Transcript Epidemic Intelligence A new paradigm for surveillance

Epidemic Intelligence
A new paradigm for surveillance
Denis Coulombier
ECDC
Epidemic Intelligence Model
Early Warning
Response
Public health
significance?
Signal
Yes
Yes
Yes
Unusual disease
pattern?
Event verified?
Public Health
Alert
International
concern?
Yes
Case-based
surveillance data
Event-based
surveillance
reports
Public Health
Emergency of
International
Concern
Investigation
& control
Process
Decision
Lab
Report
Priority
disease
notification
Media
Report
Community
Concern
Rumour
Clinician
Concern
Notification
to WHO
Status
Source
Epidemic Intelligence
Framework
Event-based surveillance
EWRS
MS
DSN’s
EWGLI
Enternet
EISS…
BSN
EMEA, EFSA
MedISys
GPHIN
WHO-OVL
Promed
OIE
FAO
…
Indicator-based surveillance
Report
Data
Capture
Filter
Verify
Collect
Analyse
Interpret
Signal
Assess
Disseminate
Public health alert
Investigate
Control measures
DSN’s
BSN
Laboratory
network
EWRS
MS
Commission
Other heath
related EU
agencies
WHO-IHR?
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
Event verification
Status
Event
Decision
Process
Is the event
relevant?
Yes
Immediate
verification
required?
No
Irrelevant event
Yes
No
Verification
Verification
within 24 hours
Signal
Event not verified
The WHO Experience
Recorded and Verified Events by Year
Year
Events recorded
Events verified (%)
1998
1999
2000
2001
2002*
164
146
235
199
68
95 (58)
104 (71)
161 (68)
129 (65)
46 (68)
Total
812
535 (66)
Median days to verification = 2
Range 0 to 109 days
* Up to March 31, 2002
Signal assessment
Status
Signal
Decision
Significant
public health
impact?
No
No
Alert not confirmed
Yes
Risk of European
spread?
Insufficient
national capacity
for response?
No
Yes
Need for European
information?
No
Alert of National scope
Yes
Yes
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