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Disease prevention and control in Europe
ECDC: Keeping Europe healthy
A potential employees guide
Prof Angus Nicoll CBE
European Centre for Disease Prevention and Control
LSHTM, London, 19 March 2010
Expanded Europe –
the five freedoms in the EU
1. Free movement of people*
2. Free movement of services*
3. Free movement of goods*
4. Free movement of monies*
5. Free movement of microbes
from Summary of Legislation — Internal Market
http://europa.eu.int/scadplus/leg/en/s70000.htm
* Adapted
21st century trends
Emerging/re-emerging infectious diseases:
 Emerging pathogens (e.g. Chikungunya,
BSE-v/CjD, Ebola, H5N1)
 Resurgence of TB, measles, dengue,
meningitis
 Animal to humans
(e.g. Nipahvirus, hanta virus, H5N1)
Change presents microbes with new
opportunities:
 Globalisation of travel and trade
 Intentional use of biological agents
(e.g. anthrax)
 Climate change
Why was ECDC established?
A young EU agency dedicated to the prevention and
control of communicable diseases
 Emerging and re-emerging communicable
diseases revitalised through globalisation,
bio-terrorism, interconnectivity, and an EU
without internal borders
 Health implications of enlarging EU
 Strengthen EU public health capacity to help
meet EU citizen's concerns
What is ECDC?
"An independent agency, named the European Centre for
Disease Prevention and Control …"
— ECDC Founding Regulation (851/2004)
A European Union Agency which:
 is a member of the European Union (EU)
family;
 covers EU 27, EEA/EFTA countries;
 reaches out to other countries beyond the
EU 27 through Neighbourhood Policy and
DG RELEX;
 supports and promotes global health
security (role in International Health
Regulations); and
 is financed through the EU budget.
What is the role of ECDC?
Identify, assess and communicate current and emerging health
threats to human health from communicable diseases.
— ECDC Founding Regulation (851/2004), Article 3
 EU level disease surveillance and
epidemic intelligence
 Scientific opinions and studies
 Early Warning System and response
 Technical assistance and training
 Communication to scientific
community
 Communication to the public
Major threats related to communicable
diseases in the EU
Major threats covered by the Annual
Epidemiological Report 2008 include:
– antimicrobial resistance
– healthcare-associated infections
– HIV infection
– pneumoccocal infections
– influenza
– tuberculosis
Antimicrobial resistance
Only 70 years after the discovery of penicillin, we
have almost come full circle and are now in a
situation similar to the pre-antibiotic era.
 Strains have emerged that are almost totally resistant
to antibiotics and for which there is no rational option
for treatment of infected patients.
 Although several EU Member States are making good
progress towards control, in particular of MRSA and
unnecessary antibiotic prescriptions in outpatients.
 However, antimicrobial resistance in general remains
high and even continues to increase in most countries.
 European Antibiotic Awareness Day. European
health initiative to promote prudent use of antibiotics.
32 participating countries in 2008, second event on 18
November 2009.
 ECDC-EMEA Joint Report. On the gap between
increasing multi-drug resistance in the EU and the lack
of novel antibiotics (June 2009).
Faroe Islands stamp
commemorating Alexander Fleming
MRSA
2007
Healthcare-associated infections
 Each year, more than four millions EU patients get at
least one nosocomial infection when hospitalised.
 Every year in the EU 27, approximately 37 000 deaths
(0.9 %) are caused directly by nosocomial infections; and
infections contributed for an additional 111 000 deaths.
 The total healthcare cost of nosocomial infections for the
EU 27 can be estimated at EUR 7 billion per year.
Photo by marsdd. Published under a Creative Commons license through http://www.flickr.com/photos/marsdd/1041679960/
Nosocomial: Originating or taking place in a hospital, acquired in a hospital, especially in reference to an infection.
HIV infection
 Over 26 000 newly
diagnosed cases reported in
2007 in EU and EFTA
countries.
 The predominant modes of
transmission for HIV
infection appear to be sex
between men followed by
heterosexual contact.
 A high number of HIVpositive persons in the EU
continue to be unaware of
their situation.
Joint surveillance with WHO
Influenza
 Annual seasonal
influenza epidemic
(see map).
 Avian influenza
Joint surveillance with WHO since
2008–2009 influenza season
Animated slide: Press space bar.
The 2009 pandemic – it could have been
lot worse for Europe! (Situation circa March 2010)
a
A pandemic
emerging in a
developing country
 A pandemic strain emerging in the Americas.
 Immediate virus sharing so rapid diagnostic and
Delayed virus
sharing
vaccines.
Based on a more
 Based on A(H1N1) currently not that
pathogenic strain, e.g.
pathogenic and without pathogenicity markers.
A(H5N1)
 Residual immunity in much of a large group
No residual
(older people).
immunity
 Sustained susceptibity to oseltamivir.
Inbuilt antiviral
resistance
 Good data and information came out of
Minimal data until
North America and the southern hemisphere.
transmission reached
Europe
 Arriving in Europe in the summer.
Arriving in the late
 Mild presentation in most
autumn or winter
people infected.
Contrast with what might
Severe presentation
have happened but what
 High immunogenicity for vaccine immediately
could still go wrong
12
Tuberculosis
 Over 84 000 tuberculosis
cases reported in 2007 in EU
and EEA/EFTA countries.
 Over 5 000 deaths reported
in EU and EEA/EFTA
countries.
 Multidrug-resistant
tuberculosis remains an
issue requiring attention.
 Despite progress over the
last decade, the elimination
target of less than one TB
case per 1 million population
is still far from being
achieved.
Joint surveillance with WHO
Threats monitoring
In 2007 ECDC monitored 168 threats of which
 142 (85%) were new;
 21 were opened in 2006 and still active in 2007;
 5 were opened in 2005 and still active in 2007;
 66 threats required an active follow-up by ECDC; and
 10 of them resulted in a detailed threat assessment
circulated to the EU Member States and the EC through the
EWRS.
Who are ECDC's strategic partners?
Council
Commission
Member
States
Networks
European
Parliament
ECDC
WHO
Research
community
NGOs
Other
countries
Industry
EU
agencies
CDCs
Advisory Forum
Management Board
Working with the Member States:
The role of Competent Bodies
• Promoting bilateral relations between the
Member States and ECDC and European
networking.
 Appointing experts to support the Community
responses to health threats.
Competent Bodies have been formally designated
by Member States. ECDC's Management Board
compiled the list, which was finalised and
published in December 2007.
Working with the European Commission
European Parliament and ECDC
Collaborating with WHO
Working with the EU presidencies
Together we
can make
sure
our citizens
sleep
safe and
sound!
Relevant Links
ECDC www.ecdc.europa.eu
Job listing
http://www.ecdc.europa.eu/en/aboutus/jobs/Pages/JobOppo
rtunities.aspx
EPIET http://ecdc.europa.eu/en/epiet/Pages/HomeEpiet.aspx
Traineeships
http://www.ecdc.europa.eu/en/aboutus/jobs/Pages/Traineeshi
ps.aspx
EuropassCV
https://europass.cedefop.europa.eu/europass/home/vernav/
Europass+Documents/Europass+CV.csp