Update on the EPIET programmeMarion Muehlen and Katharina Alpers

EPIET and PAE scientific coordinators

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EPIET

• European Programme for Intervention Epidemiology Training• Started 1996, funded by EU Commission and Member States• From Nov 07 funded by ECDC/EU Member States • Coordinators:

Viviane Bremer, based at ECDC in Stockholm, Sweden (100%, leading coordinator)

Alicia Barrasa, based at Carlos III in Madrid, Spain (100%) Marion Muehlen, based at HPA-CfI in London, UK (60%) Brigitte Helynck, based at INVS in Paris (50%) Marie-Anne Botrel, based at INVS in Paris (50%) Doris Radun, based at RKI in Berln (80%) Katharina Alpers (100% PAE-Coordinator)

• Administration: Anna Bohlin, Claudia Metz-Ruffer, ECDC staff

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EPIET programme objectives

To:

• Strengthen CD surveillance & control in EU

• Develop a European network of intervention epidemiologists Training fellows and externals together Training of trainers Sustaining and strengthening a network of training sites

• Develop a response capacity inside & beyond EU: surveillance

outbreak investigations

applied research

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Training objectives

• Plan, implement, evaluate a surveillance system

• Perform outbreak investigations

• Develop a research project on a relevant public

health issue

• Acquire oral and written scientific

communication skills

• Acquire teaching skills

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Training format

• Theoretical trainingAn introductory course (3 weeks), open to

external participantsAt least 6 one-week training modules rotating in

EU Member States

• Learning by doing practical training23 monthsAt a European public health instituteOn site supervision by senior epidemiologists and

from EPIET coordinators

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Modules

• Compulsory Introductory courseComputer tools in outbreak investigationsVaccinologyProject reviewMultivariate analysis

• OptionalScientific writingTime series analysisLab and epiRapid assessment of complex emergency

situations

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Introductory course, content

• Lectures from field epidemiologists

• Interactive case studies based on real investigations

• Development of a study protocol based on real PH issue

• Surveillance exercise• Communication exercises

Since 2004 in Menorca, Spain

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Course Modules in 2002-2007

• Biostatistics (Porto, Rome)• Communication (London, Berlin)• Rapid assessment techniques in

emergency situations (Veyrier, Berlin)• Time series analysis and Geographic

Information System (Athens, Madrid, Veyrier, Bilthoven)

• Vaccines (Glasgow, Helsinki, Stockholm, London, Bilthoven)

• Data management (Bilthoven) • Computer & outbreak investigations

(Heraklion, Paris, Athens, Prague, Budapest, Malta, Vienna, Sesimbra)

• Bioterrorism (Berlin)• Logistic Regression (Bordeaux, Madrid)• Scientific Writing (Berlin)• Multivariable Analysis (Stockholm)

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Outbreak investigations (examples)

• Campylobacter and norovirus linked to communal water in Sweden, 2002

• Q-Fever associated with sheep market in Germany, 2002

• Avian influenza in poultry cullers in NL, 2003

• Legionella associated with cooling towers in France, 2003

• Hepatitis A in homosexual men in Denmark, 2004

• Tuberculosis linked to supermarket in NL, 2005

• S. Hadar associated with roasted chicken in Spain, 2005

• Giardia linked to communal water in Norway, 2005

• S. DT 104 associated with pork meat in NL, 2005/6

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Choice of modules

• Skills assessment form at start of training• Depending on

Previous skillsLocal training opportunitiesFuture needs

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EU Cross-border Investigations 1999-2007

• Salmonella paratyphi B among EU tourists returning from Turkey, 1999

• Clostridium infection and deaths among intravenous drug users, England, Scotland, Ireland, 2000

• EU-wide outbreak of Salmonella typhimurium 204b, 2000

• Meningitis W135 in pilgrims returning from the Haj, 2000, 2001

• Hepatitis A in Ibiza and German tourists, 2001• An outbreak of gastroenteritis in holiday-makers travelling to

Andorra, January-February 2002• Hepatitis A among returning travellers from Egypt, 2004

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Research Projects (examples)

• Risk factors (RF) for Hantavirus in France and Belgium• RF for meningococcal meningitis in day care centers, Ireland• RF for Q fever in Germany • RF for sporadic cases of Listeriosis in France• RF for MRSA in nursing homes, Germany• RF for Hep C in hemodialysis Unit, France • Seroprevalence of WNV among German and

Austrian bird-ringers• RF for sporadic campylobacteriosis, Ireland• RF for CA-MRSA, Switzerland• RF for syphilis, Sweden• Influenza vaccine effectiveness, Denmark

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Surveillance Projects (Examples)

• Establishment of new surveillance Norovirus in Sweden Congenital toxoplasmosis in France CA-MRSA in Switzerland Heat and cold-related mortality in Spain Winter mortality in the UK Sales of flu medicine in Northern Ireland

• Evaluation of surveillance systems EHEC in France STI in Finnland Syphilis and Influenza in Germany Tuberculosis in Spain

