Update on ECDC and EPIET Preben Aavitsland and Jurgita Pakalniskiene Based on material from ECDC at EpiTrain V, Vilnius, October 26 2007.

Update on ECDC and EPIET

Preben Aavitsland and Jurgita Pakalniskiene

Based on material from ECDC

at

EpiTrain V, Vilnius, October 26 2007

Why was ECDC established?

•Emerging and re-emerging communicable diseases revitalised through globalisation, bioterrorism, interconnectivity, and EU without internal borders

•Health implications of enlarging EU•Strengthen EU Public health capacity to help

meet EU citizen’s concerns

• EU level disease surveillance

• Scientific opinions and studies

• Early Warning system and

response

• Technical assistance and training

• Epidemic intelligence

• Communication to scientificcommunity

• Communication to the public

What does ECDC do?

Identify, assess & communicate current & emerging health threats to human health from communicable diseases

Who are ECDC’s strategic partners?

ECDC

MS

CommissionCouncil

EP

Networks

EU agencies

Researchcommunity

WHO

NGOs

CDCs

Industry

Other countries

How is ECDC organised?

Administrative

Services

Healthcommunication

Preparedness &

response

SurveillanceScientificadvice

Director and Director's CabinetManagement Governance External relations Country

cooperation

Antimicrobial resistance & healthcare-associated infections

Food- & waterborne diseases

HIV, STI & Hepatitis

Influenza

Other diseases of environmental & zoonotic origin

Tuberculosis

Vaccine preventable diseases & invasive bacterial infections

How does ECDC communicate?

• Scientific communication- Eurosurveillance- Website- Scientific reports and publications

• Information to the

Public/Media- Press/media- Website – multilingual in 2008- Coherence in risk communication

• Support to the Member States- Network(s) of health communicators,

e.g. with EC on influenza- Sharing of information and expertise- Joint projects with MSs (in pipeline)

Some current themes

• Wide area of work- Antibiotic day- ESCAIDE conference- TESSy- Reports on H5N1 vaccines- Assistance to countries- Evaluations in countries

• Networks- EuroHIV, EuroTB, EISS etc etc

• National contact points- Vaccination- Antibiotic resistance- Etc

Learn more about ECDC:

www.ecdc.europa.eu | [email protected]

EPIET• European Programme for Intervention Epidemiology

Training (EPIET)• Created in 1994• Funded by the European Commission (60%) and EU

Member States until 2007• Coordinators:

– Arnold Bosman, based at ECDC in Stockholm, Sweden (100%, leading coordinator)

– Marta Valenciano, based at Carlos III in Madrid, Spain (100%)

– Viviane Bremer, based at RKI in Berlin, Germany (40%)– Richard Pebody, based at HPA-CfI in London, UK (40%)

EPIET programme objectives

To: • Strengthen CD surveillance & control in EU

• Develop a European network of intervention epidemiologists

• Develop a response capacity inside & beyond EU:

– surveillance

– outbreak investigations

– applied research

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

Training format

• Theoretical training– An introductory course (2½ weeks), open to

external participants

– At least 6 one-week training modules rotating in EU Member States

• Learning by doing practical training– 23 months

– At a European public health institute

– On site supervision by senior epidemiologists and from EPIET coordinators

Time frame per cohort

Sept-Oct 07 Sept-Oct 09

Cohort 13: 16? fellows

Sept-Oct 07

Cohort 11: 16 fellows

Sept-Oct 05

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.

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

Training modules in 2000-2006• 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)• Vaccinology (Glasgow, Helsinki, Stockholm, London, Bilthoven)• Data management (Bilthoven) • Computer & outbreak investigations

(Heraklion, Athens, Paris, Malta, Budapest, Vienna)• Bioterrorism (Berlin)• Time Series Analysis, Logistic Regression (Bordeaux)• Scientific Writing (Berlin)

• Logistic regression (Madrid)

Training sites in Europe “learning by doing”

Oslo

Helsinki

Copenhagen

Madrid Rome

BerlinBilthoven

Paris

Belfast

DublinLondon

Cardiff

Glasgow

LyonGeneva

Stockholm

Prague

Glasgow

Paris

Belfast

Cardiff

RomeMadrid

Helsinki

StockholmOslo

Brussels

Bilthoven Berlin

Copenhagen

LyonGeneva

London

Dublin

PragueSouthWest

Budapest

Warsaw

Vienna

Athens

• 25 Nations + Norway + Switzerland +WHO

• 24 Training sites (16 for cohort 12)

Sites in red: was open for cohort 13

Supervision of fellows

• Supervision on site by at least 1 senior epidemiologist

• Draft protocols/reports/manuscripts sent to coordinators

• Viadesk as virtual office

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 in 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

EU Cross-border Investigations 1999-2006

• 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

Research Projects (examples) • Risk factors (RF) for Hantavirus in France and

Belgium• RF for meningococcal meningitis in day care

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

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 Ireland

• Evaluation of surveillance system– EHEC in France– STI in Finland– Syphilis in Germany– Tuberculosis in Spain

EPIET international missions (1)• Outbreak investigations Infants deaths following immunisation (Egypt) Tularaemia (Kosovo) Suspected anthrax (Ethiopia) Ebola (Uganda, Gabon, Sudan) Hepatitis E (Sudan) Marburg fever (Angola) Measles (Nigeria, Niger, DRC) SARS (Hongkong) Meningitis (Sri Lanka) Avian influenza (Vietnam, Turkey, Azerbaijian)

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, Azerbaijian)

Read more

• www.epiet.org