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EUROPEAN NETWORK OF INFECTIOUS DISEASE PHYSICIANS
EU contract No:2003207
FINAL REPORT
Period from 6/15/2004 to 6/14/2007
____________________
Date
____________________
Signature Dr. Giuseppe Ippolito Scientific Director and Project Leader
National Institute for Infectious Diseases
IRCCS Lazzaro Spallanzani
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GLOSSARY EUNID European Network of Infectious Diseases physicians
HIDs Highly Infectious Diseases
HIUs High Isolation Units
EU European Union
PPE Personal Protective Equipment
HCWs Health-Care Workers
IT Information Technology
INMI Istituto Nazionale per le Malattie Infettive (National Institute for
Infectious Diseases)
E-CDC European Centres for Disease Prevention and Control
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EUNID MEMBERS AND PARTICIPANTS
The EUNID Coordination Team, Istituto Nazionale per le Malattie Infettive (INMI), “Lazzaro
Spallanzani”, Rome, Italy
Giuseppe Ippolito, Scientific Director Project leader
Vincenzo Puro Scientific adviser
Emanuele Nicastri National official
Francesco Maria Fusco Project coordinator (from 1/10, 2006 to 15/6, 2007 )
Fabio Soldani Project coordinator (from 1/4, 2006 to 30/9, 2006)
Andra Stoler Project coordinator (from 15/7, 2004 to 31/12, 2005)
Ramona Iacovino Project secretary
Lorena Fiorentini Financial administrator
Raffaele Colantoni Web designer
Fabrizio Latrofa IT support
Co-opted experts
Julia Heptonstall UK
Agoritsa Baka Greece
Philippe Brouqui France
(Simon Mardel UK)
EUNID National officials * and representatives
Austria
Norbert Vetter *, Otto Wagner Spital, Interne Lungenabteilung, Vienna
Reinhild Strauss, Generaldirektion Öffentliche Gesundheit, BM für Gesundheit und Frauen, Vienna
Belgium
Renaat Peleman *, University Hospital Ghent, Dept Internal Medicine, Division Infectious
Diseases, Ghent
Koenraad Vandewoude, University Hospital, Ghent
Denmark
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Peter Skinhoj *, Epidemiklinikken Rigshospitalet, Copenhagen
Ida Gjorup, Merlev Hospital - Med. Dept. Q, Merlev
Estonia
Kristi Ott*, West Tallinn Central Hospital, Centre for Infectious Diseases, Tallinn
Kuulo Kutsar, West Tallinn Central Hospital, Centre for Infectious Diseases, Tallinn
Finland
Heli Siikamaki *, Central Hospital, Helsinki University, Division Infectious Diseases, Aurora
Hospital, Helsinki
Outi Lyytikainen, National Public Health Institute, Infectious Disease Epidemiology, Helsinki
France
Philippe Bossi *, Hospital Pitié-Salpetrière, Service de Maladies Infectieuses et Tropicales, Paris
Christian Perronne, Hospital Pitié-Salpetrière, Service de Maladies Infectieuses et Tropicales, Paris
Germany
Hans-Reinhard Brodt *, Klinikum der Johann Wolfgang Goethe Universitaet, Med Klinik III/
Infektiologie, Frankfurt
René Gottschalk, Office of Public Health, Frankfurt
Greece
Marios Lazanas *, Erythros Stavros-Red Cross Hospital, Athens Dimitrios Iliopoulos, Hellenic
Centre for Infectious Disease Control, Athens
Helena Maltezou, Hellenic Centre for Infectious Disease Control, Athens
Ireland
William Powderly *, University College of Dublin, Mater Misericordiae Hospital, Dept of Med,
Therapeutics & Infectious Diseases, Dublin
Gerard Sheehan, University College of Dublin, Mater Misericordiae Hospital, Dublin
Italy
Emanuele Nicastri *, National Institute for Infectious Diseases, Rome
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Luxembourg
Robert Hemmer *, National Service of Infectious Diseases, Centre Hospitalier de Luxembourg,
Luxembourg
Netherlands
Andy IM Hoepelman *, Netherlands University Medical Center, Acute Medicine & Infectious
Diseases, Utrecht
Portugal
Kamal Mansinho *, Hospital de Egas Moniz, Infectious Disease and Tropical Medicine Service,
Lisbon
Spain
Antoni Trilla *, Hospital Clinic Universitat de Barcelona, Unitat de Suport i Prevencio', Barcelona
Magda Campins Marti, Hospital Clinic Universitat de Barcelona, Barcelona
Sarah Lafuente, Hospital Clinic Universitat de Barcelona, Barcelona
Sweden
Per Follin *, Swedish Institute for Infectious Disease Control, Solna
Boo Jarhall, Swedish Institute for Infectious Disease Control, Solna
Anders Tegnell, National Board of Health and Welfare, Stockholm
United Kingdom
Barbara Bannister *, Royal Free Hospital, Infection & Immunity Division, London
Robert Heyderman, University of Bristol, Dept. of Pathology and Microbiology, Bristol
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EUROPEAN NETWORK OF INFECTIOUS DISEASE PHYSICIANS (EUNID)
FINAL REPORT, SEPTEMBER 2007.
1. SUMMARY
The European Network of Infectious Diseases Physicians (EUNID) was a pan-
European network of infectious disease clinicians with experience in the management of highly
infectious diseases (HIDs) and/or high isolation units (HIUs). Sixteen Member States were involved
in the project (the original 15 Member States of European Community, plus Estonia). EUNID was
managed by the coordination team, based at the National Institute for Infectious Diseases (Istituto
Nazionale per le Malattie Infettive, INMI), “Lazzaro Spallanzani”, Rome, Italy. The main aims of
EUNID were to promote and substain co-operation, communication, and sharing of data and
expertise on HIDs among infectious disease clinicians, with the final aim to enhance preparedness
within European countries to health threats from HIDs, both those naturally occurring, newly
emergent, and deliberately released. The project started in June 2004 and finished in June 2007.
According to the aims and objectives of the project, the following results have been
reached and adequately disseminated:
• a definition of HID and a list of disease that fulfil the definition;
• a complete archive of existing national and international guidelines on the management of
HIDs;
• an inventory of isolation facilities existing in participating countries, including technical and
logistic characteristics;
• a list of physicians experts in infection control, isolation and management of patients with
HIDs in participating countries, including personal contacts;
• an agreement on best practices in infection control issues, with special focus on PPE
selection, donning and removal for each HID, both for standard and high-risk situations;
• indications on specific medical procedures (intensive care procedures, bronchoscopy,
gastroscopy, imaging exams - CT scan and RMI, Chest X rays and Ultrasound -, renal
dialysis and post-mortem examination) that could be performed in patients affected by
HIDs, and on criteria for patient’s admission in HIU;
• an agreement document on specification for HIUs/referral centres for the management of
HIDs, including logistic issues, technical features and staff management items;
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• an agreement on a core-curriculum for physician involved in the management of patients
with HIDs, and a training module based on it;
• the construction and maintaining of a part-public and part-private web-site for the
dissemination of project results to general public and for the sharing of drafts and documents
among project members in the private part.
