1. SURVEILLANCE OF WATER-RELATED DISEASES watsan@ecr.euro.who.int

2. Protocol obligations Art 8 Ensure that comprehensive national and/or local surveillance and early-warning systems are established, improved or maintained Ensure that comprehensive national and/or local surveillance and early-warning systems are established, improved or maintained Within three years of becoming a Party, each Party shall establish the surveillance and early warning system, contingency plans and response capacity Within three years of becoming a Party, each Party shall establish the surveillance and early warning system, contingency plans and response capacity

3. Protocol obligations Article 12  The establishment of joint or coordinated systems for surveillance and early-warning systems, contingency plans and response capacities as part of, or to complement, the national systems maintained in accordance with Article 8  The development of integrated systems and databases, exchange of information and sharing of technical, legal knowledge

4. Current status of surveillance  Differences in: Legal definition of water-borne diseases Legal definition of water-borne diseases National legal reporting requirements National legal reporting requirements Disease classification Disease classification Sampling protocols, laboratory analysis, data quality Sampling protocols, laboratory analysis, data quality Reporting practices Reporting practices Electronic data transmission, management and interpretation Electronic data transmission, management and interpretation Participation in international monitoring and assessment Participation in international monitoring and assessment

5. Priority diseases (1999 – 2006) CholeraEHECShigellosisTyphoidV-HPA EUR A 20911,83053,5037,04562,020 EUR B 8339,31050,13777,958332,693 EUR C 01,48891,772500145,911 TOTAL29252,628195,41285,503540,624

6. Secondary diseases (1999 – 2006) Campylo-bacteriosisCrypto-sporidiosisGiardiasis EUR A 746,51341,71875,950 EUR B 12,0916132,167 EUR C 66,31329231,357 TOTAL824,91742,071139,474

7. Discussion  Mortality: reasonably comprehensive assessment reasonably comprehensive assessment  Morbidity: Primary importance: EU covered, EFTA countries possibly look at diseases as “imported”, weak in eastern countries Primary importance: EU covered, EFTA countries possibly look at diseases as “imported”, weak in eastern countries Secondary importance: EU partly covered, very weak in eastern countries Secondary importance: EU partly covered, very weak in eastern countries  EU legislation likely to improve coverage

8. Interim implementation  Consultation on assessment of evidence base and development of reporting system (Bonn, 2001)  Consultation on waterborne disease surveillance (Budapest, 2001 and 2006)  5 th Mtg of the WGWH

9. ACTION ELEMENTS  Evaluation national surveillance systems according WHO guidelines  Strengthening of national surveillance systems in Technical areas incl diagnostic tools Technical areas incl diagnostic tools Legal issues Legal issues Data recording, reporting, and interpretation Data recording, reporting, and interpretation  International cooperation, particularly ECDC

10. Work plan elements consideration  Surveillance guidance documents including translation into national languages based on work in intermediate period.  Development of integrated strategy for surveillance of water related diseases including reporting  Outbreak definition, detection, planning

11.  Preparation of guidelines for surveillance, outbreak detection and early warning, contingency plans and capacity building  Evaluation of surveillance systems through country missions – 6 missions  TF for review and adaptation of WHO Guidelines – 3 mtgs  Translation and publications (Russian)  Staff time

12. Specific needs  Surveillance in other environments, i.e. recreational waters  Surveillance with specific targets in mind, i.e. children in line with CEHAPE  Surveillance in an environment of climate change.