Host cities prepare health plans for World Cup crowds

Millions of World Cup fans are expected to pack stadiums, fan festivals and city streets across the United States, Canada and Mexico, creating a public health challenge that officials say will test disease surveillance, food safety systems and heat planning across a continent.

The tournament starts June 11 and includes 104 matches across 16 cities through mid-July, NPR reported. In the United States, the first match is scheduled for June 12 in California, with the final more than a month later, on July 19, in New Jersey, according to NBC News. Thirty-nine teams will set up training camps in the United States, making this the largest World Cup in FIFA history.

Unlike the Super Bowl or many Olympic Games, which are usually concentrated in one city and shorter in duration, the World Cup will draw fans moving from city to city with their teams. Public health officials say that raises the odds that some travelers will arrive sick, become ill during the event or carry infections elsewhere.

Measles is a leading concern. The virus is highly contagious, and several large outbreaks are already occurring in the United States. Canada and Mexico are also dealing with thousands of measles cases, and the Pan American Health Organization has urged host cities to increase surveillance before the tournament begins.

“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.”

Measles symptoms can take time to appear. The rash may not develop for up to 14 days, and the incubation period can last up to three weeks, meaning fans could be exposed in the United States and return home before becoming sick.

In Fulton County, Georgia, which includes Atlanta, health officials have spent months preparing. Atlanta will host eight matches and the Uzbekistan team, while a fan festival at Centennial Olympic Park is expected to draw about 15,000 people a day. Cooling stations will provide air conditioning and hydration.

“We call Atlanta ‘Hotlanta’ for a reason,” said Dr. Marcus Plescia, director of the Fulton County Board of Health. “It’s going to be hot and humid here — so heat-related injuries are going to be an issue.”

Plescia said his department has also planned for measles exposure scenarios and stocked vaccines and immunoglobulin injections, which can be used in some cases after exposure. “I have specifically asked our staff to have a plan for measles if there were an outbreak,” he said. “Measles is tricky.”

Food safety is another major task. Temporary vendors and food trucks at festivals and community events will need daily inspections. “That’s actually the biggest lift for us,” Plescia said.

Dallas, which will host nine matches, is expanding wastewater surveillance and mosquito monitoring. Dr. Philip Huang, director of Dallas County Health and Human Services, said the county will test not only for influenza and COVID-19, but also use genomic sequencing for “whatever might appear.” Mosquito testing will include West Nile virus, dengue, chikungunya and Zika.

Officials are also watching for respiratory infections, stomach bugs such as norovirus and rotavirus, and illnesses more common abroad, including malaria and dengue fever. Ebola is under scrutiny because of an outbreak in the Democratic Republic of the Congo, but experts told NBC News the risk of spread at games or viewing parties is extremely low because Ebola spreads through direct contact with bodily fluids, not through the air.

The Centers for Disease Control and Prevention is finalizing a dashboard for state and local public health officials, with more than 30 staff members monitoring wastewater and helping with tracking. About 170 others are on standby if states request help with an outbreak or major health problem tied to the games.

NPR reported that some local officials see a diminished federal role compared with past international events. The Department of Health and Human Services told NPR that HHS and the CDC are “actively coordinating with state, local, and global partners to ensure public health and safety during FIFA World Cup 2026 and enhance any measures, as needed.”

Georgetown University and MedStar Health have launched a Health Security Operations Center to analyze data from wastewater, emergency personnel and de-identified health records. Dr. Ethan Booker of MedStar said officials could use those signals to detect clusters such as norovirus. “If we do the job well, people don’t see it, and that would look like success,” he said.