2. BACKGROUND
In recent years, attention has been increasingly focused on threats to health security,
including those that might be caused by emerging infections or by deliberate release of biological
agents. Many events, such as the emergence of SARS in 2003, bioterrorism-related and pandemic
threats, suggest that a global preparedness is needed to face these new challenges.
The European Commission (EC), in the 2003-2008 programme for Community action
on public health, specifically recognises the need to improve capacity to respond rapidly and in a
coordinated fashion to public health threats. Key priorities of the 2007 Work Plan included the
promoting of “cooperation among Member States through platforms and networking”. In particular,
EC included in the 2003 Work Programme a specific section requiring the “development of the
collaboration between isolation units and of treatment facilities for biological attacks” (section
2.3.3.7).
The European Network of Infectious Disease physicians (EUNID) was a pan-
European network of infectious disease clinicians with experience in the management of highly
infectious diseases (HIDs) and/or high isolation units (HIUs). The network was formed in response
to the specific section 2.3.3.7.
The main aims of EUNID were to enhance and maintain co-operation,
communication, and exchange of information on HIDs among infectious disease clinicians, with the
final aim to enhance preparedness and response within Europe to health threats from HIDs, whether
naturally occurring, newly emergent, or deliberately released. The project started in mid 2004 and
finished in mid 2007.
EUNID members were experts in their fields, and came from different background. All had
extensive experience in the different aspects of HIDs. Moreover, some co-opted experts
collaborated with the Coordination Team in specific scientific aspects.
This is the final EUNID project report, covering the whole period from 15 June 2004 to 14
June 2007, with special focus on the 3rd year of activity (June 2006 – June 2007).
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3. ACTIVITIES
3.1 Network organisation and administration
The network was led by the project leader (Dr G Ippolito) and managed by the
EUNID coordination team, which consisted of the project leader, scientific coordinator, project
coordinator, project secretary, a web-designer, and IT and financial administration support staff, and
was based at the National Institute for Infectious Diseases (Istituto Nazionale per le Malattie
Infettive - INMI), “Lazzaro Spallanzani”, Rome. The EUNID coordinator, secretary, and web
designer were recruited specifically for the project.
Some co-opted experts advised and assisted the coordination team on medical and
scientific aspects of the project. Their major activities were: (1) to review and help guide the goals
of EUNID (2) to review and edit the EUNID management reports (3) to review and edit the EUNID
questionnaires, and (4) to assist with the scientific contents of the EUNID meetings, including
selection of speakers.
EUNID involved 30 national officials and national representatives from 16 Member
States: (Austria [AU]; Belgium [B]; Denmark [DK]; Estonia [EL]; Finland [FIN]; France [F];
Germany [D]; Greece [GR], Ireland [IRL]; Italy [I]; Luxembourg [L]; Netherlands [NL]; Portugal
[P]; Spain [E]; Sweden [S]; United Kingdom [UK]). Most members are infectious disease
clinicians, but the group also covers expertise from public health and epidemiology to emergency
preparedness, pulmonary medicine, microbiology, infection control, and critical care medicine. All
of the infectious disease clinicians are associated with a national (or regional) infectious disease unit
designated for the care of patients with HIDs, including four (from units in Frankfurt, Rome, Solna,
and London) who are closely involved in the management of an HIU.
The coordination team explored in the first year the possibility of expanding the
network to include representatives from designated national (or regional) infectious disease units in
all member states, candidate countries, and EEA/EFTA countries, and, with the help of the
European Commission had identified possible national officials in Bulgaria, the Czech Republic,
Hungary, Latvia, Lithuania, Malta, Poland, Slovakia, Slovenia, and Turkey. National officials from
Bulgaria, Malta, Poland and Slovenia, thanks to the contacts established during the drafting of
EUNID enlargement proposal, are now members of a new project, EuroNHID (European Network
for Highly Infectious Diseases), accepted for co-funding from EC (Grant Agreement n° 2006205),
which will continue and reinforce the work of EUNID in the years 2007-2010.
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3.2 Communication and links with other project with convergent interest
Besides internal communication and exchange of data and experiences among project
participants, the coordination team has established links with other EU networks with convergent
interests: ENIVD (European Network for diagnosis of Imported Viral Disease), Euronet P4
(European Network of P4 laboratories), ETIDE (European Training for Infectious Diseases
Emergencies) and ETHREAT (European training for health professionals on rapid responses to
health threats). Reciprocal links between the networks’ websites are planned. Contact has also been
established with the E-CDC. A representative from E-CDC, Dr. Denis Coloumbier, participated to
EUNID second meeting, giving a presentation about E-CDC activities and possible fields of
collaboration with EUNID. During the third year of activities, a link with members of the US
Consensus Conference on Designing Biocontainment Units has been established, and the first
member of this group, Prof. P. W. Smith (Medical Director, Bio-containment Patient Care Unit,
University of Nebraska Medical Center) attended and actively participated in the 3rd EUNID
meeting.
3.3 EUNID methodology During the 3 years, many methodologies have been used in order to achieve the deliverables
of the project.
Two main questionnaires were used to collect information from members states.
The first EUNID questionnaire was designed to gather information about: (1) the definition
of HIDs (2) patient isolation requirements, infection control precautions and personal protective
equipment (PPE), and national guidelines for six selected diseases (smallpox, tuberculosis, viral
haemorrhagic fevers, SARS Co-V infection, pneumonic plague, and pulmonary anthrax) (3) the
location, design, and maintenance of HIUs in EUNID countries including some technical features of
HIUs. (4) the healthcare personnel trained to work in HIUs in EUNID countries (5) the numbers
and final diagnoses of patients treated in HIUs in EUNID countries in 2003. National officials from
14 of 16 countries completed and returned the questionnaire.
A second questionnaire was drafted to collect data on training programmes in the EUNID
countries for HCWs involved in the care of patients with suspected/probable/possible HIDs.
Moreover, the questionnaire asked for partners’ opinion on the main topics that should be included
in a training programme for such HCWs. National officials from 9 of 16 countries answered to this
questionnaire.
