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Strengthening Europe’s defences against communicable diseases – five years on Zsuzsanna Jakab, Director European Centre for Disease Prevention and Control 15 October 2009

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Page 1: Strengthening Europe’s defences against communicable ... · • EU’s Early Warning and Response System (EWRS) operated from ECDC since 2007. ... * Excludes cases originating from

Strengthening Europe’s defences against communicable diseases – five years onZsuzsanna Jakab, DirectorEuropean Centre for Disease Prevention and Control15 October 2009

Page 2: Strengthening Europe’s defences against communicable ... · • EU’s Early Warning and Response System (EWRS) operated from ECDC since 2007. ... * Excludes cases originating from

Road map

• Some success stories: Pandemic preparedness. Response to alerts. EWRS and the EOC. Scientific guidance. Europe-wide surveillance.

• The threat from communicable diseases in Europe.

• How ECDC can help Europe respond to this threat?

• ECDC’s system of governance and partnership.• How to further strengthen our cooperation.

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Pandemic preparedness

• EC/ECDC/WHO Euro workshops.

• Joint assessments of preparedness of all EU and EEA/EFTA national plans.

• ECDC guidance and self-assessment tools.

• Active contribution to new WHO guidance (issued 2009).

EC/ECDC/WHO Euro pandemic preparedness workshop, Uppsala May 2006

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Response to alerts

• Arrival of H5N1 avian influenza in Europe 2005.

• Cluster of human H5N1 cases in Turkey 2006.

• Chikungunya fever in Ravenna, Italy 2007.

• Hundreds more minor alerts.• Epidemic intelligence during

mass gatherings such a Beijing Olympics 2008.

ECDC/WHO mission to Ravenna, Italy in 2007: Collecting tiger mosquitoes

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EWRS and Emergency Operations Centre

• EU’s Early Warning and Response System (EWRS) operated from ECDC since 2007.

• State of the art Emergency Operations Centre. Operating since mid-2007. Inaugurated 2008. Tested in numerous exercises

and real life alerts.

• How to further expand EOC good practice to all Member States.

MUDr Ouzky MEP (right) inaugurates ECDC Emergency Operations Centre, March 2008

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Scientific Guidance

• Scientific Guidance on issues of common interest: Introduction of HPV vaccine. Priority risk groups for seasonal

influenza vaccination. Chlamydia control. Use of antivirals and vaccines

during pandemic.

• Can save time and effort for national authorities.

• How to further develop public health research agenda?

Page 7: Strengthening Europe’s defences against communicable ... · • EU’s Early Warning and Response System (EWRS) operated from ECDC since 2007. ... * Excludes cases originating from

EISS

IPSE

EARSS EUVACMeasles

Basic Surveillance Network

vCJD

ESAC

Divine-net EUCAST

ENVID

EWGLINet

Enter-Net

HIV/AIDS

EU-IBIS

DIP-net

Tuberculosis

ESSTI

Surveillance networks funded through the public health programme

EU’s disease surveillance system before ECDC

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The system of EU disease surveillance before ECDC – a multitude of networks

Impact for Member States:• Huge workload.• Different interfaces for data

upload.• Different database formats.

Impact for networks:• Data cleaning effort for all Member

States.• Feedback for all Member States.

Member State

Member State

Member State

Member State

Member State

Member State

Member State

Member State

Member State

Member State

Member State

Member State

DSN

DSN

DSN

DSN

DSN

DSN

DSN

DSN

DSN

DSN

DSN

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The new European surveillance system: a one-stop shop

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Data upload and access by Member States.

National institutes

Disease experts

General public

Advisory Forum members

Management Board members

WHO

EMCDDA

EFSA

Others

Data users in Member States

Data access by:

Page 10: Strengthening Europe’s defences against communicable ... · • EU’s Early Warning and Response System (EWRS) operated from ECDC since 2007. ... * Excludes cases originating from

Annual Epidemiological Report

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Key findings in the Annual Epidemiological Report 2009The Annual Epidemiological Report (AER) is the result of a collective effort between ECDC and all EU and EEA/EFTA Member States.

The Annual Epidemiological Report 2009:• contains a special chapter on vaccine-

preventable diseases and immunisation programmes (Chapter 2);

• provides incidence data (2007) for 47 communicable diseases and two health issues for which surveillance is mandatory in the EU and EEA/EFTA countries (Chapter 3); and

• assesses health threats during 2008 (Chapter 4).

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Threats from communicable diseases in the EU in 2008Major threats from communicable diseases in the EU in 2008 have not changed from the two previous reports:

• antimicrobial resistance;• healthcare-associated infections;• vaccine-preventable diseases, with particular

emphasis on pneumococcal infections;• respiratory tract infections, with particular focus

on influenza (pandemic potential as well as annual seasonal epidemics), and tuberculosis; and

• HIV infection.

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Antimicrobial resistance and healthcare-associated infections (AMR/HCAI)AER, Chapter 3.6

• Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant problem all over Europe. In some of the high-endemic countries, MRSA proportions seem to be stabilising, and decreasing trends are observed in a few countries.

• Penicillin non-susceptibility in Streptococcus pneumoniae(PNSP) shows a heterogeneous picture in Europe with most northern European countries reporting low levels; relatively high levels are reported by southern European and Mediterranean countries.

• Resistance to fluoroquinolones, aminopenicillin, aminoglycosideand third generation cephalosporins in Escherichia coli has increased significantly in nearly all reporting countries.

