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ECDC activities in Epidemic Intelligence.
Pedro Arias, European Centre for Disease Prevention and Control, Stockholm
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Scope of this presentation
• Epidemic Intelligence (EI) activities at ECDC • Sources of Information • EPIS: Epidemic Intelligence Information System
• TTT: Threat Tracking Tool • Challenges
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History of Epidemic Intelligence
• Epidemic intelligence service at USCDC established 1951 • Following start of the Korean War • Founded by Alexander Langmuir – chief for 29 years • Started as earlywarning system against
– biological warfare and – manmade epidemics
• 2 year epidemiology training program for approx. 80 medical doctors, researchers and scientists
• Includes also chronic diseases, environmental diseases and injuries
• Starting point for similar programs all over the world (FETP, TEPHINET, EPIET)
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Mission and tasks of ECDC in Epidemic Intelligence
• ECDC shall – Establish, in cooperation with MS, procedures for the identification of emerging health threats
– Identify, assess and communicate current and emerging communicable disease threats
– Inform EC and MS about emerging health threats requiring their immediate attention
– Communicate on emerging health threats, including to the public
Reg. 851/2004 of the European Parliament and of the Council, 21/4/2004
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Definitions…
– The systematic collection and collation of information from a variety of sources, usually in realtime, which is then verified and analysed and, if necessary, activates response.
– Main aim is to speedy up detection of potential health threats and provide timeliness response
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Public Health Stakeholders PreECDC situation
NSI: National Surveillance Institute MoH: Ministry of Health
EC
MoH
MoH
MoH
MoH
MoH
EWRS ESCON DSN
NSI
NSI
NSI
NSI
NSI
HSC
Ecdc: European Centre for disease Prevention
and Control AF: Advisory Forum
NSI: National surveillance institute
EC: European Commission HSC: Health Security
Committee EWRS: Early Warning and Response System
ESCON: European surveillance Committee Network
MOH: Ministry of health
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Public Health Stakeholders ECDC established
EWRS
EC
MoH
MoH
MoH
MoH
MoH
NSI: National Surveillance Institute MoH: Ministry of Health
ESCON
NSI
NSI
NSI
NSI
NSI
ecdc
DSN AF HSC
Ecdc: European Centre for disease Prevention
and Control AF: Advisory Forum
NSI: National surveillance institute
EC: European Commission HSC: Health Security
Committee EWRS: Early Warning and Response System
ESCON: European surveillance Committee Network
MOH: Ministry of health
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Epidemic Intelligence Framework
Report Data Capture
Filter Validate
Collect Analyse Interpret
Assess
Investigate
Signal
Event monitoring
Control measures
Public health Alert EWRS
Network inquiries IHR CDTR Eurosurveill. w/m EAlerts Press Releases ECDC Website
Disseminate
“ Surveillance” systems
Identified risks Mandatory notification Laboratory surveillance
Emerging risks Syndromic surveillance Mortality monitoring Health care activity monitoring Prescription monitoring Poison centres …
Domestic Media review EI focal points
International Info scanning tools
Distribution lists International agencies
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Early Warning & Response Processes
Monitor information
Implement control measures
Assess signal
Investigate PH alert
Disseminate information
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Early Warning
Response
Early warning vs. Response
Monitor information
Implement control measures
Assess signal
Investigate PH alert
Disseminate information
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Risk assessment
Risk management
Risk Assessment vs. Risk Management
Monitor information
Implement control measures
Assess signal
Investigate PH alert
Disseminate information Risk communication
Risk monitoring Epidemic intelligence
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Risk Assessment vs. Risk Management The grey zone…
Risk assessment
Risk management
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Early Warning Model
Yes
Yes Yes
Public health significance?
Unusual disease pattern?
International concern?
Investigation & control
Yes
Signal
Rumour Media Report
Community Concern
Priority disease
notification
Lab Report
Clinician Concern
Early Warning Response
Event verified?
surveillance data
Public Health Alert
Eventbased surveillance reports
Process
Decision
Status
Source
Public Health Emergency of International Concern
Notification to WHO
Indicator based
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Event verification
No
Is the event relevant?
Yes
Immediate verification required?
