Epidemic Intelligence A new paradigm for surveillance Denis Coulombier ECDC

Epidemic Intelligence Model

Epidemic Intelligence Framework Event-based surveillance Indicator-based surveillance EWRS MS DSN’s EWGLI Enternet EISS… BSN EMEA, EFSA MedISys GPHIN WHO-OVL Promed OIE FAO … DSN’s BSN Laboratory network Report Data Capture Filter Verify Collect Analyse Interpret EWRS MS Commission Other heath related EU agencies WHO-IHR? Signal Assess Disseminate Public health alert Investigate Control measures

Epidemic Intelligence Definition « Epidemic intelligence is the process to detect, verify, analyze, assess and investigate signals that may represent a threat to public health. It encompasses all activities related to early warning functions but also signal assessments and outbreak investigation. »

Epidemic Intelligence Input MS, EWRS, DSN’s (EWGLI, Enternet, EISS…), BSN MedISys, GPHIN, WHO outbreak verification list, Promed Verification, analysis Assessment, investigation, response In liaison with MS and Commission With a European added-value perspective Output Daily verification list (internal) Weekly summary (EWRS, epidemiologists, policy-makers) EuroSurveillance weekly? Yearly report

Epidemic intelligence Event detection

Event verification The systematic process by which ECDC verifies the reality of events, their aetiology, potential for spread and the need for assistance in affected member states Focuses on events of European Public Health Concern

Immediate verification required? Verification within 24 hours Event verification No Is the event relevant? Yes Immediate verification required? Status Decision Process Irrelevant event Event Verification within 24 hours Event not verified Verification Signal

The WHO Experience Recorded and Verified Events by Year 95 (58) 104 (71) 161 (68) 129 (65) 46 (68) 535 (66) Median days to verification = 2 Range 0 to 109 days Year Events recorded Events verified (%) 1998 164 1999 146 2000 235 2001 199 2002* 68 Total 812 * Up to March 31, 2002

Signal assessment Signal Status Significant public health impact? No Decision Significant public health impact? No Yes Risk of European spread? Alert not confirmed No Insufficient national capacity for response? No Need for European information? Yes Yes No Yes Alert of National scope Alert of National scope requiring European information Alert of national scope requiring European support Alert of European scope Requiring European coordination

Criteria for Signal Assessment Unknown illness High mortality or morbidity European disease spread Interference with travel or trade Need for European assistance Suspected accidental or deliberate release of biologic or chemical agents

Standard operating procedures Daily Coordinating Meeting Review incoming reports of events Monitor the verification process Determine which events should be included in the weekly bulletin Determine which events should be posted on the Early Warning and Response System Assess the need for ECDC-facilitated assistance Initiate a response to the assessed need for ECDC-facilitated assistance Monitor ECDC-facilitated assistance

Event verification list, Olympic Games EWAR system, Athens, Greece, August 2004

Feedback at European Level ECDC threat assessment weekly bulletin European commission commisionner briefing Early Warning and Response System Eurosurveillance ECDC website