In addition to the drafting and dissemination of these questionnaires, a “networking
strategy” was used to reach the project deliverables. Each deliverable has been committed to a
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member of the coordination team or to a co-opted expert or to a national official with specific
expertise in the topic. Persons committed for each deliverable performed a review of existing
literature, sent drafts and preliminary results to the project coordinator, who disseminate all the
material to national officials and their representatives, stimulating suggestions and amendments. All
the comments were forwarded to the committed person for the specific topic, who revised the draft
considering comments from the partners. Usually a final agreement has been reached during the
work groups and meetings, but in some cases the definitive approval of a document has been
obtained after e-mail and phone contacts.
Please find listed in the table 1 the main methodologies used for each deliverable.
Table 1 – Summary of committed persons and methodologies used for each deliverable
Deliverable
(see below) Committed Person Methodologies
4.1 All members involved Data from questionnaire, discussion at meetings
4.2 Coordination team Data from questionnaire, review of literature, e-mail and
personal contacts, discussion at meetings
4.3 Coordination team Data from questionnaire, e-mail and personal contacts,
exchange of drafts and comments, discussion at meetings
4.4 Coordination team Discussion at the meeting, e-mail and personal contacts
4.5 Vincenzo Puro Data from questionnaire, review of literature, discussion at
meetings
4.6 Philippe Brouqui Review of literature, discussion at meetings, exchange of
drafts and comments
4.7 Barbara Bannister,
Julia Heptonstall
Data from questionnaire, discussion at meetings, review of
literature, exchange of drafts and comments
4.8 Agoritsa Baka, Julia
Heptonstall
Data from questionnaire, discussion at meetings, review of
literature, exchange of drafts and comments
4.9 Coordination team
4.10 Not performed Not performed
3.4 EUNID meetings
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The meetings represented, during the 3-year-long project, the main occasions for sharing
experiences and knowledge. The participation has always been numerous and active. In each
meeting some national officials or their representatives gave a little presentation showing the
isolation facilities of their countries and the policies for management of patients with
suspected/probable/confirmed HIDs.
The first meeting was in Rome, on May 27-28, 2005, and was attended by national officials
and national representatives from 13 of the 16 states involved in EUNID. As co-opted experts, Dr.
Julia Heptonstall from UK and Dr. Agoritsa Baka from Greece were present. In that occasion, the
participants reviewed the results of the first questionnaire and agreed that a revised questionnaire
would be prepared from coordination team in consultation with national officials and
representatives. The main results of the first meeting included the agreement about a working
consensus definition of ‘a highly infectious disease’ and a working list of relevant agents. National
officials from the Netherlands, Germany, Sweden and United Kingdom presented their facilities and
national strategies for isolation and management of patients with HIDs. During the meeting,
participants discussed about criteria for patient’s admission in the HIUs, about selection, donning
and removal of PPE, and about the inventory of isolation facilities in European countries, but final
agreement on these points was postponed to next year of activities. Finally, a strategy for the rapid
fulfilment of EUNID guidelines archive was decided.
The report of the first meeting is attached at the present document as Annex 1. The report of the
first meeting has been disseminated and can be read by all users on the EUNID website
(www.eunid.com) in the folder “Documents”, after registration.
The second EUNID meeting was held in London, on April 7-8, 2006. and was attended by
national officials and national representatives from 13 of the 16 countries. As co-opted experts, Dr.
Julia Heptonstall from UK and Dr. Agoritsa Baka from Greece were present. Dr. Denis Coulombier
from E-CDC gave a presentation about E-CDC activities. The main accomplishments of this
meeting included:
a final agreement, after a long discussion on selection, donning and removal of PPE to be
used giving care to patients with suspected/probable/confirmed HIDs;
a final agreement, after a long discussion on the Core-Curriculum and the training modules
for the HCWs involved in the care of such patients.
An update of data collected for the inventory of Isolation Facilities in European countries was done,
and an extensive discussion was done about technical and logistic specification for HIUs, criteria
for patient’s admission in HIUs and management of specific medical procedures in HIUs.
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Moreover, national officials from Denmark, Estonia, Finland, Ireland and France presented their
facilities and national strategies for isolation and management of patients with HIDs.
The report of the second meeting is attached at the present document as Annex 2. The report of the
second meeting has been disseminated and can be read by all users on the EUNID website in the
folder “Document”, after registration.
The third EUNID meeting was held in Rome, on May 24, 2007. National officials and
national representatives from 11 of the 16 countries attended the meeting. Among co-opted experts,
Dr. Philippe Brouqui from France was present. Moreover, Dr. Philip W. Smith, head of
Biocontainment Patient Care Unit of the University of Nebraska Medical Centre, USA, and Dr.
Michael Borg, head of Infectious Diseases Department at St. Luke’s Hospital in Malta (partner in
the next project, EuroNHID) were present.
The EUNID meeting was included in a whole week of events focused on bio-safety, bio-security
and management of HIDs: the final meeting of EuroNET-P4 project (an EC co-funded network of
P4 laboratories in Europe, coordinated by INMI), and a meeting of the GHSAG-Lab (Global Health
Security Action Group – Laboratories) were scheduled in the same week. In the middle of the week
an International Workshop on “Critical Aspects of Highly Infectious Diseases” was organized. Find
attached the programme of the workshop as Annex 3. The presentations of the workshop for which
authorizations have been obtained by the authors, are available on the EUNID web-site for all users,
after registration, in the folder “Documents”. This workshop represented, according to all EUNID
members, an useful event in order to share project’s results and to consult other experts on project’s
still open tasks.
The main results of 3rd EUNID meeting included:
a final agreement, after a discussion moderated by Dr. Bannister and Dr. Smith, on technical
and logistic specifications of HIUs;
a final agreement, after a discussion moderated by Dr. Brouqui, on criteria for patient’s
admission in HIUs;
a final agreement, after a discussion moderated by Dr. Brouqui and Dr. Smith, on
recommendations for some specific medical procedures to be performed in HIUs. The
analyzed procedures have been: endotracheal intubation, broncoscopy, endoscopy, radio-
imaging (CT Scanning and MRI), renal dialysis and post-mortem evaluation.
A strategy for the accomplishment of a “List of experts” in Europe on isolation and infection
control procedures was developed with all the attendants. Moreover, national officials or their
representatives from Belgium, Italy and Spain presented their facilities and national strategies for
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isolation and management of patients with HIDs. Finally, a brief presentation of the next project
EuroNHID was presented.