Status
Decision
Process
Irrelevant event
Event
No
Verification within 24 hours
Event not verified
Yes
Verification
Signal
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Signal assessment
No
No
Yes
No
Yes
Yes
No
Yes
Signal
Alert of National scope requiring
European information Alert of National scope
Alert of national scope requiring
European support
Alert of European scope Requiring
European coordination
Significant public health impact?
Insufficient national capacity for response?
Risk of European spread?
Need for European information?
Status
Decision
Alert not confirmed
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Surveillance networks funded through PH programme
EWGLINet
EnterNet
Influenza
VIH/SIDA
IPSE
ENIVD
EARSS
EUIBIS
Measles
Basic Surveillance Network H. influenza
CJD
Tuberculosis
ESSTI ESAC
Divinenet
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Eventbased EI : ECDC routine sources
• MS and partner organisations bulletins: – National bulletins – WHO , CDC, RASFF, EMSA (… etc.) bulletin
• P.H. specialized mailing lists: – Confidential (EWRS, MediSys, FWD, GOARN, etc.) – Subscription (GPHIN, etc.) – Public (Promed, OIE alert ms., GoogleAlert etc.)
• Websites: – National P.H. institutes (of EU MS and from abroad) – EU PH agencies/projects (Epinorth, Eurosurveillance, …) – International Health agencies (WHO, FAO, OIE, etc.) – Internat. news providers (Alertnet, EC press rew., ..)
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MedISys
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GPHIN
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ProMED
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Public health event verification
• Verified events – Source known to be verified (GOARN) – Public health official sources (EWRS)
• Nonverified sources – Media – Unofficial sources
• Verification process – Crosschecking independent sources – Active search for additional information
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Sources of Information: First
1 other DSN 1 Eurosurveillance 1 Other public sources 2 Info from MS authority 2 Other confidential source 2 MedISys 2 Info fr. WHO/nonMS Auth 6 WHO OVL 6 ENTERNET 6 Public Report on Web 6 GPHIN 17 Promed 17 EWGLI 30 EWRS % Source of Information
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Sources of Information: Updates
0 other DSN 1 Eurosurveillance 2 ENTERNET 3 MedISys 3 Other public source 3 EWGLI 3 Info from MS authority 3 DGRELEX 4 Info fr. WHO/nonMS Auth 4 Other confidential source 9 WHO OVL 11 GPHIN 11 EWRS 21 Promed 21 Public Report on Web % Sources Of Information
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Outputs
• Daily RT reports • Weekly CDTR (customize according to the audience: confidentiality)
• Weekly EIWR • Adhoc: Threat assessment and web information
• Annual reports • Charts • Maps
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Challenges and future needs • Balance between cost of the noise vs. cost of human filtering
• How much information is enough? • A network of experts for filtering and verification • Standard operating procedures • Effective communication tools • Duplication of efforts • How to deal with unknown diseases • How to deal with different levels of information (temporal and/or geographical)
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Meta robot: ProMED/ GPHIN/ MedISys
Threat n Threat 1 Threat 2
X X
X X
X
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Feedback at European Level
• EC – EC commissioner briefing
• MS – Early Warning and Response System – ECDC threat assessment weekly bulletin
• Public – Eurosurveillance weekly – ECDC website
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MSs CB and Focal Points for Networks
Disease Specific Fora
ECDC
Risk Assessment /EI Forum
MSs Contact Points (EWRS)
EWRS
IHR
Alert Ad Hoc Fora
SANCO C3
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Epidemic intelligence Sources of Information
Signal fora
Risk Assessment/ EI Forum (RT)
Adhoc Fora
EWRS
DSN
DSN
DSN
DSN
Ev1 Ev1
DSN DSN
TTT TESSY
MedISys HEDIS
IHR
Integrated communication platform: EPIS
Data Events Collect Analyse Interpret
Capture Filter Validate
Assess
Investigate
Signal
Control measures
Public health Alert
Confidential: EWRS… Restricted access: network inquiries, ECDC threat bulletin Public: Eurosurveillance, press release, web site
Disseminate/Notify
Indicatorbased component “ Surveillance” systems
Eventbased component Event monitoring
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