Update on ECDC and EPIET

1. Update on ECDC and EPIET Preben Aavitsland and Jurgita Pakalniskiene Based on material from ECDC at EpiTrain V, Vilnius, October 26 2007

2. Why was ECDC established? • Emerging and re-emerging communicable diseases revitalised through globalisation, bioterrorism, interconnectivity, and EU without internal borders • Health implications of enlarging EU • Strengthen EU Public health capacity to help meet EU citizen’s concerns

3. What does ECDC do? Identify, assess & communicate current & emerging health threats to human health from communicable diseases • EU level disease surveillance • Scientific opinions and studies • Early Warning system and response • Technical assistance and training • Epidemic intelligence • Communication to scientific • community • Communication to the public

4. Council EU agencies Commission EP MS ECDC Industry Networks NGOs CDCs WHO Researchcommunity Other countries Who are ECDC’s strategic partners?

5. Antimicrobial resistance & healthcare-associated infections Food- & waterborne diseases HIV, STI & Hepatitis Influenza Other diseases of environmental & zoonotic origin Tuberculosis Vaccine preventable diseases & invasive bacterial infections How is ECDC organised? Director and Director's Cabinet Management Governance External relations Country cooperation Administrative Services Health communication Preparedness & response Scientific advice Surveillance

6. How does ECDC communicate? • Scientific communication • Eurosurveillance • Website • Scientific reports and publications • Information to the Public/Media • Press/media • Website – multilingual in 2008 • Coherence in risk communication • Support to the Member States • Network(s) of health communicators, e.g. with EC on influenza • Sharing of information and expertise • Joint projects with MSs (in pipeline)

7. Some current themes • Wide area of work • Antibiotic day • ESCAIDE conference • TESSy • Reports on H5N1 vaccines • Assistance to countries • Evaluations in countries • Networks • EuroHIV, EuroTB, EISS etc etc • National contact points • Vaccination • Antibiotic resistance • Etc

8. Learn more about ECDC: www.ecdc.europa.eu | info@ecdc.europa.eu

9. EPIET • European Programme for Intervention Epidemiology Training (EPIET) • Created in 1994 • Funded by the European Commission (60%) and EU Member States until 2007 • Coordinators: • Arnold Bosman, based at ECDC in Stockholm, Sweden (100%, leading coordinator) • Marta Valenciano, based at Carlos III in Madrid, Spain (100%) • Viviane Bremer, based at RKI in Berlin, Germany (40%) • Richard Pebody, based at HPA-CfI in London, UK (40%)

10. EPIET programme objectives To: • Strengthen CD surveillance & control in EU • Develop a European network of intervention epidemiologists • Develop a response capacity inside & beyond EU: • surveillance • outbreak investigations • applied research

11. Training objectives • Plan, implement, evaluate a surveillance system • Perform outbreak investigations • Develop a research project on a relevant public health issue • Acquire oral and written scientific communication skills • Acquire teaching skills

12. Training format • Theoretical training • An introductory course (2½ weeks), open to external participants • At least 6 one-week training modules rotating in EU Member States • Learning by doing practical training • 23 months • At a European public health institute • On site supervision by senior epidemiologists and from EPIET coordinators

13. Time frame per cohort Cohort 11: 16 fellows Each cohort begins with an introductory course, and ends with a scientific seminar, where each fellow presents his/her work. Sept-Oct 05 Sept-Oct 07 Cohort 12: 13 fellows Sept-Oct 06 Sept-Oct 08 Cohort 13: 16? fellows Sept-Oct 07 Sept-Oct 09

14. Introductory course, content • Lectures from field epidemiologists • Interactive case studies based on real investigations • Development of a study protocol based on real PH issue • Surveillance exercise • Communication exercises Since 2004 in Menorca, Spain

