The World Cup is presenting a unique challenge for public health officials. Dozens of teams from around the globe — along with millions of their dedicated fans — will descend on major U.S. cities in the coming weeks.

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It’s the largest in FIFA history, with 39 teams setting up training camps in the United States. The first match in this country will be June 12 in California, with the last match more than a month later, on July 19, in New Jersey.

The scale is unlike that of the Super Bowl or even the Olympic Games, which are generally limited to one city and a shorter time frame. Soccer enthusiasts tend to travel en masse with their teams from city to city for the matches.

Inevitably, some will either arrive ill or get sick along those travels.

Despite the ongoing outbreak in the Democratic Republic of the Congo and increased scrutiny on incoming passengers from affected areas, experts say the chances that Ebola would spread at World Cup games or viewing parties are extremely slim. Ebola transmission isn’t respiratory; it’s spread through direct contact with an infected person’s bodily fluids. Healthcare personnel and caregivers are most at risk for exposure.

A more likely virus to spread is the extremely contagious measles, which is causing several large outbreaks around the U.S.

“I would not be surprised if we saw a measles outbreak linked to the World Cup,” said Andrew Pekosz, a virologist at the Johns Hopkins Bloomberg School of Public Health. “Crowds are an ideal place for measles virus to spread.”

It takes up to 14 days for the measles rash to appear, so an outbreak before the tournament ends is possible. Because the incubation period can last up to three weeks, foreign fans could potentially be exposed while in the U.S. and bring the virus back to their home countries.

Some matches will be played in Mexico and Canada, which are also dealing with thousands of measles cases. The Pan American Health Organization is urging health officials in host cities to boost surveillance of measles outbreaks even before the games begin.

Dr. Marcus Plescia, director of the Fulton County, Georgia, Board of Health, which includes Atlanta, said his staff members have been preparing for months, making certain they have an adequate supply of vaccines and immunoglobulin injections, which can be given in some cases after an exposure. “I have specifically asked our staff to have a plan for measles if there were an outbreak,” he said.

The team has gone over a slew of scenarios: What if a visitor tests positive for measles, for example? How would or could health officials make that traveler and their friends and family stay isolated in hotel rooms, especially if they’re not U.S. citizens?

“Measles is tricky,” Plescia said. “It’s possible people might come here for the World Cup and get exposed, but they might not actually go back to their home countries before they get sick.”

Other potential disease spread

Flu and Covid levels are in a summer lull in the U.S. But it’s winter in some parts of the Southern Hemisphere. “There’s a fairly good possibility that influenza-infected people might be coming from that area, and that we’ll see respiratory infections that we’re not used to seeing in the summer,” Pekosz said.

And what if those travelers bring an illness that U.S. doctors rarely see, such as malaria or dengue fever? “It may take a little bit more time to diagnose people” with these diseases, Pekosz said. “Therefore treatments aren’t put into place as quickly as they would be if a person were in their native country.”

Even higher on the infectious disease radar are nasty stomach bugs such as norovirus and rotavirus that can spread with contaminated or spoiled food.

“The public health agencies in the cities that are hosting World Cup games are in charge of making sure that all of the food that is served is served safely,” Plescia said. His team is tasked with daily inspections of temporary vendors and food trucks stationed at festivals and other community events. “That’s actually the biggest lift for us.”

The Centers for Disease Control and Prevention is finalizing a dashboard geared toward local and state public health officials, with more than 30 staffers assigned to monitor wastewater levels and assist local public health authorities with tracking. About 170 others are on standby if states need help with an outbreak or other major health problem related to the games.

Separately this past week, Georgetown University and MedStar Health in Washington, D.C., launched a Health Security Operations Center to collect and analyze health data related to World Cup games nationally — including wastewater detections, electronic health record data that’s been scrubbed of personal information and real-time information from emergency personnel.

“If, suddenly, there’s a cluster of people who show up at an emergency department with nausea, vomiting and diarrhea, you would be looking to see if you could coordinate that with wastewater data that demonstrated, say, an outbreak of norovirus,” said Dr. Ethan Booker, chief medical officer for telehealth at MedStar Health and vice president of care innovation at the MedStar Institute for Innovation.

Rebecca Katz, director of Georgetown University’s Center for Global Health Science and Security, said the team will also monitor mobility data — watching as throngs of fans move from one city to the next — and offer regular situation reports and a daily briefing. Both will be available to the public.

Booker said all the preparations for potential issues should be reassuring to the public.

“I want people to come to the U.S. and have a blast and support their teams and feel that sense of community,” he said. “If we do the job well, people don’t see it, and that would look like success.”