The report of the third meeting is attached at the present document as Annex 4. The report of
the third meeting has been disseminated and can be read by all users on the EUNID website in the
folder “Documents”, after registration.
3.5 Clinical audits
One of the planned project activity was the visits and the audits, from each national
officials or their representatives, of the other HIUs/referral centres for the management of patients
with HIDs in the country, if any other than their own. But, during the 2nd EUNID meeting in
London, all the project members decided not to perform these planned clinical audits because of
organizational difficulties and lack of adequate funding for travel. Indeed, they judged that reaching
and visiting the HIUs/referral centres personally would be difficult, and above all there was
absolutely no agreement on the method to employ in performing the audits, owing to the lack of
international guidelines for audits in the specific ambit of infectious diseases. Otherwise these
guidelines should have been developed by the partners, requiring a great effort in a too narrow
period of time. The developing of specific checklists for the auditing of HIUs is the first results
planned in the next project, EuroNHID (European Network for Highly Infectious Diseases),
accepted for co-funding from EC (Grant Agreement n° 2006205), which will continue and reinforce
the work of EUNID in the years 2007-2010.
3.6 Dissemination
All the results of the project are currently available for all visitors on the EUNID web-site, after
registration. Moreover, some general aspects and some specific results were disseminated through
posters or oral communications at national and international meetings, or through scientific papers
on journals or scientific bulletins. In particular:
• Articles:
o Baka A., Fusco F.M., Puro V. et al. A curriculum for training healthcare workers in
the management of highly infectious diseases. Euro Surveill 2007;12(6)[Epub June
2007]. Available online: http://www.eurosurveillance.org/em/v12n06/1206-223.asp
o Puro V., Fusco F. M., Ippolito G. Biocontainment patient care units. Biosecur
Bioterror. 2007 Mar;5(1):86.
• Oral Communications:
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o ‘EUNID Consensus on Personal Protective Equipment for Highly Infectious
Diseases in High Isolation Units’. Speaker: Vincenzo Puro. IMED, Vienna, Austria,
February 23-25, 2007.
o ‘Highly Infectious Diseases: evidence for isolation and minimal requirements for
Health Care Settings’. Speaker: Francesco M. Fusco. National Seminar
“Infektionsverhutung bei Kontaktinfektionen sowie aerogen ubertragbaren
Erkankungen”, Vienna, Austria, March 9-10, 2007.
o ‘EUNID project’. Speaker: Vincenzo Puro. International Workshop “Critical Aspects
of Highly Infectious Diseases”, Rome, Italy, May 22-23, 2007.
o ‘Medical procedures in High Isolation Units’. Speaker: Philippe Brouqui.
International Workshop “Critical Aspects of Highly Infectious Diseases”, Rome,
Italy, May 22-23, 2007.
• Posters:
o Baka A. et al. ‘A Core Curriculum for Health Care Workers on Training in
Management of Highly Infectious Diseases’. Presented at International Meeting on
Emerging Diseases (IMED), Vienna, Austria, February 23-25, 2007.
o Fusco F.M. et al. ‘High Isolation Hospital Beds for Patients with Highly Infectious
Diseases: an Inventory of Resources in Europe’. Presented at IMED, Vienna,
Austria, February 23-25, 2007.
o No authors listed. ‘EUNID project’. Presented at Network Corner at 25th
International Congress of Chemotherapy / 17th European Congress of Clinical
Microbiology and Infectious Diseases (ICC/ECCMID), Munich, Germany, March
31-April 3, 2007.
The coordination team, in collaboration with co-opted experts and national officials and/or
their representatives, wish to continue to disseminate the project’s results by publication of articles
and reports on international scientific journals and epidemiological bulletins. Consequently, other
articles are currently in advanced phase of writing.
4. RESULTS and DELIVERABLES
4.1 Definition and specification of HIDs
4.1.1 Main result
The working definition of ‘Highly Infectious Disease’ and the list of agents that cause
infections that satisfy the definition were agreed at the first EUNID meeting, as:
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“ A highly infectious disease is transmissible from person-to-person, causes life-threatening
illness, and presents a serious hazard in health care settings and in the community, requiring
specific control measures.”
and
Viral haemorrhagic fevers (VHF) (marburgvirus, ebolavirus, Crimean Congo haemorrhagic
fever virus, Lassa virus, and South American haemorrhagic fever - Junin, Machupo, Sabia,
and Guanarito) viruses;
SARS Co-V
Multi Drug- and Extensively Drug- resistant (added in 2007) M tuberculosis (MDR- and
XDR-TB, known or suspected infection)
Emerging highly pathogenic strains of influenza virus
Smallpox and other orthopox infections (eg monkeypox, camel pox, but excluding vaccinia
virus)
Other emerging highly pathogenic agents, including agents of deliberate release (eg
pneumonic plague)
It was also agreed that the following agents would not be included in the list of HIDs: Group
A streptococci, Neisseria meningitidis, Clostridium difficile, methicillin resistant Staphylococcus
aureus, pulmonary anthrax, other multidrug resistant (eg GISA) strains of S aureus, other multidrug
resistant organisms (eg vancomycin resistant enterococci), dengue and yellow fever viruses,
measles virus, hepatitis A virus, varicella zoster virus, vaccinia virus, and rabies virus.
4.1.2 Methodology
In the first EUNID questionnaire the following proposed definition was given: “Highly
infectious diseases pose a very high concern because of their potential ease of dissemination or
transmission and high morbidity and mortality”, and a list of diseases (smallpox, tuberculosis,
VHFs, SARS, pulmonary plague, pulmonary anthrax) has been proposed. Coordination team
collected the answers and all the proposed changes were discussed during the first EUNID meeting.
After a long discussion, the group agreed to modify the proposed definition and adopted the
definition reported in the point 4.1.1. The group also agreed that the definition needed to be future-
proof, such that it would encompass newly emergent diseases which might, at least initially, be of
unknown lethality and transmissibility, and flexible enough to be adaptable to advances in
treatment, prevention, and understanding of natural history and epidemiology.
4.1.3 Critical points
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The most important critical point of this deliverable was the difficulty emerged during the
discussion. Indeed, it was very difficult to harmonize EUNID definition with different national
guidelines and with different background of the participating countries. Above all, an extensive
discussion was needed to define the diseases that should be included, especially about tuberculosis
and influenza virus. About tuberculosis some partners do not consider it as “highly infectious”, but
finally MDR-TB (and, later, XDR-TB) was included because it is of concern in many EUNID
countries, particularly Estonia and Austria, and because of wider concern about transmission risks
associated with imported cases from the Ukraine and other countries in the former Soviet Union,
where MDR-TB has become a problem. About influenza, the group recognised that, although
person-to-person transmission of avian influenza H5N1 had not yet been conclusively proven, there
was great concern that the virus might become transmissible, and concurred with WHO that suspect
cases should be managed as though the virus was highly infectious. Finally a agreement on a
general definition of influenza strains that should be included in the definition has been reached.
