Epidemic Surveillance at a Psytrance Festival in Portugal - An Example to Set the Standard

Summary: The National Health Institute Ricardo Jorge (INSA), in collaboration with the Local Health Unit of Castelo Branco (ULSCB) and local authorities, implemented comprehensive epidemiological surveillance during the BOOM Festival 2023, held from July 20-27 in Idanha-a-Nova, Portugal. This multidisciplinary psytrance festival, attracting around 40,000 attendees from 169 countries, presented unique public health challenges due to high interpersonal contact, diverse international attendance, and temporary accommodation facilities that increase the risk of infectious disease transmission, injuries, and substance-related incidents. The primary goal of this collaboration was the early detection and timely response to health risks. Real-time health monitoring was conducted using data collected from the “Boom Medical Service” field hospital, the Kosmicare facility (dedicated to psychological care), and ULSCB (Local Health Unit of Castelo Branco) units, including the Idanha-a-Nova Health Center and Hospital Amato Lusitano. A daily report compiled health data, analyzed trends, and identified emerging risks, which was then shared in briefings with key stakeholders, including civil protection, law enforcement, and festival organizers. The epidemiological team comprised 17 members, including public health physicians, general practitioners, EUPHEM program microbiologists, and medical students. Key observations included a notable increase in gastrointestinal complaints, prompting further investigation into potential exposures. Surveillance data revealed various health issues, such as wound care (33.1%), altered consciousness (10.7%), musculoskeletal complaints (12.4%), ENT problems (7.7%), and gastrointestinal issues (6.0%). The festival setting demonstrated the importance of real-time surveillance, integrated health responses, and multidisciplinary collaboration to safeguard public health at mass gatherings. These measures emphasize the need for adaptable strategies and ongoing evaluation to optimize health interventions in similar high-risk environments. This experience also highlights the role of public health in mitigating risks while promoting safer, enjoyable events.