situation that took place in Portugal during EURO-2004 when 10 outbreaks of food poisoning, 7 cases of meningococcal infection and several sporadic cases of legionellosis were registered. We also analyzed in detail the clustered poisoning of 50 journalists during the world football championship in Germany in 2008, and the 5 clustered cases of food poisoning including 1 case in which 120 people were poisoned in a volunteers’ camp during the world championship in South Africa in 2010.
Ukraine was one of the few countries that managed to conduct a mass gathering event without any clustered cases of infections.

References
1. Международные медико-санитарные правила, 2005 г. Всемирная организация здравоохранения, 2008. Available on: http://whqlibdoc.who.int/publications/2008/9789244580417_rus.pdf  
2. Правила санитарной охраны территории Украины: Постановление Совета министров Украины, 25.08.2011. Available on: http://www.kmu.gov.ua/control/publish/article?art_id=244481570


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