Disease prevention and control in Europe

ECDC: Keeping Europe healthyA potential employees guideProf Angus Nicoll CBE European Centre for Disease Prevention and Control

LSHTM, London, 19 March 2010

Expanded Europe – the five freedoms in the EU

1. Free movement of people*

2. Free movement of services*

3. Free movement of goods*

4. Free movement of monies*

5. Free movement of microbes

* Adapted from Summary of Legislation — Internal Market http://europa.eu.int/scadplus/leg/en/s70000.htm

21st century trends

Emerging/re-emerging infectious diseases:

Emerging pathogens (e.g. Chikungunya, BSE-v/CjD, Ebola, H5N1)

Resurgence of TB, measles, dengue, meningitis

Animal to humans (e.g. Nipahvirus, hanta virus, H5N1)

Change presents microbes with new opportunities:

Globalisation of travel and trade Intentional use of biological agents

(e.g. anthrax) Climate change

Why was ECDC established?

Emerging and re-emerging communicable diseases revitalised through globalisation, bio-terrorism, interconnectivity, and an EU without internal borders

Health implications of enlarging EU Strengthen EU public health capacity

to help meet EU citizen's concerns

A young EU agency dedicated to the prevention and control of communicable diseases

What is ECDC?

"An independent agency, named the European Centre for Disease Prevention and Control …" — ECDC Founding Regulation (851/2004)

A European Union Agency which: is a member of the European Union (EU)

family; covers EU 27, EEA/EFTA countries; reaches out to other countries beyond

the EU 27 through Neighbourhood Policy and DG RELEX;

supports and promotes global health security (role in International Health Regulations); and

is financed through the EU budget.

What is the role of ECDC?

Identify, assess and communicate current and emerging health threats to human health from communicable diseases.— ECDC Founding Regulation (851/2004), Article 3

EU level disease surveillance and epidemic intelligence

Scientific opinions and studies Early Warning System and

response Technical assistance and training Communication to scientific

community Communication to the public

Major threats related to communicable diseases in the EUMajor threats covered by the Annual Epidemiological Report 2008 include:– antimicrobial resistance– healthcare-associated infections– HIV infection– pneumoccocal infections– influenza– tuberculosis

Strains have emerged that are almost totally resistant to antibiotics and for which there is no rational option for treatment of infected patients.

Although several EU Member States are making good progress towards control, in particular of MRSA and unnecessary antibiotic prescriptions in outpatients.

However, antimicrobial resistance in general remains high and even continues to increase in most countries.

European Antibiotic Awareness Day. European health initiative to promote prudent use of antibiotics. 32 participating countries in 2008, second event on 18 November 2009.

ECDC-EMEA Joint Report. On the gap between increasing multi-drug resistance in the EU and the lack of novel antibiotics (June 2009).

Antimicrobial resistance

MRSA2007

Only 70 years after the discovery of penicillin, we have almost come full circle and are now in a situation similar to the pre-antibiotic era.

Faroe Islands stamp commemorating Alexander Fleming

Healthcare-associated infections

Each year, more than four millions EU patients get at least one nosocomial infection when hospitalised.

Every year in the EU 27, approximately 37 000 deaths (0.9 %) are caused directly by nosocomial infections; and infections contributed for an additional 111 000 deaths.

The total healthcare cost of nosocomial infections for the EU 27 can be estimated at EUR 7 billion per year.

Nosocomial: Originating or taking place in a hospital, acquired in a hospital, especially in reference to an infection.

Photo by marsdd. Published under a Creative Commons license through http://www.flickr.com/photos/marsdd/1041679960/

HIV infection

Over 26 000 newly diagnosed cases reported in 2007 in EU and EFTA countries.

The predominant modes of transmission for HIV infection appear to be sex between men followed by heterosexual contact.

A high number of HIV-positive persons in the EU continue to be unaware of their situation.

Joint surveillance with WHO

Animated slide: Press space bar.

Influenza

Annual seasonal influenza epidemic (see map).

Avian influenza

Joint surveillance with WHO since 2008–2009 influenza season

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The 2009 pandemic – it could have been a lot worse for Europe! (Situation circa March 2010) A pandemic strain emerging in the Americas.

Immediate virus sharing so rapid diagnostic and vaccines.

Based on A(H1N1) currently not that pathogenic and without pathogenicity markers.

Residual immunity in much of a large group (older people).

Sustained susceptibity to oseltamivir. Good data and information came out of

North America and the southern hemisphere. Arriving in Europe in the summer. Mild presentation in most

people infected. High immunogenicity for vaccine

A pandemic emerging in a developing countryDelayed virus sharing

Based on a more pathogenic strain, e.g. A(H5N1)

No residual immunity

Inbuilt antiviral resistance

Minimal data until transmission reached Europe

Arriving in the late autumn or winter

Severe presentation immediately

Contrast with what might have happened but what could still go wrong

Tuberculosis

Over 84 000 tuberculosis cases reported in 2007 in EU and EEA/EFTA countries.

Over 5 000 deaths reported in EU and EEA/EFTA countries.

Multidrug-resistant tuberculosis remains an issue requiring attention.

Despite progress over the last decade, the elimination target of less than one TB case per 1 million population is still far from being achieved.

Joint surveillance with WHO

Threats monitoring

In 2007 ECDC monitored 168 threats of which 142 (85%) were new; 21 were opened in 2006 and still active in 2007; 5 were opened in 2005 and still active in 2007; 66 threats required an active follow-up by ECDC; and 10 of them resulted in a detailed threat assessment

circulated to the EU Member States and the EC through the EWRS.

Who are ECDC's strategic partners?

ECDC

MemberStates

Council

EuropeanParliament

Networks

Commission

Researchcommunity

WHO

NGOs

CDCsOther

countries

Industry

EU agencies

Advisory Forum

Management Board

Working with the Member States:The role of Competent Bodies • Promoting bilateral relations between the

Member States and ECDC and European networking.

Appointing experts to support the Community responses to health threats.Competent Bodies have been formally designated by Member States. ECDC's Management Board compiled the list, which was finalised and published in December 2007.

Working with the European Commission

European Parliament and ECDC

Collaborating with WHO

Working with the EU presidencies

Together we can make sureour citizens sleep safe and sound!

Relevant Links

ECDC www.ecdc.europa.eu

Job listing http://www.ecdc.europa.eu/en/aboutus/jobs/Pages/JobOpportunities.aspx

EPIET http://ecdc.europa.eu/en/epiet/Pages/HomeEpiet.aspx

Traineeshipshttp://www.ecdc.europa.eu/en/aboutus/jobs/Pages/

Traineeships.aspxEuropassCV

https://europass.cedefop.europa.eu/europass/home/vernav/Europass+Documents/Europass+CV.csp