World Cup is Coming and So Are the Crowds
by Ilan Shapiro, MD, NHHRI Leadership Advisory Board member
The jerseys are pressed, the brackets are printed, and millions of fans from every corner of the planet are converging on stadiums across the United States for the 2026 FIFA World Cup. It is arguably the greatest sporting spectacle on Earth. It is also, from a public health standpoint, one of the most consequential mass gathering events of the decade.
Let that settle for a moment before you reach for your vuvuzela.
When the world gathers, pathogens travel first class. Mass gatherings compress diverse populations into shared air, shared surfaces, and shared enthusiasm — conditions that infectious disease experts spend careers studying and public health systems spend budgets preparing for. The World Cup is not just a tournament. It is a live stress test for global disease surveillance.
Three threats deserve attention in this moment.
Measles leads the conversation. Global vaccination coverage has been slipping since the COVID-19 pandemic disrupted routine immunization programs. Outbreaks have re-emerged across multiple continents. Measles spreads through the air with extraordinary efficiency — an infected individual can expose up to 90% of unvaccinated contacts in a shared space. Fever, cough, runny nose, red eyes, and a characteristic rash are the clinical hallmarks, but the contagious period begins 4 days before the rash appears. If you or your patients do not know their measles vaccination status, now is the time to find out. Two doses of the MMR vaccine remain the gold standard of protection.
Hantavirus warrants a quieter but equally serious mention. Transmitted primarily through contact with infected rodent droppings, urine, or saliva, it does not spread person-to-person, but large outdoor events, temporary housing, and stadium infrastructure can create rodent exposure risks. Early symptoms mimic influenza: fatigue, fever, and muscle aches. Pulmonary involvement can escalate rapidly.
Ebola, while not endemic in the Americas, remains a concern given the international travel profile of this event. Clinicians should maintain an index of suspicion in febrile travelers with relevant exposure histories. Early identification and contact tracing are the cornerstone of containment.
The bottom line for professionals and policymakers is this: the World Cup is an opportunity to celebrate human connection — and to act on what we know about how infections exploit it.
Check vaccination records. Brief your clinical teams. Coordinate with your local and state health departments on surveillance protocols.
The beautiful game deserves a healthy crowd. Make sure yours shows up ready to play.
Ilan Shapiro,MD,MBA, FAAP, FACHEDr. Ilan Shapiro is the Chief Health Correspondent and Medical Affairs Officer at AltaMed Health Services, one of the largest federally qualified health center systems in the United States, where he integrates clinical insight, public health communication, and organizational strategy to expand access to care for diverse communities. In this role, he serves as both a trusted media voice and a strategic leader on health equity issues, regularly providing bilingual guidance on trending health topics and public health priorities to audiences across national television, radio, and digital platforms