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Antimicrobial resistance constitutes an increasingly important public health hazard in Europe.

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Respiratory tract infections: Tuberculosis, legionellosis, influenza• 84 917 tuberculosis cases reported in EU and EEA/EFTA in 2007

• High rate of Multi-drug resistant TB in some Member States

• Elimination target of less than one TB case per 1 million population still far from being achieved.

14Source: Joint reporting with WHO

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HIV and STIs

• Chlamydia continues to be the most frequently reported disease in EU, accounting for the majority of all STI reports.

• In 2007, 253 386 confirmed cases of Chlamydia trachomatis infection were reported by 22 EU and EEA/EFTA Member States, with an overall rate of 122.6 per 100 000 population.

• In 2007, 26 029 newly diagnosed cases of HIV infection were reported in 28 Member States with a rate of 6.0 per 100 000 population.

15Country reports: Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia (IDU only), Finland, France, Germany, Greece, Hungary, Ireland, Latvia, Lithuania, Luxembourg, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, UK, Iceland, Norway.* Excludes cases originating from countries with generalised epidemic

Number of reported HIV infections by transmission mode and origin in EU and EEA/EFTA countries, 2003–07

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Threats monitoring

In 2008, ECDC monitored 250 threats (up from 168 in 2007), of which:• 227 were new (91 %);• 14 were carried over from 2007; and• 9 represented recurrent threats (e.g. avian influenza, chikungunya

fever).Events monitored included outbreaks of hepatitis A, measles, and lethal cases of Marburg and CCHF.

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Vaccine-preventable diseases (VPDs)

Success stories

• Vaccination is one of the most cost-effective measures for the prevention and control of infectious diseases.

• The global eradication of smallpox and the elimination of polio in most parts of the world (including Europe) are examples of successful vaccination programmes.

• After the introduction of vaccination in several countries, hepatitis B infections and disease incidence rates fell significantly.

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Vaccine-preventable diseases (cont'd)

Challenges • Ensuring high coverage for VPDs and maintaining immunity.• Improving the sensitivity and specificity of rubella surveillance

(particularly in view of the WHO 2010 elimination goal).• Eliminating measles (see below) and congenital rubella.

18Source: AER 2009, country reports: Austria, Denmark, Estonia, France, Germany, Ireland, Italy, Netherlands, Poland, Romania, Spain, Sweden, UK and Norway. Cyprus, Finland, Hungary, Latvia, Lithuania, Luxembourg, Portugal, Slovakia, Slovenia and Iceland all reported zero cases.

Notification rates of measles cases by age and gender, in EU and EEA/EFTA countries, 2007 (n = 2 684)

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Measles — progress and challenges

• Measles remain a leading cause of death among children worldwide; in 2006, 242 000 measles deaths were estimated globally.

• In Europe, a total of 2 817 confirmed cases was reported in 2007, fewer than last year (overall notification rate of 0.56 per 100 000 population).

• Only four countries (representing less than 3 % of the EU population) have been measles-free during the last three years.

• Around 90 % of all people with measles cases in 2007 had not been vaccinated.

• The vast majority of measles cases (2007) are indigenous and more than 60 % of all imported cases originated in another EU country.

• In 2007, one case was fatal and two developed encephalitis (2006: six deaths and eight cases of encephalitis).

• Measles continue to spread in populations with low vaccination coverage; this could be prevented with catch-up programmes for hard-to-reach population groups.

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ECDC’s role in the EU health protection system

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ECDC contribution to health security

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SurveillanceEarly warningPrevention• EU Surveillance• Support to Risk

Management• Outbreak

Communication

• Epidemic Intelligence• Rapid Alert• Risk Assessment• Public Communication

• Training• Preparedness• Scientific Communication• Health determinants• Prevention (AMR, VPD)

Outbreak Assistance

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The EU health security system: conceptual overview

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Risk monitoring Collect information and monitor health threatsAssess risks, build knowledge and capacity

Risk assessment Investigate alerts,issue scientific advice,provide support

Risk management Implement control measures

ECDC and

MemberStates

EC and

MemberStates

Com

mu

nic

atio

n

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Risk assessment vs. risk management: a complex interrelation

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Risk assessment

Risk management

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Success in the EU system depends on three-way collaboration

ECDC

Commission Member StatesCoordinate

Report

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ECDC’s governance system and relations with Competent Bodies

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Who are ECDC's strategic partners?

ECDC

EU MemberStates

EUCouncil

EuropeanParliament

Networks

EUCommission

Researchcommunity

WHO

NGOs

CDCsOther

countries

Industry

EU agencies

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ECDC bodies – the Advisory Forum

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Management Board: our Governing Body

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ECDC as the node of the network of national partnersCalled ‘Competent Bodies’ in the ECDC Regulation:• National institutions, agencies and authorities that

carry out similar tasks to ECDC.• Designated to work with ECDC by the EU Member

States.• Some countries nominate only one body, others

several. • This is a major difference between ECDC and the

US CDC.• Examples of Competent Bodies: Robert Koch

Institute (D), Health Protection Agency (UK), Ministry of Health and Social Policy (E).

The EU network of Competent Bodies working with ECDC includes today 87 national organisations.

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The EU network of Competent Bodies working with ECDC

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Challenges to address

• The definition of “Competent Body” is complex• What do CBs expect of ECDC?• What demands can ECDC place on CBs?• Relationship between CBs, the Advisory Forum

and the Management Board.• How to make the network on CBs stronger and

more coherent?