4.2 Archive of existing national guidelines on isolation and management of patients with HIDs
4.2.1 Main result
EUNID project accomplished an archive of existing national guidelines on HIDs in
participating countries. The archive focuses on national guidelines in the field of management of
HIDs, in particular for smallpox, plague, SARS Co-V infection, tuberculosis, emergent influenza
viruses, and viral haemorrhagic fevers, but it will also include details of guidelines relevant to good
infection control practice. Moreover, relevant international guidelines on infection control have
been included.
So far, 102 links to national documents/guidelines regarding all the participating countries
and 30 links to European and international documents and guidelines are available. Furthermore, 29
hard documents, obtainable from the coordination team, were collected.
These documents are available on www.eunid.com , divided by diseases or by country. For further
details about disseminations see point 3.6.
4.3 Inventory of isolation facilities in EUNID countries
4.3.1 Main result
Complete data are available from Austria, Denmark, Estonia, Finland, Germany, Greece,
Ireland, Italy, Luxembourg, the Netherlands, Sweden, and the United Kingdom, and partial data are
available from Belgium, France, Portugal and Spain.
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For each country, we collected data concerning the following items:
• number of hospitals with rooms equipped with negative pressure and anteroom;
• number of hospital beds available in the rooms equipped with negative pressure and
anteroom;
• number of hospital beds equipped with negative pressure and anteroom in which intensive
care capabilities are available;
• some logistic features of these rooms (position – in a separate building, in a single ward, in
the same ward as other hospital facilities -, direct connection with a BSL 3/4 laboratory
area);
• some technical features of these rooms (number of air changes per hour, way of air-
exhausting, sealing of the rooms).
The whole data gives an exhaustive overview of current isolation capabilities in EUNID countries.
4.3.2 Methodology
Data were mainly collected by questionnaire. In some case, personal contacts, by e-mail or
by phone, were necessary to obtain information. After the collection of all data, the coordination
team wrote a draft report on current capabilities of isolation in European Countries. In this draft,
few sentences describing the isolation capabilities of each country were included. During the second
meeting, each partner agreed to review, update and correct these few sentences. During the third
year of the project, some information were revised and updated, while some missing data from
Belgium, France and Portugal were collected. The complete report is attached at the present
document as annex 5.
4.3.3 Critical points
The complete accomplishment of this deliverable presented some critical points. Indeed, it is very
hard to obtain national data without a national commitment. Sometime, only national authorities are
recognized by the single hospital/institution that should provide data. Moreover, some of the
information that EUNID would like to gather (eg the numbers and locations of all monitored
negative pressure isolation rooms with anteroom) may not be readily available, since this
information is not centrally held, unless an inventory has recently been performed at
national/federal level. Finally, in each country the criteria of collection and registration of these data
is different, and these differences make the collection of well-organized information very difficult.
4.3.4 Dissemination
The inventory of isolation facilities in EUNID countries is available on the web-site, for all
users, after registration, and has been presented through a poster at IMED, and through oral
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communications at national seminar in Vienna and at international workshop in Rome. See point
3.6 for further details.
4.4 Inventory of health care professionals who work in the isolation facilities (list of experts)
4.4.1 Main result
EUNID produced a list of physicians with expertise in infection control and management of
patients with HIDs in participating countries. Experts have been selected on the basis of the core-
curriculum developed by EUNID (see point 4.8 for further details). For each name included in the
list, affiliation, current work position, complete address, phone and e-mail contacts, and main fields
of expertise are indicated.
The accomplishment of a complete inventory of skilled staff (divided in physicians, nurses,
therapists, technicians, laboratory workers and housekeeping staff) trained to care for patients
affected by suspected/probable/confirmed HIDs resulted not possible. Indeed, the differences
among participating countries in recruiting and training staff are considerable (see 4.4.3 for further
details). Consequently, EUNID consortium agreed that, without standardization on training
requirements for the staff involved in the care of patients with HIDs, it is impossible to obtain
harmonized and homogenous data on the number of “skilled” staff.
All EUNID members agreed to change this deliverable into the achievement of a list of
physicians experts in infection control and in the management of HIDs, and agreed to use the
commonly accepted EUNID core-curriculum to select the names to be included. Moreover, EUNID
members agreed to look for a link with E-CDC, in order to integrate the list of experts produced by
E-CDC.
Indeed, in 2006, E-CDC began to produce a list of experts (see E-CDC web-site,
http://ecdc.europa.eu/). According to the web-site, E-CDC is looking for external experts to help the
Centre to develop and maintain its scientific position. The areas of professional background that are
included in the call are: clinical infectious diseases, microbiology, public health, epidemiology,
statistics and/or modelling of infectious diseases, social sciences, medical informatics, scientific
and/or risk communication, programme evaluation, bioterrorism, training in any of the above areas,
and other expertise within the remit of E-CDC. The specific area of infection control, including
isolation and management of HIDs is not included, although it can be considered as incorporated in
some of the previously listed areas. E-CDC requires to physicians who sign themselves as experts
to give a brief curriculum, and to give their availability as scientific advisers or scientific
consultants.
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In order to integrate (and not to duplicate) E-CDC work, EUNID coordination team will
establish contact with E-CDC staff, in order to propose the EUNID list as an integration of E-CDC
list, in the specific field of infection control including isolation and management of HIDs, and to
propose all the name included in the EUNID list as scientific advisers.
The list of expert is attached at the present document as annex 6.
4.4.2 Methodology
See table 1
4.4.3 Critical points
The main critical point is the heterogeneity of criteria of staff recruitment and/or selection.
Indeed, because of lack of standardization in Europe on core-curriculum required for HCWs
selected for giving care to patients affected by suspected/probable/confirmed HIDs, each country
apply its own criteria for staff selection. Consequently, the questions included in the first
questionnaire (number of skilled staff trained to care for patients affected by HIDs) produced a
large variety of different, not-standardized answers, or absolutely no answers. Only in few countries
the staff posted to care for patients with HIDs had been previously specifically trained, and only by
their own hospitals/institutions. In some other countries all the hospital/ward staff is planned to be
involved in the care of such patients. In other country some staff members had been selected, on a
voluntary basis, without specific training. In some other countries, finally, specific plans for staff
selection simply do not exist.
