As World Cup Fans Flock to the US, Are Public Health Laboratories Prepared?

The 2026 FIFA Men’s World Cup games have been dubbed the biggest sporting event in history. An estimated 6.5 million visitors from around the world are expected to travel through 11 US cities this summer as the country hosts 78 of the World Cup games.  

And those globe-trotting fans are apt to bring with them more than just soccer fever. 

There’s also the potential that Lassa Fever, dengue, chikungunya and other emerging infections, which are far more common in other parts of the world than here, will hitch a ride into the country. Add those pathogens to a long list of expected infections—things like measles, norovirus, Covid, sexually transmitted infections, hepatitis A, influenza and more—and it’s easy to see how the nation’s public health laboratories might become overwhelmed. Are they ready? 

Missouri: Preparation and partnership 

The Kansas City, Missouri, area will host 11 teams, four base camps and six World Cup games. And readiness, says Adam Perkins, laboratory director, State Public Health Laboratory, Missouri Department of Health and Senior Services, comes down to “preparation and partnerships.” 

The preparations, he said, started two years ago and involved multiple state, local and public health partners from a variety of healthcare fields.  

“We started looking at where we might have gaps and how one lab can help another,” Perkins said. “As we started talking, we discovered, for example, that Missouri and some of the surrounding states share a courier service. We realized that, hey, if a specimen was collected here, could we do an interstate transfer to another lab that had the test? And it turns out the answer is yes.” 

Knowing which tests to prepare for based on what parts of the world fans are coming from has proven more challenging, said Perkins. For starters, fans are likely traveling through multiple cities to reach their final destinations, which means they could be exposed to any number of things along the way. What’s more, Kansas City will be home to several games in the “knockout round,” a round teams advance to based on whether they win. “We really have no idea which teams and their fan bases will be represented,” Perkins said. “So, we have to be prepared for everything.”  

“Everything,” said Perkins, includes not only the sort of pathogens seen every day here (influenza, measles, gastrointestinal bugs, etc.), but also those endemic in other parts of the world—things like Middle East Respiratory Syndrome (MERS) and Ebola, for example.  

“MERS is actually a test we brought back with the World Cup in mind,” Perkins said, “thinking we would have travelers from that part of the world visiting our region.” It was also a test recommended by the US Centers for Disease Control and Prevention (CDC) and the US Department of Health and Human Services’ regional partners, Perkins reported. 

Perkins also noted that the lab has boosted its resources. In addition to stocking up on collection kits, media and reagents, the lab has sent prepositioned kits to local public health partners along with instructions on how to collect and handle specimens so samples can be collected quickly and sent to the lab for testing.  

“Getting a quick indication of what’s happening is going to be the most important thing we can do as a public health lab,” Perkins commented. “It helps us put into place what’s next for our epidemiologists, local public health agencies and healthcare systems and the overall public health response.” 

New York City: Perpetual preparedness 

The New York City metro area will be home to eight World Cup games, including the final on July 19 that could bring up to two million fans into the region. 

Like Missouri, New York City has beefed up its supplies, obtaining additional tests, reagents and collection kits for everything from E. coli to Ebola. And like Missouri, “We have to prepare for everything,” said Adam Szczerba, director of laboratory operations, New York City Department of Health and Mental Hygiene (NYC DOHMH), Division of Disease Control, Public Health Laboratory. “The final game will be played here and, theoretically, it could be any of the 48 teams playing. We really don’t know where the fans will be coming from.” 

To help them “prepare for everything,” the NYC DOHMH has implemented an Incident Command System (ICS) that meets at least weekly to discuss not only the current health situation, but also how to handle various hypothetical scenarios—everything from the detection of polio in wastewater sampling to tracing passengers who may have been exposed to MERS on a flight. The laboratory has also conducted training sessions with local hospital representatives; disseminated information to partners on how to order tests and submit samples; updated guidance documents and posted them on its website; and met with its courier service to discuss how an influx of tests will be transported.  

“We’re always in a state of perpetual preparedness,” said Victoria Ruiz, PhD, chief of biothreat response at the New York City Public Health Laboratory. “What we’re doing now is fine-tuning our communication between divisions, bureaus, units and partners. We’re communicating more frequently to ensure we’re all on the same page.”  

To reinforce that perpetual preparedness, Ruiz says certain staff are cross-trained in different laboratory methods and procedures so any surge in testing can be accommodated. “For example, we have someone from our environmental lab whose day-to-day work is testing beach water, but that person is also trained in botulism and environmental white powder testing,” she explained. “We also have people in our respiratory division who can conduct biothreat testing. This is something we have in place all the time, but we’ve just honed it for the World Cup. For instance, when you think of surge testing, you might not think of the accessioning process, but because of the World Cup, we worked with other units and developed a plan that supports accessioning if we get a surge in testing.” (Accessioning is the process of receiving, logging, labeling and otherwise preparing samples for testing.) 

“Basically,” added Szczerba, “we hope for the best and prepare for the worst.” 

Philadelphia: On-the-ground testing 

Philadelphia will host six World Cup games, including one on July 4 when the city will already be bursting at the seams with revelers celebrating the nation’s 250th birthday.  

Not far from Philadelphia Stadium, where the games will be played, laboratory scientists from the city’s department of public health will work in a 53-foot modular trailer that will be equipped with the BioFire Global Fever Special Pathogens Panel. This nucleic acid test can detect a variety of highly contagious pathogens, including Ebola, Lassa Fever, dengue and Marburg, in less than an hour.  

Those kinds of speedy results are essential when it comes to mounting a quick public health response and curbing dangerous outbreaks. What’s more, conducting the testing in a self-contained trailer away from the main laboratory, said Bernadette Matthis, laboratory director, Philadelphia Department of Public Health laboratory, helps ensure a higher level of safety and protection when working with these high-consequence organisms. 

While the trailer wasn’t brought on for the World Cup, per se, the lab did speed up its procurement and build-out so it would be ready for the games.   

“With the trailer, we will increase functionality and the ability to provide broader support to respond to infectious diseases,” Matthis said. “We’re also looking forward to working with the state public health laboratory, APHL and CDC to level up from a Laboratory Response Network for Biological Threats (LRN-B) sentinel lab to an LRN-B reference lab in the near future.” 

LRN laboratories are capable of responding to biological and chemical threats as well as other public health emergencies. An LRN-B sentinel lab provides routine diagnostic services and the rule-out or referral of a sample to an LRN-B reference lab for further testing. 

Santa Clara County: “We don’t get ready, we stay ready” 

For Brandon Bonin, DrPH, laboratory director of the Santa Clara County Public Health Laboratory, it’s business as usual. Six games will be played in the county’s Levi Stadium, and Bonin says his lab is ready “for pretty much anything thrown at us.”  

Bonin credits his laboratory’s preparedness to being one of the country’s several dozen LRN labs. 

“We’re not bringing on any new testing,” Bonin said. “We’re an LRN lab and also a viral hemorrhagic fever testing laboratory, so we feel pretty prepared for what we’re going to see.”  

One of the things he’s worried about seeing is an influx of measles cases. But if there’s an outbreak that tests their limits, Bonin says his lab will call on partner laboratories to help support the additional testing.  

“We will have people coming into the area from countries where measles vaccination rates are much lower than in the US,” Bonin explained. “And with measles being one of the most contagious infections on the planet, I think that’s one of our biggest concerns. But we’re not really doing anything different than we normally do. As an LRN lab, we don’t get ready, we stay ready. And if something gets out of hand, we can lean on our partner labs to help with surge capacity. We’re well-positioned for just about anything.”