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Eurosurveillance Weekly: Thursday 21 June 2001. Volume 5, Issue 25
Contents:
1. European Community action to enhance the capacity to tackle communicable diseases takes
a major step forward
2. EU extended inventory of resources for communicable diseases control now available on the
internet
3. Outbreak of Crimean-Congo haemorrhagic fever in Kosovo - update
4. Council of Health Ministers decision on variant-CJD and TSE
5. Central and Eastern Europe - Baltics Communicable Disease Network
6. European Community committed to supporting new Global Health Fund for HIV/AIDs, malaria
and tuberculosis
European Community action to enhance the capacity to tackle communicable
diseases takes a major step forward.
On June 5th the EC Council of Health Ministers agreed a common position on the proposal to adopt a
programme of Community action in the field of public health for 2001 to 2006. The current version(1)
incorporates the modifications introduced by the Commission following the first reading of the
proposal by the European Parliament on April 4th. There will be a second reading in the Parliament
before the Council of Health Ministers can proceed with final adoption.
A major part of the public health programme will be concerned with enhancing the capacity to tackle
communicable diseases. This will be achieved through a) progressing the implementation of Decision
2119/98/EC on the Community network on the epidemiological surveillance and control of
communicable diseases, b) enhancing the safety and quality of human blood through a
haemovigilance network, c) operating an appropriate Community network to enhance the safety and
quality of organs and substances of human origin, and d) developing a Community vaccination
strategy.
Progressing the Community communicable disease surveillance networks will involve developing
case definitions and epidemiological and surveillance methods, including specifying the nature and
type of data to be collected about priority diseases or special issues. Provision is to be made for a
Community incident investigation team and procedures will be developed for information exchange
consultation and co-ordination between Member States and with the candidate countries. Guidelines
will be prepared on the protective measures to be taken, in particular at external frontiers and in
emergency situations including epidemics or pandemics.
The communicable disease part of the programme will also include assembling and analysing
surveillance data held in existing databases, and conducting network inventories, in order to identify
the most appropriate public health strategies. An emphasis will be placed on improving the operation
of networks, especially in relation to common investigations, through training, continuous assessment
and quality assurance.
The Commission did not accept the Parliament’s reference to a specific identified ‘centre’ or
‘structure’, but agreed it is important to ensure co-ordination so that any networks that are established
work together in an integrated fashion. The Commission is adhering to the view that the best way to
continue to make available the essential technical and analytical expertise of the Member States is by
putting in place appropriate structural arrangements.
While the Council of Health Ministers recommended that the overall Programme budget be reduced to
euro 280 million from the euro 380 million advocated by the Parliament, The Commission remains
hopeful that the final budget will be close to the euro 300 million it proposes. Of special interest is the
decision by the Commission to raise to 70% the maximum percentage of a project’s cost that it will
fund.
References
1. Commission of the European Communities. Amended proposal for a decision of the European Parliament and
Council adopting a programme of Community action in the field of public health (2001-2006). Brussels, 01.06.2001,
COM(2001)302 final. 2000/0119 (COD). (http://www.europa.eu.int/eur-lex/en/com/greffe_index.html)
Reported by Noel Gill, ([email protected]), Public Health Laboratory Service, Communicable
Disease Surveillance Centre, London.
EU Extended Inventory of Resources for Communicable Diseases Control now
available on the Internet
The infrastructure for co-ordinating the monitoring, control and prevention of communicable disease at
the European level has been developed in recent years through a series of European Commission
funded projects and programmes and the formation of the EU Network Committee. The major
horizontal elements of this infrastructure, bridging across the disease-specific initiatives, include the
weekly and monthly Eurosurveillance journal (1), the European Programme on Intervention
Epidemiology Training (EPIET) (2) (http://www.epiet.org) and the European Union Public Health
Information Network (EUPHIN) (http://hsscd.euphin.org). An important component of EUPHIN is the
new Extended Inventory on Resources of Communicable Diseases Control (IRIDE)
(http://iride.cineca.org) which will be continuously updated through a network of national gatekeepers
each in charge of a specific part. At present much of the information currently held is that which was
originally collected in 1997 (3). While this may not reflect current arrangements in some countries,
the new internet access will facilitate swift revision. In future the resource will be accessed through
the EUPHIN portal.