4.4.4 Dissemination
The EUNID list of expert is available for all users, after registration, on EUNID web-site
(www.eunid.com), and has been presented through a poster at ICC/ECCMID, and through oral
communication at international workshop in Rome. See point 3.6 for further details.
4.5 Exchange of good practices on infection control precautions including PPE
4.5.1 Main result
Exchange of experiences and good practices of infection control precautions among the
partners has been successfully promoted and implemented all along the 3 years of the project.
During each meeting, and sometime during the routine activities, the sharing of national guidelines
and internal procedures on infection control always represented a focal and interesting point.
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During the second meeting a specific work session was dedicated to accomplish a consensus
on appropriate PPE to be used for each HIDs, and an agreement of the safe procedures of donning
and removal of PPE for each diseases, considering both standard and high-risk (likely to produce
aerosol) situations. The discussion finally led to a consensus on PPE for each HID, on the basis of
the need dictated by the specific disease but also considering a balance between the need for
protection into the framework of European legislation on work safety and the necessity to ensure
adherence of the HCWs, for example by avoiding over-protection or reducing the redundancy of
requirements for the different diseases. Detailed results are available on the web-site
(www.eunid.com), in the folder “documents”, for all users after registration, and are attached at the
present document as annex 7.
4.5.2 Methodology
Preliminary data on this point were collected with the first questionnaire, where some
questions on selection, donning and removal of PPE were included. In particular, coordination team
asked for which PPE are used in giving care to patients with HIDs, and requested to provide
detailed information on removal procedures of PPE for each disease. Collection of data evidenced
similar criteria of selection, with some differences on some diseases, especially tuberculosis, while
sequences of removal changed widely. During the first meeting, EUNID members agreed to further
discuss the point after an extensive review of literature and to put their conclusions within the
framework of European Community legislation on safety at work.
The coordination team revised the available evidence from the literature, and prepared draft
schemes showing the advisable/preferred PPE for each considered infection, for further discussion
by EUNID members during the second meeting in London. During the second EUNID meeting, a
working group discussed this topic in detail. Each proposed scheme was discussed and modified if
necessary. A final agreement has been finally reached for both routine and high-risk situations (i.e.
aerosol-producing procedures).
4.5.3 Critical points
No critical points emerged.
4.5.4 Dissemination
The agreement on PPE selection, donning and removal for each HIDs, both for standard and
high-risk situation, is available in the EUNID web-site for all users, in the folder documents, after
registration, and has been presented through an oral communication at IMED and at international
workshop in Rome. See point 3.6 for further details.
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4.6 Consensus management guidelines including medical procedures and criteria for patient’s
admission
4.6.1 Main result
The EUNID archive demonstrates that, in most cases, recommendations for the management
of HID already exist, in the appropriate languages at national level, and, where they do not, detailed
European or other guidance (e.g. from WHO, and from CDC, Atlanta) is readily available as a
reference (see deliverable 4.2).
Consequently, EUNID members considered more interesting to develop indications only on
specific aspects of the management. They also decided to include in this deliverable the
development of criteria for patient’s admission in HIUs, that was initially joined with deliverable
4.1. Coordination team co-opted initially Dr. Simon Mardel, who gave up after some months for
other emerging duties, and then Dr. Philippe Brouqui in September 2006, to accomplish this
specific deliverable. Dr. Brouqui reviewed existing literature and developed specific guidelines on
criteria for patient’s admission and on some specific medical procedures, selected on the basis of
the discussion done during first and second EUNID meeting. In particularly, the medical procedures
analyzed include: intensive care procedures, bronchoscopy, gastroscopy, imaging exams (CT scan
and RMI, Chest X rays and Ultrasound), renal dialysis and post-mortem examination.
Indications proposed by Dr. Brouqui were discussed during third EUNID meeting in Rome.
Many participants proposed comments and amendments. First of all, because of lack of evidence
due to the limited number of patients with HIDs decrypted in the scientific literature, it was decided
to not consider the final results as guidelines, but as indications and/or expert’s opinions. After the
discussion, Dr. Brouqui revised his draft, in order to include comments and different opinions by
other members of the network. A revised draft has been sent to all project participants for further
suggestions and comments. Currently, a preliminary draft of these recommendations, including
contrasting issues emerged during the third meeting, is available on EUNID web-site. The definitive
version will be disseminated as soon as possible. The draft is attached at the present document as
annex 8.
4.6.2 Methodology
See table 1
4.6.3 Critical points
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Many critical points emerged on this issue. First of all, it became early clear that complete
management guidelines can only duplicate the already existing, and well accepted, documents.
Consequently, the second critical point was the selection of specific issues to be treated. Some of
the proposed issues were included in the deliverable 4.7, while some others were included in the
deliverable 4.5.
The main critical point was the scarcity of data existing in the literature. Indeed, HIDs are
very rare, and mainly they hit developing regions, where some medical procedures are not routinely
applied. Consequently, the main source of information was represented by experiences emerged
during the SARS outbreak.
Because of the scarcity of data, evidence-based recommendations are impossible to develop, and
consequently these can be based on personal experiences and expert’s opinions, that not always are
convergent. When a final consensus has no been reached on some points, EUNID members decided
to include in the final document the different opinions.
4.6.4 Dissemination
A preliminary draft is currently available on the web-site, where final document will be
published as soon as possible. This deliverable has been presented through a poster at
ICC/ECCMID and through oral communication at international workshop in Rome. See point 3.6
for further details.
4.7 Definition of requirements for isolation facilities in Europe
4.7.1 Main result
A comprehensive consensus document on specifications for isolation facilities, with special
focus on HIUs, has been reached. The document includes both logistic and technical aspects of
HIUs. Staff requirements and policies for staff management are discussed, too. In particular, the
document presents the EUNID agreement on the following topics:
• the appropriate number and distribution of units within each Member State;
• the minimum technical requirements for facilities and services provided by such units,
including requirements for the whole structure and for each patient’s room;
• the management of airflow control and potential air contamination;
• clinical staff numbers, training and health assessment;
• staff and patient circulation pathways within the unit;
• transport of patients and laboratory specimens outside the unit;
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• requirements for patient management laboratory services;
• requirements for clinical waste handling;
• methods of decontamination of staff;
• methods of decontamination of the units and associated equipment;
• security measures to protect the unit from damage and intrusion.
A complete agreement among project members on each point has been reached. The final
version of the report is available on the web-site and is attached at the present document as annex 9.
4.7.2 Methodology
During the second EUNID meeting in London, a discussion group on the minimal
requirements for HIU in European countries was created, taking into account different national
legislations. After the meeting Dr. Bannister, national official from UK, wrote a draft document that
was available for partners’ revision.
