the european centre for disease prevention and control
TRANSCRIPT
Protecting European citizen’s health ECDC, an added value for the OCTs?
European Centre for Disease Prevention and Control
Denis Coulombier, Head of the Unit for Preparedness and Response
European Centre for Disease Prevention and Control
Stockholm, Sweden
Presentation of ECDC
SARS in 2003, a wake-up call for the EU
3
4
(cc) Xavier Larrosa, via flickr.com 5
2005, ECDC established in Stockholm
6
ECDC mission
7
• Identify, assess and communicate current and emerging threats to human health from communicable diseases.
• In the case of other outbreaks of illness of unknown origin, which may spread within or to the Community, the Centre shall act on its own initiative until the source of the outbreak is known.
• In the case of an outbreak which clearly is not caused by a communicable disease, the Centre shall act only in cooperation with the competent authority upon request from that authority.
ECDC Founding regulation*
The Community should address European citizens’ concerns about public health threats in a coordinated and coherent way
* REGULATION (EC) No 851/2004 OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 21 April 2004, establishing a European centre for disease prevention and control
9
ECDC in 2011: 57 million € budget , 350 staff
Epidemiology, surveillance
and Response Support Unit
Office of the Chief Scientist
Capacity Strengthening and Communi-
cation Unit
Director and
Director's Office
10
Organisational structure
Internal Coordination
Unit
Deputy Director and Deputy
Director's Office
ECDC disease-specific programmes (DSPs)
• Antimicrobial resistance and healthcare-associated infections
• Emerging and vector-borne diseases
• Food- and waterborne diseases and zoonoses
• Respiratory tract infections (influenza, tuberculosis, legionellosis)
• HIV/AIDS, sexually transmitted infections and hepatitis
• Vaccine-preventable diseases
11
ECDC stakeholders
12
13
World Health Organization
ECDC work with countries
14
European Union (EU). 27 Member States
EEA/EFTA. Iceland, Norway, Liechtenstein
EU candidate countries. Croatia, Iceland (also EEA/EFTA), Montenegro, the former Yugoslav Republic of Macedonia, Turkey
Potential candidate countries. Albania, Bosnia and Herzegovina, Kosovo under UN Security Council Resolution 1244/99, Serbia
European Neighbourhood Policy. Algeria, Armenia, Azerbaijan, Belarus, Egypt, Georgia, Israel, Jordan, Moldova,
Morocco, Lebanon, Libya, Palestinian Authority, Syria, Tunisia, Ukraine
OCTs?
15
Partnerships with global CDCs
• Close working relations with US CDC
• Memorandum of Understanding (MoU) with US CDC: CDC liaison officer in Stockholm
• MoUs with China CDC and Public Health Agency of Canada
• Joint activities
Photo by Nrbelex. Published under a Creative Commons License. See http://www.flickr.com/photos/nrbelex/322790178/
Scope and timeframe of ECDC's scientific advice
Broadly two types:
• Urgent (up to 48 hours to deliver)
• Non-urgent (weeks – months to deliver)
16
Summary of
evidence
Guidance (options
with pros and cons)
Position of ECDC
Clear conclusion for
suggested action
Scientific advice
17
EWRS and TESSy: our health radars
TESSy is a European database for reporting cases of 49 CD
EWRS is a secure platform for reporting public health alerts in the EU and coordinating response measures.
18
Cases Events
Collect Analyse
Interpret
Capture Filter Validate
Assess
Investigate
Signal
Communicate and control
Alert
Disseminate
TESSy: D i s e a s e m o n i t o r i n g
EWRS: E v e n t m o n i t o r i n g
Threats monitored by ECDC since May 2005
19
EWRS access by day: January – November 2009
20
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
01/01/2009 01/02/2009 01/03/2009 01/04/2009 01/05/2009 01/06/2009 01/07/2009 01/08/2009 01/09/2009 01/10/2009 01/11/2009
Data upload and access by Member States.
Data access by:
National institutes
Disease experts
General public
Advisory Forum members
Management Board members
WHO
EMCDDA
EFSA
Others
Data users in Member States
The European surveillance system: a one-stop shop
21
Member States
Member States
Member States
European networking works!
22
• European Network for Imported Viral Diseases (ENIVD) • Collaborative Laboratory Response Network (CLRN)
Vaccine preventable (measles, mumps, rubella, etc.) Sexually transmitted diseases, bloodborne infections HIV Invasive bacterial diseases Foodborne diseases Antimicrobial resistance Hospital-acquired infections Others…
Preparedness
23
Emergency Operations Centre
24
• 188 fellows have passed through the EPIET EU track.
• 66 fellows have participated in the EPIET Member State track.
