Paula VasconcelosPreparedness and Response Unit (PRU)

Vaccine Preventable Diseases Horizontal Project (VPD)Feb 13th, 2008 Luxembourg

Measles outbreaks in Europe: Contributions from Epidemic Intelligence

Overview

• Epidemic Intelligence at ECDC• Measles threats – information available at

TTT – Threat Tracking Tool• Conclusions and Comments • Next steps

Epidemic Intelligence

• Definitions…

The systematic collection and collation of information from a variety of sources, usually in real-time, 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

Epidemic Intelligence framework

Data EventsCollect

Analyse Interpret

Capture Filter Verify

Assess

Investigate

Signal

Control measures

Public health Alert Early Warning and Response System

Rapid inquiries (Enternet)E-Alerts (Eurosurvelilance)Intern. Health Regulations (WHO)TTT – CDTR, EIWR, ECDC WEBSite

Disseminate

Identified risks Mandatory notification

Laboratory surveillance

Emerging risksSyndromic surveillance

Mortality monitoringHealth care activity monitoring

Prescription monitoring

Non healthcare basedPoison centres

Behavioural surveillanceEnvironmental surveillance

Veterinary surveillanceFood safety/Water supply

Drug post-licensing monitoring

DomesticMedia reviewEI focal points

InternationalInfo scanning toolsDistribution listsInternational agencies

Event monitoring“Surveillance” systems

Event-based surveillanceIndicator-based surveillance

Risk assessment

Risk management

Epidemic Intelligence on risk assessment and risk management

Monitor information

Implement control measures

Assess signal

Investigate PH alert

Disseminate informationRisk communication

Risk monitoringEpidemic intelligence

Epidemic Inteligence components

• Surveillance systemsunusual disease patterns analysis and interpreting common indicators systematic systems - what is “known”

• Event monitoringcapture of ad-hoc unstructured informationdetect new, emerging diseases – unknown

Epidemic Intelligence at ECDC

• Concept - surveillance processesIndicator-based surveillanceEvent-based surveillance

• Sources of information:Official: Governments, EWRS, international organisations, epidemiological bulletins, mandatory notificationNon official: media, DSN, websites,

• Tools - Threat Tracking Tool (TTT):compiling, following, archiving and monitoring threats

Concept: Epidemic Intelligence framework

Data EventsCollect

Analyse Interpret

Capture Filter Verify

Assess

Investigate

Signal

Control measures

Public health Alert Early Warning and Response System

Rapid inquiries (Enternet)E-Alerts (Eurosurvelilance)Intern. Health Regulations (WHO)TTT – CDTR, EIWR, ECDC WEBSite

Disseminate

Identified risks Mandatory notification

Laboratory surveillance

Emerging risksSyndromic surveillance

Mortality monitoringHealth care activity monitoring

Prescription monitoring

Non healthcare basedPoison centres

Behavioural surveillanceEnvironmental surveillance

Veterinary surveillanceFood safety/Water supply

Drug post-licensing monitoring

DomesticMedia reviewEI focal points

InternationalInfo scanning toolsDistribution listsInternational agencies

Event monitoring“Surveillance” systems

Event-based surveillanceIndicator-based surveillance

Process of event-based surveillance used to identify the measles threats currently

opened at TTT

Sources of information

• No officialsMedisys (Medical Information System)RNS (Rapid News Service)Promed (Program for Monitoring Emerging Diseases)GPHIN (Global Public Health Information Network)Press/News AgenciesSurveillance networks (DSN) Internet

- …

• Officials Governments, ministries, institutes, …Internationals organisations

Epidemiologic Bulletins

EWRS…

Sources of information - Medysis

Sources of information - RNS

12

Sources of information - Promed

13

Sources of information - GPHIN

14

Sources of information - Reuters

EI tool “share point” – Threat Tracing Tool

EI tool “share point” – Threat Tracing Tool

Threat Tracing Tool: inclusion criteria for potential communicable disease threats:

• Diseases with a high potential for spread• Severe diseases or diseases with limited

treatment• Diseases that require infection control

measures• Emerging or resurging diseases• Diseases that change spread or resistance

patterns• or diseases that are of unknown origin

(independent from where in the world they are detected)

and at least one of the following:– Cases occur or are expected in more than one MS– Exposure to a source to which citizens from more than

one MS may have been in contact (including environmental, food, medical)

– Considerable or unclear risk of importation into Europe through trade and travel

– Adequate verification and investigation of a threat might require assistance from ECDC and/or partner organizations

– Affecting a single MS but requiring information of national health authorities of other European MS

– High media or political attention– Events reported through EWRS or through IHR– Risk of introduction of disease in Europe

Threat Tracing Tool: inclusion criteria for potential communicable disease threats (cont):

* simultaneous with National bulletin** simultaneous with WHO report

ECDC TTT – Measles threats: first source of information in 30 events from 2005- 2007

First source countries years No %

EWRS Italy, Belgium, UK*, Norway, Germany, Denmark, Estonia, Spain, Portugal

2005 - 2007 9 30%

News scrapers (Promed/GPHIN)

UK*, Ukraine **, Romania

2005-2007 7 23%

Eurosurveillance Italy, Switzerland, Belarus, Poland, Greece

20062007

5 16%

National authorities Germany 2006 -2007 4 13%

DSN Italy 2007 2 6%

Others Serbia, Bosnia 2006-2007 2 6%

Local media Spain 2006 1 3%

Total 30 100%

Measles in Europe –TTT threats opened (June 2005 – November 2007)

Italy(4)

2006

2007

Germany (5)

2006

UK (6)

2006

2007

Spain (2)

2006

Belarus (1)

2006

Poland (1)

2006

Ukraine (1)

2006

Estonia (1)

2006

Greece (1)

2006

Norway (1)

2007

Romania (1)

2005

Denmark (1)

2006

Bosnia- Herzegovina (1)

2007

Portugal (1)

2005

Switzerland (1) 2006

Serbia (1)

2007

Belgium (1)

2007

published inEurosurveillancenot published inEurosurveillance

47%

53%

ECDC TTT – Measles threats: publication on Eurosurveillance of 30 events from 2005- 2007(June 2005 – November 2007)

Published

Conclusions and comments

• From May 2005 till Nov 2007, 30 events of measles outbreaks from 17 European countries were included at the TTT

• Main first source of information of events and threats:ERWS (30%)web crawlers (23%)

• Other first sources were Eurosurveillance (16%)National authorities (13%)DNS (6%)Others (9%)

Conclusions and comments• UK (6/30 events - 20%), Germany (16%), Italy (13%)

and Spain (7%) are the leading countries with most measles events identified at TTT.

• The other 13 countries have only 1 measles event identified.

• Eurosurveillance was the first source of information in 5 (16%) events

• Nevertheless, more than half of the events (53% ) were published in Eurosurveillance.

• The information available is not on outbreak notification/reporting but in events detected through Epidemic Intelligence (EI)

• Leading countries with events identified at TTT – does it mean more outbreak or more sources of information available?...

• Threat criteria of TTT does not include single case/outbreak of measles in one single place in Europe – should be a new criteria?

Conclusions and comments

Contributions

• Disease under eliminination target!!!!

• Increase awareness and detection

• Speed up response at EU level (coordination)

• “one gate” for information

...Added value to notify all these outbreaks at EU level...

Next stepsIntegrating indicator-based surveillance and event-based surveillance - Tessys to be incorporated in more regular contributions for EI activities

Integrate other early warning system (measles outbreak monitoring from EUVACNET) - should be a routine system in place…

Review TTT inclusion criteria

Priority for measles in EPIS …… One single case should be reported Europewide

Develope guidelines for response for measles in 2008 - need to harmonize detection, investigation and response procedures

Thank You! Tack! Merci!

Obrigada!

www.ecdc.europa.eu