Mass gatherings

Travel advice for anyone planning to attend a mass gatherings event

Key messages

• Mass gatherings are events attended by large numbers of people. As mass gatherings are diverse in nature, travellers should be offered specific, tailored advice ideally 4-6 weeks before travel.

• Travellers should be up to date with routine vaccinations including measles.

• Crowded conditions are likely; travellers should be prepared to manage these, as well as the environmental and physical demands of the planned trip.

• Pre-existing medical conditions may worsen during mass gathering events; travellers should be fit to travel.

• Infections have the potential to spread quickly in crowded conditions; travellers should not attend an event if acutely unwell.

• When advising travellers attending a mass gathering, health professionals should ensure they understand the nature of the mass gathering.

• A pre-travel consultation is an opportunity to review individual routine and travel vaccine recommendations, as well as any additional vaccine requirements specific to the event.

Overview

Mass gatherings are planned or spontaneous events in a specific location attended by large numbers of people [1]. They can be planned or unexpected; recurrent or unplanned [2]. Examples include protests, religious events (e.g. Hajj, Umrah, Kumbh Mela), sporting occasions (e.g. Olympics/Paralympics, FIFA World Cup), LGBT+ Pride celebrations, music festivals and cultural events (e.g. literary festivals and scouting jamborees) [3].

While there are many different types of mass gatherings, they all have the potential to put pressure on local resources in the host country [1, 2].

Mass gatherings present a unique set of health concerns. These include the potential for underlying health conditions to get worse, crowded conditions to be physically and mentally challenging, and catastrophic outcomes due to poor crowd control, fire, structural collapse, or violence [2, 4].

Ideally, you should seek pre-travel tailored advice 4-6 weeks before travel, although last minute advice is still helpful if travel is not planned.

Before travel

Take time to prepare for safe and healthy travel. Before travelling to a mass gathering check our Country Information pages

For guidance on safety and security, follow advice from the Foreign, Commonwealth & Development Office (FCDO).

If you have any pre-existing physical or mental health conditions, discuss your planned trip with a health professional before travel. Some mass gatherings can be physically challenging, for example Hajj and Arbaeen; you should be fit to travel and participate. If you are pregnant or have a pre-existing health condition that is not well controlled, you should carefully consider your plans to attend a mass gathering [4].

Make sure you get comprehensive medical insurance, covering repatriation, pre-existing medical conditions and all planned activities, before you attend a mass gathering.

Pack a first aid kit appropriate for your destination, planned activities and any pre-existing medical issues. If you are travelling with medicines, carry a doctor's letter and copy of all prescriptions; ensure that you have sufficient medications for the duration of your trip

Outbreaks of infections that can be prevented by vaccination have been reported at mass gathering events, including measles, flu, hepatitis A, mumps, and meningitis [5, 6].

Check you are up to date with all vaccinations in the routine UK immunisation schedule.

Consider other recommended vaccines for the country you are travelling to, using our Country Information pages. There may be a vaccine certificate requirement for your trip. Proof of vaccination is a requirement for some mass gatherings, for example, meningitis ACWY vaccine is a visa requirement for those planning to travel to Saudi Arabia to perform Hajj or Umrah.

During travel

Mass gatherings happen for many different reasons and risks to health are not always the same. Following are some general precautions that can help you reduce your risk of travel-related health problems.

Outbreaks of infections including flu, norovirus, measles, hepatitis A, and meningitis have been reported during and after mass gatherings and have sometimes caused international spread of infections like meningitis [2, 5]. Crowding, shared accommodation and prolonged exposure to infected people means that infections can spread quickly during mass gatherings, particularly respiratory and gastrointestinal (gut) infections [6]. Do not travel if you are acutely unwell. This is to avoid passing infections on to others and to safeguard your own health [2].

The UK Health Security Agency have produced guidance about living safely with respiratory infections, including COVID-19 and flu. This advice stresses the importance of good hand hygiene, covering your mouth and nose when sneezing/coughing and wearing a face covering if unwell or in contact with someone who is unwell.

It is difficult to avoid all gastrointestinal (gut) infections, but precautions for safe food and water hygiene should be followed [7]. Wash your hands regularly, especially after using the toilet and before eating or preparing food. Hand sanitizers can be used when soap and water is unavailable. However, they are not as effective as hand washing against certain infections [8].

Food should be cooked, peeled, or cleaned. Water must be disinfected in some destinations by boiling, filtering, or using suitable chemical disinfectants [8]. Be prepared to manage the symptoms of travellers' diarrhoea.

Infections spread by exposure to blood or bodily fluids, such as hepatitis B, may be a concern at some mass gatherings events. Avoid unprotected sex; and use appropriate protective precautions where contact is unavoidable; avoid tattooing, piercing and acupuncture. Do not share needles or shaving equipment. There is a hepatitis B vaccine for those at increased risk, but there are no vaccines to protect against hepatitis C or HIV.

Mass gatherings are likely to be crowded; overcrowded conditions may lead to panic and stampedes, with the possibility of crush injuries or deaths [2]. Be aware of your surroundings; make sure you are familiar with emergency exits; and preplan a meeting place if you are travelling with others in case you get separated [9].

Be prepared to manage crowded conditions; make sure you are wearing well-fitting shoes, keep your hands up in front of your body, try to stay upright, go with the crowd, and do not hurry or stop to pick up anything [9].

Crowds can trigger or make existing mental health conditions worse [4]. Be aware of the location of medical assistance stations and seek advice from a health professional if you become ill or injured during the event or experience any significant psychological distress [3, 9].

Mass gatherings occur in a variety of destinations and environmental conditions should be considered [10]. For example, daytime temperatures in Saudi Arabia during Hajj can be very high, particularly in the summer, increasing your risk of heat exhaustion, dehydration, and sunburn [10, 11]. Protect against the sun and extreme heat.

Insect/tick spread infections, including dengue, malaria and Zika may be a concern at some mass gatherings. In 2015, a total of 941 confirmed malaria cases were recorded at the Grand Magal of Touba mass gathering in Senegal [12]. For destination specific advice, check our Country Information pages. If you are planning to visit areas where insect/tick infections are a problem, reduce your risk of infection by following insect and tick bite avoidance advice.

Misuse of alcohol and drugs are reported more commonly at certain mass gatherings, including sporting events and music festivals [3]. The Foreign Commonwealth and Development Office provide country-specific information about rules and customs around behaviour, alcohol and drugs when travelling abroad. Penalties for drug possession can be severe in some countries [13].

Moderate your alcohol intake, avoid alcohol sold in unlicensed places and never accept drinks from strangers or leave a drink unattended [13]. Alcohol can reduce inhibitions and increase the risk of accidents or doing something risky. Carry your own condoms and practice safer sex. If you have symptoms or think you may have been exposed to a sexually transmitted infection (STI) get medical advice and STI screening as soon as possible.

After travel

When you return to the UK, if you have any on-going health concerns or symptoms after attending a mass gathering, get advice from a health professional.

It is important to get urgent medical advice for symptoms like fever, flu-like illness, prolonged or bloody diarrhoea, abdominal pain, or a rash if they appear once you are back in the UK. Remember to tell your doctor, nurse, or other health professional that you have recently travelled abroad, tell them every country you went to and that you visited a mass gathering. Symptoms of malaria can appear up to a year after travel.

Resources

• Centers for Disease Control and Prevention: Travel to Mass Gatherings
• Foreign, Commonwealth and Development Office: Foreign travel advice
• Travel and mental health
• Hajj and Umrah