EPIET: European Programme on Intervention Epidemiology Training
25
Katarina Widgren, Sweden, EPIET graduate, class of 2009
Agnes Hajdu, Hungary, EPIET graduate, class of 2007
Peter Markary, Hungary, EPIET graduate, class of 2007
Updated February 2012
Capacity building of specialists and harmonisation of methods and approaches
European Programme on Public Health Microbiology (EUPHEM)
26
Sneak preview: Report available April 2011
Short courses for public health workforce
27
One week courses At EU or regional level Outbreak investigation Outbreak response Vaccinology Communication Risk assessment Crisis management … One course in Trinidad for OCTs’ in 2010
28
ECDC in action, 3 scenarios: - Chikungunya in EU, OR and OCT - Cholera in Haiti - Pandemic in 2009
International travel and spread of a vector-borne infection: the example of chikungunya
Aedes Albopictus
Serial interval
Viraemic subjet
Reproduction number (R) : 3 to 4
Country with an epidemic
To a country with no competent vector
Source: Jean-Claude Desenclos, InVS
To a country with competent vector
Chikungunya transmission in the EU
2005: threat monitoring
• Outbreak of Chikungunya in La Réunion, French OR
2006: risk assessment
• January: dramatic increase in cases in La Réunion
• March: ECDC confirms risk for Europe
2006/2007: preparedness
• April–May 06: EU lab capacity established
• July 06: Italy implements surveillance of imported cases
• January 07: training on chikungunya crisis management for Europe
Chikungunya outbreak in Italy, Aug 2007:
33
Emilia-Romagna region
2007: support to containment August: Italy detects cluster of local Chikungunya in Emilia-Romagna September: ECDC supports Italy to contain outbreak
Mission report: lessons learnt
• Presence of Aedes albopictus in the region
• Ecological situation ideal for the development of high density of the vector in the two villages: dense local vegetation; domestic backyards with plant pots.
• Introduction of the virus by a visitor returning from a chikungunya endemic area during summer months of mosquito activity season.
• Sufficient human population density to ensure transmission.
34 http://ecdc.europa.eu/en/publications/Publications/0709_MIR_Chikungunya_in_Italy.pdf
Areas of possible establishment of Aedes albopictus in Europe
35 Source: Schaffner, F. Development of Aedes albopictus risk maps. TigerMaps project. ECDC, Stockholm 2009. Available from: http://ecdc.europa.eu/en/files/pdf/Publications/0905_TER_Development_of_Aedes_albopictus_risk_maps.pdf
2008: further preparedness Risk mapping for Ae. Albopictus Tender for vector monitoring in the EU
2010: surveillance Detection of 2 autochthonous cases in France
2011: ?
Cholera epidemic in Haiti A threat to “safe tourism” in the Caribbean?
36
Haiti 241,360 Dominican republic 609 Venezuela 75 Spain, US, Mexico, Canada 1
Cholera epidemic in Haiti Risk for the Caribbean OCTs’?
ECDC provides technical assistance to the European Commission in Port-au-Prince
• 2 experts dispatched to ECHO office
• 1 expert in MIC team
• 1 follow-up visit
ECDC assists WHO for dispatching field teams in Haiti • Call to MS: 4 experts dispatched • 9 ECDC EPIET fellows dispatched in Haiti
Assistance offered to OCTs through MS
● Spain 4 cases
● UK 5 cases
● Germany 3 cases
● Austria 1 case
Epidemiological situation, as of 29/04/2009 novel influenza virus A(H1N1)
38
Initial RTA for 2009 pandemic
- Data in Mexico indicating severe clinical presentation:
• Reporting bias?
• Poor surveillance?
- Interim RTA, indicating uncertainties, continuously updated;
- Activation of ECDC-EOC 24/7 for 2 weeks, to gather information on parameters;
- Dispatching of one ECDC staff in US-CDC, and hosting one China-CDC in ECDC;
- Daily teleconferences with MS;
- Daily situation reports.
40
Communicating the facts Monitor evolution
41
Emphasis put on southern hemisphere over summer Importance of the OCTs as outposts for emerging threats
Possible public health activities with added values for OCTs
ECDC activities with OCTs
Concerns in 2006 and 2007 because of extending chikungunya pandemic
2008 – Call for tender for “Assessment of the needs of the European Overseas Countries and Territories”
March 2010 – Training course in Trinidad & Tobago
March 2010 – Finding presented to OCTs
July 2010 – Feedback to relevant Directorates General of the European Commission (DG SANCO, DG DEV, DG REGIO and AIDCO
44
Findings of the needs assessment
Limited capacity in
– human resources resulting in no surge capacity
– public health microbiology
– information technologies
Need for
– strengthening preparedness through training and support
– access to updated guidance documents from EU
– stockpiles of medical and other supplies was highlighted
– Expert/team support for emerging threats
Networking
– Strengthen regional networks
– Translation of documents
Possible actions: threat detection
Sharing regular outputs
- Threat bulletins
- Threat and risk assessments
- Guidance documents
OCT dedicated activities
- Epidemic intelligence tools adapted for OCTs (MedISys)
- Special bulletins during large mass gathering e.g. World cricket cup…
Strengthen preparedness Supporting response
Strengthening preparedness
- Invite experts from OCT’s in technical meetings
- Involve OCT in EC preparedness projects (e.g. Shipsan, virtual stockpile)
- Support OCT preparedness plans for emerging threats
Supporting response
- Joint threat assessment - Dispatch experts to support investigation
-Dispatch field teams
- Provide surge capacity
47
Improve communication among OCTs and with EU
Unregulated
- Extend access to ECDC risk assessment platforms:
- Urgent inquiries on food pathogens
- Travel associated legionnaire disease
- Vaccine preventable diseases
- Antimicrobial resistance…
- Develop platform for risk assessment, for OCTs
Requiring an EU committee decision
- Extend the use of the EU Early Warning and Response System to OCTs
48
Strengthen specific capacity
Training
- EPIET/EUPHEM
- Short courses dedicated to OCT’s issues
- Participation of OCT experts in ECDC short courses
Simulation exercises
- Participation in EU command-post exercises
- Organisation of table-top exercises for OCTs
Public health laboratories
- Mapping capacity at national/regional level
- Ad-hoc support
49