The Extended Inventory represents another key resource for all those involved in the monitoring,
control and prevention of communicable disease within Europe. It contains information that will
facilitate the comparison of health status and the evaluation of programmes and actions across the
EU, as well as acute responses to communicable disease outbreaks and collaborative working and
research.
The original database contained information on Member States of the European Union plus Norway
and Switzerland, while the Extended Inventory will contain information on Member States and
countries that are candidates to join the European Union, including countries from Central and
Eastern Europe and the Baltic. The development of the earlier inventory and the more recent
extended inventory has been co-ordinated by the Istituto Superiore di Sanità (ISS) in Rome.
For each participating country IRIDE holds information on each of the following themes:
1. The system of statutory notification of infectious diseases,
2. The systems of non-statutory reporting,
3. The system of outbreak detection and investigation and the management of highly contagious
patients,
4. The institutions with a significant role in the monitoring and control of infectious diseases,
5. The laboratories acting as reference centres for specific pathogens.
The main body of information in the original Inventory was collected by means of standardised
questionnaires filled out by specific “local counterparts” for each area investigated in each Member
State. In most cases, the appropriate primary local counterparts were the heads of the public health
institutions dealing with communicable diseases. In addition, an ad hoc collection of information
through questionnaires (or “surveys”) was conducted on the following topics:
1. The legal basis, general organisation, and hierarchy of responsibility for the monitoring and
control of communicable diseases,
2. The existence of warning procedures and epidemic preparedness at the national level,
3. The existence of training activities for personnel involved in monitoring and control.
The new facilities for querying the Inventory not only allow information to be accessed rapidly and
dynamically but also facilitate exploration of variations between countries and between diseases in
the systems employed for monitoring and control. This information will allow public health
practitioners and policy makers to identify different models of communicable disease control and will
provide important background information for the interpretation of indices of disease frequency in
different countries. Moreover, the Inventory contains contact information so that further information
may be obtained directly from participating countries should this be necessary. This collation of
comparative data is also an important first step towards developing standards for communicable
disease monitoring and control (4).
The effective and efficient control of an acute communicable disease incident often requires rapid
access to relevant epidemiological or microbiological expertise and to surveillance data and
appropriate laboratory facilities. This can often be a problem when dealing with international
incidents, particularly for those diseases that are not covered by any of the dedicated European
surveillance networks. Similarly rapid access to such information can be required when an incident is
confined to one country if there are not the appropriate resources within that country. IRIDE
addresses this problem by providing ready access to reliable contact information on national experts
and reference microbiology services
The continued value of the Inventory will depend on its being updated and subjected to appropriate
quality assurance.
References
1. Eurosurveillance (http://www.eurosurveillance.org)
2. van Loock F, Rowland M, Grein T, Moren A. Intervention epidemiology training: a European perspective.
Eurosurveillance 2001; 6: 37-43.
3. Salmaso, S. Inventory of the means of controlling communicable diseases in the European Union, Norway, and
Switzerland: Report on the analysis of the information collected. European Commission – Directorate General V:
1998.
4. Tegnell A, Giesecke J. Setting standards for surveillance at European Union level. Eurosurveillance Weekly 2000;
4:000914 (http://www.eurosurv.org/2000/000914.htm)
Report prepared by S Salmaso, ([email protected]), Istituto Superiore de Sanita, Rome, M Catchpole,
([email protected]) and K Macarthur, ([email protected]), Public Health
Laboratory Service, Communicable Disease Surveillance Centre, London, and B Pedalino,
([email protected]), Istituto Superiore de Sanita, Rome
Outbreak of Crimean-Congo haemorrhagic fever in Kosovo – update
Last week, Eurosurveillance Weekly reported on an outbreak of Crimean-Congo haemorrhagic fever
(CCHF) in Kosovo (1). Three new suspect cases were reported on June 18 and 19 so that from May
18, 2001 to June 19, 2001, 57 suspected CCHF cases were registered, of which 4 have died. Twelve
of the cases have been classified as confirmed (10 on laboratory and 2 on clinical/epidemiological
grounds). Twenty seven cases are negative on laboratory tests and 18 further suspected cases are
still under investigation. Of the 12 confirmed cases, 5 were infected through contact with 1 case with
haemorrhagic disease. The remaining seven are likely to be primary infections (Source: Institute of
Public Health, Pristina, Kosovo).
Most of the primary infections have occurred in areas of Kosovo that have had CCHF activity in
previous years. CCHF infections are expected to continue throughout the summer and autumn
months while ticks are active.
The WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference in Ljubljana,
Slovenia continues to provide support in the field by extending the stay of their staff member. In
addition the North Manchester General Hospital, Department of Infectious Diseases, have provided a
clinician with specific expertise in hospital infection control who is working to strengthen procedures at
the isolation unit. A two person WHO rapid assessment team visited Kosovo from 12 to 15 June
2001. The team worked with the epidemic response committee, the Institute for Public Health, the
Clinic for Infectious Diseases and WHO Kosovo to support the outbreak response in epidemiology,
laboratory support, case management, hospital infection control, environmental control measures and
health education.
References
1. Outbreak of Crimean-Congo haemorrhagic fever in Kosovo. Eurosurveillance Weekly 2001; 5: 010614.
(http://www.eurosurv.org/2001/010614.html)
Reported by Cathy Roth, ([email protected]), WHO, Geneva.
Council of Health Ministers decision on variant-CJD and TSE
The EC Council of Health Ministers at its Meeting on June 5 reviewed the epidemiology of variant
Creutzfeldt-Jakob Disease (vCJD) and the EC’s pro-active strategy on Transmissible Spongiform
Encephalopathies (TSEs) and concluded that the Member States and the Commission should further
develop prevention efforts for these diseases within the network for epidemiological surveillance and
control of communicable diseases(1).
The Council agreed that Member States should ensure effective surveillance for human cases of
TSEs and promote good practice for risk communication to the public on vCJD. Information on good
practice for medical and social care of patients with CJD, including vCJD, and their relatives, should
be exchanged. Research in this area should be promoted and co-ordinated, and there should be
close cooperation on the topic with the Commission and other international fora, such as the WHO.
The Commission was invited by the Council to ensure that relevant Community policies and activities
contribute to health protection against risk from TSEs. Efficient and reliable strategies and methods
for the prevention and control of TSEs at Community level and methods to assess their risks to
human health should be promoted and developed. Community policies should take account of any
TSE risk assessment. Existing surveillance mechanisms on vCJD at the Community level should be
enhanced to make full use of the data on human cases in order to improve risk assessment.
The Commission was also asked to support exchange of information on good practice for risk
communication to the public about vCJD and to consider measures for the safety of organs and
substances of human origin. Research, that builds upon the Inventory of National Research on TSEs
in Europe, should be promoted into - the origin and possible transmission of TSE agents, - methods
and products to render TSE agents inactive, - diagnostic tests for TSEs, especially those for early
detection in accessible tissues, - the risks of iatrogenic transmission and protective measures against
these possible risks, - the development and evaluation of possible therapies.
Protective measures against possible risks of iatrogenic transmission are to be kept under continual
review by the Commission, applying the precautionary principle as appropriate. Finally the
Commission is to support the exchange of information on measures to eradicate risk overall and to
reduce possible risks of iatrogenic transmission.
References
1.
Press release, 2354th Council Meeting 5 June 2001, 9295/01 (217) (http://ue.eu.int/newsroom/main.cfm?LANG=1)
Reported by Noel Gill, ([email protected]), Public Health Laboratory Service, Communicable
Disease Surveillance Centre, London.
Central and Eastern Europe - Baltics Communicable Disease Network begins
with measles surveillance
Surveillance experts have always responded to the threats of communicable diseases from other
countries by collaborating and exchanging information across borders. These activities are now
becoming formalised with the establishment of surveillance networks which facilitate and promote the
exchange of communicable disease data and information.
An Expert Consultation on the Harmonization of Surveillance Systems for Central and Eastern Europe
held in Bucharest, Romania, in December 2000 agreed to the establishment of a CCEE-Baltics
Communicable Disease Network (CEE-CDN). This comprises technical representatives with
responsibilities in communicable disease surveillance at national level from the following States:
Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Latvia,
Lithuania, Poland, Romania, Slovakia, Slovenia, The former Yugoslav Republic of Macedonia,
Turkey, (Yugoslavia and Malta joined the group in May 2001).
A short questionnaire had been circulated before the meeting which helped to determine the range of
opinion about where benefits are likely to be gained from participation in an international
communicable disease surveillance network. The meeting was supported by expert input from
individuals with experience of taking similar action within the EU. It was decided that the full network
would meet at least annually and that a small working group, supported by a secretariat, would be
established to develop discussion papers and proposals for consideration by the full CEE-Baltics
CDN.
