1. Epidemic Intelligence A new paradigm for surveillance
Denis Coulombier
ECDC

2. Epidemic Intelligence Model

3. 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

4. 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. »

5. 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

6. Epidemic intelligence Event detection

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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

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