Protecting European citizen s health ECDC, an added value for the OCTs?

Transcription

1 European Centre for Disease Prevention and Control Protecting European citizen s health ECDC, an added value for the OCTs? Denis Coulombier, Head of the Unit for Preparedness and Response European Centre for Disease Prevention and Control Stockholm, Sweden

2 Presentation of ECDC

3 SARS in 2003, a wake-up call for the EU 3

4 4

5 (cc) Xavier Larrosa, via flickr.com 5

6 2005, ECDC established in Stockholm 6

7 ECDC mission 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. 7

8 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 9

10 Organisational structure Director and Director's Office Deputy Director and Deputy Director's Office Office of the Chief Scientist Epidemiology, surveillance and Response Support Unit Capacity Strengthening and Communication Unit Internal Coordination Unit 10

11 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

12 ECDC stakeholders 12

13 World Health Organization 13

14 ECDC work with countries 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 OCTs? European Neighbourhood Policy. Algeria, Armenia, Azerbaijan, Belarus, Egypt, Georgia, Israel, Jordan, Moldova, Morocco, Lebanon, Libya, Palestinian Authority, Syria, Tunisia, Ukraine 14

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 15

16 Scope and timeframe of ECDC's scientific advice Scientific advice Summary of evidence Guidance (options with pros and cons) Position of ECDC Clear conclusion for suggested action Broadly two types: Urgent (up to 48 hours to deliver) Non-urgent (weeks months to deliver) 16

17 17

18 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. TESSy: D i s e a s e m o n i t o r i n g Collect Analyse Interpret Cases EWRS: E v e n t m o n i t o r i n g Events Capture Filter Validate Assess Signal Alert Investigate Disseminate Communicate and control

19 Threats monitored by ECDC since May

20 EWRS access by day: January November /01/ /02/ /03/ /04/ /05/ /06/ /07/ /08/ /09/ /10/ /11/

21 The European surveillance system: a one-stop shop Data upload and access by Member States. Data access by: Data users in Member States National institutes Disease experts General public Advisory Forum members Management Board members WHO Member States Member States Member States EMCDDA EFSA Others 21

22 European networking works! Vaccine preventable (measles, mumps, rubella, etc.) Sexually transmitted diseases, bloodborne infections HIV Invasive bacterial diseases Foodborne diseases Antimicrobial resistance Hospital-acquired infections Others European Network for Imported Viral Diseases (ENIVD) Collaborative Laboratory Response Network (CLRN) 22

23 Preparedness 23

24 Emergency Operations Centre 24

25 EPIET: European Programme on Intervention Epidemiology Training Katarina Widgren, Sweden, EPIET graduate, class of 2009 Agnes Hajdu, Hungary, EPIET graduate, class of 2007 Peter Markary, Hungary, EPIET graduate, class of fellows have passed through the EPIET EU track. 66 fellows have participated in the EPIET Member State track. Updated February

26 Capacity building of specialists and harmonisation of methods and approaches Sneak preview: Report available April 2011 European Programme on Public Health Microbiology (EUPHEM) 26

27 Short courses for public health workforce 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

28 28

29 Thank you

30 ECDC in action, 3 scenarios: - Chikungunya in EU, OR and OCT - Cholera in Haiti - Pandemic in 2009

31 International travel and spread of a vector-borne infection: the example of chikungunya Reproduction number (R) : 3 to 4 Viraemic subjet To a country with competent vector Aedes Albopictus Serial interval Country with an epidemic To a country with no competent vector Source: Jean-Claude Desenclos, InVS

32 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

33 Chikungunya outbreak in Italy, Aug 2007: Emilia-Romagna region 2007: support to containment August: Italy detects cluster of local Chikungunya in Emilia-Romagna September: ECDC supports Italy to contain outbreak 33

34 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

35 Areas of possible establishment of Aedes albopictus in Europe 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:? Source: Schaffner, F. Development of Aedes albopictus risk maps. TigerMaps project. ECDC, Stockholm Available from: 35

36 Cholera epidemic in Haiti A threat to safe tourism in the Caribbean? Haiti 241,360 Dominican republic 609 Venezuela 75 Spain, US, Mexico, Canada 1 36

37 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

38 Epidemiological situation, as of 29/04/2009 novel influenza virus A(H1N1) Spain 4 cases UK 5 cases Germany 3 cases Austria 1 case 38

39 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 40

41 Communicating the facts Monitor evolution Emphasis put on southern hemisphere over summer Importance of the OCTs as outposts for emerging threats 41

42 Thank you

43 Possible public health activities with added values for OCTs

44 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

45 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

46 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

47 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

48 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

49 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

50 Thank you