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EPIET international missions (1)

Outbreak investigations Infant deaths following immunisation (Egypt) Tularaemia (Kosovo) Suspected anthrax (Ethiopia) Ebola (Uganda, Gabon, Sudan) Hepatitis E (Sudan) Marburg fever (Angola) Measles (Nigeria, Niger, DRC, Serbia, Kosovo) SARS (Hong Kong) Meningitis (Sri Lanka) Avian influenza (Vietnam, Turkey, Azerbaijan) Mumps (Moldovia) Meningitis (Burkina Faso)

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EPIET international missions (2)

Surveillance projects and surveys Cholera Surveillance (Mozambique) Unsafe Injection Practices survey (Burkina Faso) Assessment of neonatal tetanus status (Zimbabwe) Vaccine coverage (Côte d’Ivoire, Republic of Guinea,

East-Timor, Pakistan) SARS (Hong Kong) Retrospective Mortality Survey (Darfur, Sudan) Nutritional survey (Niger, East-Timor) Early warning system (Pakistan after Earthquake) Avian influenza (Georgia, Azerbaijan)

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Scientific Conference

• ESCAIDE annually in fall co-organized ECDC, EPIET, EAN, TEPHINET-Euro

• Slots for EPIET fellows 500 persons from European and international

field epidemiology• EPIET fellows, alumni, FETPs Europe, supervisors

and colleagues from training sites EPIET Fellows prepared by “project review” module

• Review of methods and presentations during a whole week, this year in September

• Satellite workshops: training the trainers organized by EPIET, Tephinet, EAN, PAE and FETP-Canada

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modules

outbreakinvestigationsurveillance-projectresearchproject

teaching

ESCAIDE

SeptOkt Nov Dez Jan Feb Mrz Apr Mai Jun Jul Aug Sep Okt Nov Dez Jan Feb Mrz Apr Mai Jun Jul Aug Sep Okt Nov

Time frame

Year 1 Year 2

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Practical Training“learning by doing”

• 27 Nations + Norway + Switzerland + WHO+ EpiCentre / MSF+ ECDC

• 27 Training sites (23 for cohort 11-13)

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Who does What?

• ECDC Pays grants and expenses for modules and international

missions• Training sites

Host fellow, offer supervision, activities and projects• Supervisors

First responsible for training the fellow Teaching

• Coordinators Overall responsible for training Review all work of fellows Advise supervisors on questions Organise training modules / courses Supervise international missions

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Supervision of fellows

• Supervision on site by at least 1 senior epidemiologist (4 hours/week)

• Draft protocols/reports/manuscripts sent to all coordinators

• Viadesk as virtual office• Final work uploaded to folder on viadesk

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Time frame per cohort

Sept-Oct 07 Sept-Oct 09

Cohort 13: 13 fellows

Sept-Oct 08

Cohort 12: 13 fellows

Sept-Oct 06

Each cohort begins with an introductory course, and ends with a scientific seminar, where each fellow presents his/her work.

Cohort 14: 19 fellowsSept-Oct 08 Sept-Oct 10

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Selection process

• 1st stage Check eligibility (ECDC human resources) ECDC Selection Panel goes through all applications and

selects eligible candidates MS rank 2 best candidates - for this year’s selection

process this had NO effect on eligibility for ECDC selection panel!

• 2nd stage Candidates choose 3 preferred training sites Face to face interview with ECDC selection panel

• 3rd stage Training site market Interviews with training sites

• 4th stage Final selection meeting between panel and host site

representatives and placement of candidates

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Output of EPIET 1995-2007

• Cohort 1-12:

124 fellows trained in EPIET

39 in EU FETP’s (Germany, Norway, Sweden)

• 149 (93%) graduated (diploma)

• Network of trainers (until 2007)

12 different modules

252 individual trainers

55 organisations

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Number of graduated EPIET Fellows 1995-2008 by Country of Origin/Training

(nr=146) Hosted

Sent

Number of EPIET fellows

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EPIET graduates working in MS (1998-2007)

Place of work Number

EU Member States 89

ECDC 6

Norway 4

Switzerland 1

Ouside Europe 9

Global level (WHO, NGO's, UN etc) 20

Unknown 1

Total 130

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Next challenges for EPIET

• Training seatsEquity of accessNumber of salaries

• TrainersExpand training sites to all EU member states Increase number of trainers

• National field epidemiology training programmes Increase synergy with national FETP’sCreate new FETPs

• Training material

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European added value

• Promotion of field epidemiology in EU

• Contribution to the European Network for surveillance and control of CD

• Training of trainers in EPIET host institutes

• Promotion of national training programmes

• Increased mobility of epidemiologists

• Cross border investigations in EU

• International missions

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More information

More information is available on the web at:

http://www.epiet.org

Or writing an e-mail to:

Epiet.office@ecdc.europa.eu

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Thank you

EuropeanProgramme for Intervention Epidemiology Training