1. European Legionnaires’ disease Surveillance Network (ELDSNet)
Julien Beauté
ECDC Legionnaires' disease training course
London, 15 October 2012
Minor update: 2018

2. Outline
Introduction
The European Centre for Disease Prevention and Control
From EWGLINet to ELDSNet
Surveillance of Legionnaires’ disease in Europe
Annual retrospective surveillance
Daily surveillance of travel-associated cases

3. 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
ECDC : An EU agency dedicated to the prevention and control of infectious diseases

4. What does ECDC do?
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
Scientific opinions and studies
Early Warning System and response
Technical assistance and training
Epidemic intelligence
Communication to scientific community
Communication to the public
In the EU, public health is a shared competence. Our role is primarily in risk assessment and we have an advisory role in risk management which is primarily a Member State competence coordinated by the Commission.

5. The European Surveillance System (TESSy) : a unique platformMS
Data upload and access by Member States (MS)
Data access by…
National institutes
Disease experts
General public
Advisory Forum members
Management Board members
WHO
EMCDDA
EFSA
Others
Data users in Member States
TESSy The European
Surveillance System
Now ECDC provides a one stop shop for the collection, analysis and dissemination of EU level data. This makes facts and analysis more easily available to policy makers and contributes to the detection and assessment of threats of European dimension. A key task now for ECDC and its counterparts in the Member States is to improve the quality, timeliness and comparability of EU data.
Standardisation of data collection on infectious disease surveillance
Database:
One single point of reporting and retrieving data for Member States
Standardisation of reports based on surveillance data
Providing a consistent overview of the current situation in the EU
Outputs:
Automatic reports within TESSy
Regular updates on website
Annual Report
Interactive database

6. Surveillance networks funded by the European Program of Public health
Basic Surveillance Network
Divine-net
vCJD
EUCAST
DIP-net
EISS
EARSS
Enter-Net
EUVAC
Measles
EWGLINet
EU-IBIS
ESSTI
ENVID
ESAC
Tuberculosis
HIV/AIDS
IPSE
Surveillance networks funded by the European Program of Public health

7. From EWGLINet… European Working Group for Legionella Infections
Created in 1986
EU funding since 1993
International collaboration
Epidemiologists and microbiologists
Biennial reports since 2000

8. … to ELDSNet European Legionnaires’Disease Surveillance Network
Since 2010
EU27 + Island + Norway
First report in 2011
3rd annal meeting : sept. 2012
Activities
Surveillance of Legionnaires’ disease
Follow-up of travel-associated clusters
Laboratory activities …

9. Annual retrospective surveillance
Collection of disaggregate data through TESSy
ELDSNet members (each country’s own residents)
Confirmed and probable cases of Legionnaires’ disease with onset in the previous year
EU case definition

10. TALD surveillance Data Daily surveillance Cases reported in TESSy
Notifications
Single cases
Clusters (all network)
Rapidly evolving clusters
Follow-up
Forms A & B
Publication of non compliant accommodations

11. Supplementary data

12. Definitions
Cluster: Two or more cases who stayed at or visited the same accommodation site in the 2-10 days before onset of illness and whose onset is within the same two-year period.
Rapidly evolving cluster: Cluster that has 3 cases with dates of onset within a period of 3 months. [this will lead to a specific notification report to tour operators]

13. ELDSNet Travel-associated Legionnaires’ disease (per year) ~900 cases
>100 clusters (167 in 2015)
>50% clusters unlikely to be detected without ELDSNet
Most clusters: 2 cases
~10 accommodation sites published per year
All Legionnaires’ disease in Members States
cases reported per year (7034 in 2015)
France, Italy and Spain = 60% of all cases

14. ELDSNet: cluster detection
Three people from three different EU MS has been to the same Spanish hotel. They fell ill at home and are reported through the national system to the national contact point. Then it is reported to ECDC/ELDSNet and the cluster is detected by the ECDC ELDSNet team. A cluster notification is sent out to all MS and the country of infection should provide ECDC with timely information about implemented control measures. If no information is sent or if the control measures are unsatisfactory the name of the accommodation site will be published on the ECDC website.

15. ELDSNet work flow ECDC Single case notification ECDC web EU Member
Cluster detection
Online case
reporting
EU Member
States
TESSy
EPIS
Tour operators **
Notification single site/
cluster *
Forms A
+ B
Country of infection
** Tour operators are informed about all clusters outside EU and all rapidly evolving clusters. When a satisfactory form B is returned they are also informed
* Cluster notifications are copied to all Member States

16. References
ECDC Annual Epidemiological Report for Legionnaires’ Disease (

17. Facilitator notes:
Acknowledgements The creation of this training material was commissioned in 2010 by ECDC to Health Protection Agency (UK) and the University of Chester (UK) with the direct involvement of Louise Brown, Janice Gidman, Emma Gilgunn-Jones, Ian Hall (on behalf of the ECDC Legionnaires Disease Outbreak Toolbox Development Group), Tim Harrison, Rob Johnston, Carol Joseph, Sandra Lai, John Lee, Falguni Naik, Nick Phin, Michelle Rivett, and Susanne Surman-Lee. This presentation was created by ECDC in The revision and update of this training material was commissioned in 2017 by ECDC to Transmissible (NL) with the direct involvement of Arnold Bosman and Kassiani Mellou.