In an additional “experts’ meeting” in Vienna on February 22, 2007, a step-by-step
document written on the basis of the review of the literature and, above all, on the analysis of an
article recently published on an international journal by an U.S. panel of experts on the same issue
(Smith P.W. et al. Designing a Bio-containment Unit to Care for Patients with Serious
Communicable Diseases: A Consensus Statement. Biosecurity and Bioterrorism: biodefense
strategy, practice, and science. Volume 4, Number 4, 2006, pages 351-364) was revised.
The step-by-step document, with proposal of agreement as reached in Vienna, was proposed
to all EUNID members during the third EUNID meeting in Rome. A specific session of the
meeting, conducted by Dr. Bannister and by Prof. Smith (the first author of the article on
Biosecurity and Bioterrorism), was devoted to this point. After an extensive discussion, some
suggestions were included in the draft, and a complete consensus was obtained. Dr. Bannister
revised the draft taking into account all the suggestions emerged during the third meeting.
4.7.3 Critical points
Different legislations in participating countries, and lack of clear scientific evidence.
4.7.4 Dissemination
The final document on this deliverable is available on the web-site for all users, after
registration. Moreover, a scientific article on this point will be submitted for publication on a
relevant international scientific journal as soon as possible. This article is in advanced status of
writing, and is currently under last revision by Dr. Heptonstall, before submission. This deliverable
24
has been presented through an oral communication at national seminar in Vienna and at
international workshop in Rome. See point 3.6 for further details.
4.8 Core curriculum and training modules for HCWs who are involved in the care of patients
affected by HIDs
4.8.1 Main result
A core-curriculum for physicians involved in the management of patients with HIDs and a
module for a 3-days course have been developed and are available on the web-site for all users,
after registration.
The core curriculum includes both theoretical knowledge and practical skill. The topic that
should be well known by HCWs involved in the management of HIDs are: general disease-specific
knowledge (aetiology, epidemiology, modes of transmission, clinical presentation, diagnosis and
treatment), public health-related issues of each HID, specific knowledge of hospital infection
control, including appropriate management of hospital and family contacts, occupational exposure,
PPE, disinfection, decontamination and waste management, and biosafety issues. Moreover, these
HCWs should have technical knowledge about procedures inside an HIU. About practical skill,
according to core curriculum, HCWs should be able to: use safely and correctly the respiratory
protection and other PPE, perform infection control procedures, use and check correctly an HIU.
Moreover, these HCWs should have specific training in team working and specific practical skill on
some country - specific items (such as stretcher transport isolator, or special ambulances).
In order to achieve this level of knowledge and practical expertise, a course has been
developed. The course is targeted primarily at infectious disease clinicians and other hospital-based
health care professionals (including hospital infection control practitioners, intensivists, emergency
medicine practitioners, nurse-consultants, and clinician-managers), and puts a strong emphasis on
the public health response to infectious disease emergencies. The course is intended to be taught
over three days on site in a healthcare facility with an attached high level isolation unit, so that
trainees can gain exposure to the specialised equipment and techniques used in such units,
developing theoretical and practical knowledge at the same time.
Documents regarding this deliverable are attached at the present report as annexes 10, 11,
12.
4.8.2 Methodology
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In 2004-2005, national officials have provided information about national accreditation
requirements for infectious disease clinicians: in most countries, experience within a HIU is not a
requirement for accreditation, and in some others, there is no formalised accreditation process.
However, institutes with designated national HIUs regularly run specific training courses for their
own and external staff, and hold regular drills and exercises that involve nurses, paramedics, and
health care workers from other specialties as well as infectious disease clinicians. Dr. Agoritsa
Baka, the expert with specific expertise in training co-opted for this deliverable, spent in more
occasions some time in Rome, working in close relation with the coordination team.
In April 2005, a questionnaire was sent to all EUNID members about current training
requirements in their country for healthcare professionals working in HIUs and/or caring for
patients with HIDs. The questionnaire also sought the partners’ views on whether formal,
standardised training of such professionals in the management of HIDs was desirable, and asked
them to list the key elements of an optimum training programme. Dr. Baka used these data to
develop a draft core curriculum and outline training course. This draft was presented to all
participants and discussed in detail at the second annual EUNID meeting in April 2006, amended by
the coordination team, and subsequently further refined jointly by co-opted experts Dr. Baka and
Dr. Heptonstall.
4.8.3 Critical points
No critical points emerged
4.8.4 Dissemination
The final document of core curriculum and the training modules are available on the web-
site for all users, after registration. Moreover, the final document has been revised and organized by
Dr. Baka, Dr. Heptonstall and the coordination team as an article, already published on Euro
Surveillance, with Dr. Baka as first author (Baka A. et al. A curriculum for training healthcare
workers in the management of highly infectious diseases. Euro Surveillance monthly releases. 2007
Volume 12 / Issue 6). This deliverable has been presented through a poster at IMED and through
oral communications at international workshop in Rome. See point 3.6 for further details.
4.9 EUNID website development with public access site for information and members only area
4.9.1 Main result
EUNID web-site is active from the mid of 2005. It was developed by a web-designer funded
by the EUNID project grant, who ended his collaboration with INMI at the middle of the second
26
year of the project (Contract from 1/5, 2005 to 30/4, 2006). The web-site is currently maintained by
the coordination team, with support from IT personnel from INMI.
The web-site has public and private areas. The public area is divided in two parts, a general
part without registration, and a specific part available for all users after registration: the general part
includes pages with free access to information regarding the Coordination Team, including contacts,
a description of the project, links to other networks and organisations with convergent interests, and
a section “News”, continually updated by coordination team, that report articles and guidelines of
interest for the project. Other public pages require a registration procedure. Visitors can register by
clicking the “Sign Up” link on the home page and filling in the registration form. This procedure
allows visitors to access to: the “Report Page” containing a report concerning the activities carried
out at the last EUNID meeting, the “List of members” page, with name and personal contacts of all
EUNID members, the “Guidelines” page, which contains the archive of national and international
guidelines (listed both by disease and by country), and the “Documents” page, which provides
access to the final version of meeting presentations (available in PPS and PDF format), interim and
meeting reports, and all other documents regarding EUNID activities and results. Members, through
a password different for each participating country, can have access, in addition to the public areas,
to private files which contain notices and information on project administration, as well as draft
versions of documents and articles.
By 12th September 2007, the number of web-site visitor 1996 (one thousand ninety-six)
while registered users 6705 (six thousand five).