The working group undertook a prioritisation exercise that selected measles as a pilot infectious
disease for the exchange of surveillance data. Subsequently measles data has been interchanged
using the technical support of the European Regional Office of WHO.
A full meeting of the 17 members of the CCEE-Baltics CDN was held in Prague last week (June
2001). Progress was reviewed and future directions discussed. Participants agreed with the
selection of Measles for piloting information exchange systems. All participants will begin to
contribute to a database to be managed by WHO. Systems will be set up for the rapid feedback of
surveillance information and data queries to participants. The establishment of electronic rapid alert
systems and extension of data exchange to other diseases was also discussed.
The importance of training in intervention epidemiology was a major issue for participants, and will be
the subject of future consideration by the working group – and a bid for funding a training programme
will be prepared. The experience gained within the EU, particularly with the EPIET programme(1) will
be invaluable in helping to shape future training programmes.
Other activities discussed at the Prague meeting included
- contributing to the IRIDE (EU) database(2) of communicable disease resources,
- closer links to other EU based Networks such as Enternet(3)
- the harmonisation of case definitions(4)
- the development of agreed minimum datasets for exchange of information at international level.
The CCEE-Baltics CDN has progressed rapidly and is now developing some ambitious proposals
which will enhance the quality of communicable disease surveillance at international level in the
participating countries. It will also enhance the global effort to combat the threat of communicable
disease through better international collaboration and the swift exchange of data and information.
References
1. van Loock F, Rowland M, Grein T, Moren A. Intervention epidemiology training: a European perspective.
Eurosurveillance 2001; 6: 37-43 (http://www.eurosurveillance.org/eurosurveillance.htm)
2. Catchpole M, Macarthur K, Salmaso S. EU extended inventory on resources of communicable diseases control,
Eurosurveillance Weekly 2001; 5: 010621 (http://www.eurosurv/2001/010621.html)
3. Fisher IST, on behalf of the Enter-net participants. The Enter-net international surveillance network - how it works.
Eurosurv 1999; 4: p 52-5. (http://www.eurosurveillance.org/eurosurveillance.htm)
4. Tegnell A. Case definitions for infectious diseases. Eurosurveillance Weekly 2000; 4: 000316.
Reported by Bohumir Kriz, Chairman CEE-Baltics CDN, National Institute of Public Health, Prague,
Massimo
Ciotti,
([email protected]),
WHO
Euro,
Copenhagen
and
Julius
Weinberg,
([email protected]), City University, London.
European Community committed to supporting new Global Health Fund for
HIV/AIDs, malaria and tuberculosis
The Global Health Fund is intended to mobilise, manage and disburse additional and complementary
grant resources to enable developing countries to achieve more rapid progress with preventing
HIV/AIDS, malaria and tuberculosis (TB). The Fund aims to lower transaction costs for both donors
and countries, maintain high accountability for results, and build on existing development processes.
This international fund will be open to contributions from government and private donors, and will
provide support to beneficiary countries based on defined eligibility criteria. It is to be an alliance of
partners working from existing institutions under the collective responsibility of a governing board.
The proposed structure comprises an Executive Board, a Secretariat supported by a technical
resource panel and an intermittent Stakeholders meeting.
The Fund will be a complementary instrument to facilitate additional resource flows and has evolved
from a series of high level consultations over the past year. These have included the High Level
Round Table on accelerated action targeted at major communicable diseases within the context of
poverty reduction: HIV/AIDS, malaria and tuberculosis, (convened by the European Commission
under the aegis of the French Presidency of the EU and co-sponsored by WHO and UNAIDS in
Brussels), the G8 Okinawa Summit and the adoption of the EC Programme for action: Accelerated
action on HIV/AIDS, malaria and tuberculosis in the context of poverty reduction by the General
Affairs Council.
A transitional board or working group will be set up immediately following the UN special session on
HIV/AIDS (25-27 June 2001). It is envisaged that the Global Health Fund will be politically launched
at the G8 summit in Genoa in July and that recommendations will be made at this event for the more
permanent governance mechanism to be discussed and approved at a stakeholder meeting to be
held in September/October. The aim is for the Fund to be operational and to receive the first financial
contributions by the end of the year.
Reported by Helmut Walerius ([email protected]), European Commission, Communicable,
rare and emerging diseases, Luxembourg.