1. ecdc.europa.eu Tommi Asikainen, Tubingen, 22 October 2008 European Centre for Disease Prevention and Control FUTURE DISEASE CHALLENGES IN EUROPE – where modelling is needed

2. 2 ECDC modelling activities Expert meeting: Now-Casting and short-term forecasting –Realtime modelling during an influenza pandemic Expert meeting: Chikungunya modelling Seminars HIV (open) –Prevalence estimations Varicella (open) –Introduction into national child vaccination schedules

3. 3 Upcoming ECDC modelling activities Surveillance in an influenza pandemic meeting –60 participants, 20 modellers Pandemic influenza planning assumptions meeting –30 participants, 15 modellers HIV prevalence estimation meeting

4. 4 Upcoming ECDC modelling activities Curriculum for providing modelling training meeting TB modelling in low prevalence countries meeting Use of synthetic populations meeting –Upon budget availability Modelling call for tenders –Upon budget availability

5. 5 How will this meeting benefit you? Meetings –Specialized –With other expertise involved Project proposals –DG Research (European Commission) –EAHC Executive Agency for Health and Consumers (former PHEA) –ECDC Ways to influence –Meeting report –Shared with partners –ECDC ”lobbying” – Time frame

6. 6 Will ECDC only rely on your opinion?

7. 7 Top 10 future disease threats Excellent meeting

8. 8 Antimicrobial resistance Production line on developing new drugs –Today new treatments are available after 7-10 years –Effect on the spread by reducing this time Community acquired MRSA

9. 9 Antimicrobial resistance Some other strategies, of varying cost effectiveness depending on how resistant and how prevalent a particular pathogen is, would include: 1.Developing vaccines against completely resistant pathogens. 2.Increasing effectiveness of infection control methods and technologies in the healthcare setting. 3.Developing and implementing screening and cohorting methods to prevent exposure and transmission.

10. 10 Antimicrobial resistance Some other strategies, of varying cost effectiveness depending on how resistant and how prevalent a particular pathogen is, would include: 4.Developing effective methods for eliminating carriage of resistant pathogens. 5.Developing and using point of care tests that detect antibiotic susceptibility patterns to ensure appropriate treatment. 6.Developing and using point of care tests that have high sensitivity and specificity for distinguishing viral from bacterial infections to ensure appropriate treatment.

11. 11 Vaccine preventable diseases Measles –Can we eliminate the disease within a five year period in EU countries? –What happens with the groups in seventies who were not affected and did not get a measles vaccine Rubella –What is the situation within a five year period? Varicella –New quadrivalent measles-mumps-rubella-varicella available in EU –Data from US (effectiveness, impact on herpes zoster) –Member States need help

12. 12 Tuberculosis Forecasting of impact on the epidemic in low incidence countries of cohorts from high burden countries and the relative impact of control measures (i.e. screening) –Ongoing ECDC work, but in need of better modelling work Modelling future progress towards elimination given current trends of transmissions and burden distribution in low incidence countries

13. 13 Tuberculosis Modelling impact of new tools on control effectiveness –Diagnostics –Interferon Gamma Release Assays (IGRA) –Line probe assays (rapid molecular testing) –Liquid media culture, Moxifloxacin, Gatofloxacin –Drugs reducing treatment period

14. 14 Influenza School closures, closing bordures, reduced travel..... –School closures (Simon Cauchemez et al 2008) –Border closures, reduced travel But......... Operational modelling –Decision makers want to know optimal distribution of antivirals and anticipated hospital occupancy Seasonal influenza – Prevalence – Vaccine effectiveness

15. 15 Vector borne / emerging infections ”Climate change” –Effect of extreme heatwaves –MoMo (Mortality Monitoring) network –Introduction of new pathogens Risk Mapping –Risk maps of Aedes Albopictus (unpublished) –TBE Swedish data used to predict the situation in Finland Linking epidemiological and environmental data –E3 network

16. 16 Burden of Disease ECDC has launched a huge tender Total burden for ”all” infectious diseases

17. 17 ”ECDC wish list” More work on vaccine effectiveness definitions Advice on how to measure and analyse contact patterns –Build on the POLYMOD project Model comparisons Methodology for modelling mortality of diseases –Baseline –Bayesian based

18. 18 ”Top 10” future modelling challenges

19. 19 ECDC expert meeting on Chikungunya modelling 1.Entomological data –”Biased” traps 2.Effects of interventions –Need to know how the surveillance system works Example 1

20. 20 Expert meeting on pandemic influenza realtime modelling 1.What data to collect –Modellers Surveillance Decision maker 2.Which models to use –What does the decision maker want to know? Example 2

21. 21.........the floor is now open for discussion on what YOU think is important.