4.9.2 Dissemination
The Web site has been presented through a poster at ICC/ECCMID and through oral
communication at international workshop in Rome. See point 3.6 for further details.
4.10 Outbreak response management guidelines
4.10.1 Main result
The original deliverable of the project was the “Preparation of a report on a study of the
feasibility of developing additional international outbreak response resources within Europe”. This
deliverable has not been achieved, because the coordination team, in agreement with all project
participants, decided that this study is not more a task of EUNID in the current epidemiological
situation within Europe, in order to not duplicate the work of E-CDC.
EUNID project was written and submitted for co-funding in 2003, when the need of a plan
to establish an outbreak response team within European countries was very strong. E-CDC was
27
established in mid 2004, and became operative in the mid 2005. Among the main E-CDC activities
are included:
• Risk identification and risk assessment;
• Preparedness planning;
• Response to health threats and events.
These activities are carried out by the Preparedness and Response Unit, that is devoted to threat
assessment, capacity building and crisis operations. The main actions performed by Preparedness
and Response Units include the providing of technical assistance in outbreak investigation and
response through:
• Identify outbreak assistance teams (epidemiologists, microbiologists and infection control
specialists),
• Establish links with and seek for support to international partners (WHO);
• Inventory and development of response guidelines.
The similarity between the E-CDC already established activity and EUNID planned deliverable
is evident. Consequently, considered the changed scenario of needs, all EUNID members decided to
not undertake activities on this specific point. For the same reason, points 4.10.2 “Methodology”,
4.10.3 “Critical points” and 4.10.4 “Dissemination”, are not included in this report.
5. TOOLS and INDICATORS
Some tools and indicators were originally chosen to monitor and survey project’s results and
outcomes. This tools and indicators have been lightly modified in order to face critical points,
changed needs and evolving issues emerged during the project (see chapter 4. Results and
Deliverables for further details).
a. Project Meetings: number held according to time table; percentage of network participants
attending; percentage of meetings where all minutes/discussion papers/ reports were
disseminated. Four meetings have been organized and successfully accomplished: 3 general
meetings (first EUNID meeting, Rome, May 27-28, 2005; second EUNID meeting, London,
April 7-8, 2006; third EUNID meeting, Rome, May 24, 2007) and one additional meeting
with coordination team, co-opted experts and one national official (Vienna, February 22,
2007). The percentage of network participants who attended the three general meetings were
81.25%, 81.25% and 68,75% respectively. The percentage of participants who attended the
additional meeting in Vienna was the 100% of invited person. All (100%) the reports and
documents came out from the 4 meetings have been adequately disseminated mainly
28
through the web-site, but also through other channels (see point 3.6 “Dissemination” for
further details)
b. Inventories of isolation facilities in Europe and of the health professionals who work in
them: reported accuracy, completeness, and accessibility. The inventory of isolation
facilities in Europe has been successfully completed. Its accuracy is the best as possible
considering the difficulties (see point 4.3.3 for further details). Completeness is good:
complete data has been obtained from 75% of participating countries, while not complete
but satisfactory data has been obtained from remaining 25% of participating countries. The
inventory is accessible on the web-site, and has been adequately disseminated (see point 3.6
“Dissemination” for further details). The inventory of health professionals who work in the
isolation facilities has not been accomplished, because of lack of standardization in
European countries in the selection criteria of the staff involved in the management of
patients with HIDs. This deliverable has been modified, and a list of European physicians
experts in infection control, isolation and management of HIDs has been completed and
adequately disseminated. See point 4.4 for further details.
c. Guidelines: number published and adopted or referenced by authorities, professional,
organisations or individuals at local, national or international level. EUNID developed,
according to expected results, two different guidelines/recommendations. The first one is
focused on specifications for technical, logistic and staff management issues for HIUs
and/or referral centres for the management of patients with suspected/probable/confirmed
HIDs (see point 4.7 for further details). The second one should be considered a
recommendation/expert’s opinion instead of a guideline, and is focused on specific medical
procedures to be performed in to patients affected by HIDs, and on criteria for patient’s
admission in the HIUs (see point 4.6 for further details). Both the document are available on
the EUNID web-site, and scientific papers based on them are currently in advanced status of
writing or editing. Consequently, the number of EUNID guidelines adopted or referenced by
local, national and international authorities and organisations can not still be evaluated.
d. Core curriculum on isolation and management of highly infectious diseases: agreement to,
and adoption of, curriculum by authorities and professional organisations at national level.
The EUNID core-curriculum and related training modules have been developed and
disseminated adequately (see point 4.8 for further details). Recently this result has been
disseminated through an article, categorized as “guidelines”, on Euro Surveillance Monthly
Release. In the article, adequate links with web-site are present. Until now, another
European co-funded project, ETIDE (European Training for Infectious Diseases
Emergengies), decided to adopt for one of its aim the core-curriculum developed by
29
EUNID, and to use related EUNID training module as an useful guide to develop its own
training programme.
e. Website: hit –counting and feedback from network members, health professional and
general public. EUNID web-site (www.eunid.com) is functioning by 2 years (see point 4.9
for further details). It represents an useful tool for sharing documents among project
members and an useful source of data and information for all users interested in infection
control and management of HIDs. Indeed all the project activities (except administrative
topics and preliminary drafts) are available for all visitors after registration, while project
members can access to public and private parts through a password specific for each
country. The web-site will also represent an helpful instrument for the next project,
EuroNHID, that will continue and implement the EUNID work. Consequently, the use of
web-site will be disseminated and promoted further in the future. Until now, the total
number of visitors is 1996, while the total number of registered users 76.
f. Study of the feasibility of developing additional European outbreak response resources:
completion , publication and dissemination. This deliverable has not been performed, in
order to avoid duplication with E-CDC activities (see point 4.10 for further details).
The EUNID website (www.eunid.com, see deliverable 2.4.9) is currently in use and
provides an important tool to manage the project and to share and disseminate information among
infectious disease clinicians and other professionals with an interest in highly infectious diseases
and infection control. The coordination team is responsible for ensuring that the content of the
website is accurate and up to date. The Coordination Team, with the support of an IT expert,
regularly maintains and updates the site.
____________________
Date
____________________
Signature Dr. Giuseppe Ippolito Scientific Director and Project Leader
This report was produced by a contractor for Health & Consumer Protection Directorate General and represents the views of thecontractor or author. These views have not been adopted or in any way approved by the Commission and do not necessarilyrepresent the view of the Commission or the Directorate General for Health and Consumer Protection. The EuropeanCommission does not guarantee the accuracy of the data included in this study, nor does it accept responsibility for any use madethereof.