15. Training modules in 2000-2006 • Biostatistics (Porto, Rome) • Communication (London, Berlin) • Rapid assessment techniques in emergency situations (Veyrier, Berlin) • Time series analysis and Geographic Information System (Athens, Madrid, Veyrier, Bilthoven) • Vaccinology (Glasgow, Helsinki, Stockholm, London, Bilthoven) • Data management (Bilthoven) • Computer & outbreak investigations(Heraklion, Athens, Paris, Malta, Budapest, Vienna) • Bioterrorism (Berlin) • Time Series Analysis, Logistic Regression (Bordeaux) • Scientific Writing (Berlin) • Logistic regression(Madrid)

16. Training sites in Europe “learning by doing” • 25 Nations + Norway + Switzerland +WHO • 24 Training sites (16 for cohort 12) Sites in red: was open for cohort 13 Helsinki Helsinki Oslo Stockholm Stockholm Oslo Glasgow Copenhagen Belfast Copenhagen Belfast Glasgow Cardiff Cardiff Dublin Warsaw Dublin London Bilthoven London Berlin Bilthoven Berlin SouthWest Brussels Prague Prague Paris Paris Vienna Budapest Geneva Geneva Lyon Lyon Rome Madrid Madrid Rome Athens

17. Supervision of fellows • Supervision on site by at least 1 senior epidemiologist • Draft protocols/reports/manuscripts sent to coordinators • Viadesk as virtual office

18. Outbreak investigations (examples) • Campylobacter and norovirus linked to communal water in Sweden, 2002 • Q-Fever associated with sheep market in Germany, 2002 • Avian influenza in poultry cullers in NL, 2003 • Legionella associated with cooling towers in France, 2003 • Hepatitis A in homosexual men in Denmark, 2004 • Tuberculosis in supermarket in NL, 2005 • S. Hadar associated with roasted chicken in Spain, 2005 • Giardia linked to communal water in Norway, 2005 • S. DT 104 associated with pork meat in NL, 2005/6

19. EU Cross-border Investigations 1999-2006 • Salmonella paratyphi B among EU tourists returning from Turkey, 1999 • Clostridium infection and deaths among intravenous drug users, England, Scotland, Ireland, 2000 • EU-wide outbreak of Salmonella typhimurium 204b, 2000 • Meningitis W135 in pilgrims returning from the Haj, 2000, 2001 • Hepatitis A in Ibiza and German tourists, 2001 • An outbreak of gastroenteritis in holiday-makers travelling to Andorra, January-February 2002 • Hepatitis A among returning travellers from Egypt, 2004

20. Research Projects (examples) • Risk factors (RF) for Hantavirus in France and Belgium • RF for meningococcal meningitis in day care centres, Ireland • RF for Q fever in Germany • RF for sporadic cases of Listeriosis in France • RF for MRSA in nursing homes, Germany • RF for Hep C in hemodialysis Unit, France • RF for sporadic campylobacteriosis, Ireland • RF for CA-MRSA, Switzerland • RF for syphilis, Sweden • Influenza vaccine effectiveness, Denmark

21. Surveillance Projects (Examples) • Establishment of new surveillance • Norovirus in Sweden • Congenital toxoplasmosis in France • CA-MRSA in Switzerland • Heat and cold-related mortality in Spain • Winter mortality in the UK • Sales of flu medicine in Ireland • Evaluation of surveillance system • EHEC in France • STI in Finland • Syphilis in Germany • Tuberculosis in Spain

22. EPIET international missions (1) • Outbreak investigations • Infants deaths following immunisation (Egypt) • Tularaemia (Kosovo) • Suspected anthrax (Ethiopia) • Ebola (Uganda, Gabon, Sudan) • Hepatitis E (Sudan) • Marburg fever (Angola) • Measles (Nigeria, Niger, DRC) • SARS (Hongkong) • Meningitis (Sri Lanka) • Avian influenza (Vietnam, Turkey, Azerbaijian)

23. EPIET international missions (2) • Surveillance projects and surveys • Cholera Surveillance (Mozambique) • Unsafe Injection Practices survey (Burkina Faso) • Assessment of neonatal tetanus status (Zimbabwe) • Vaccine coverage (Côte d’Ivoire, Republic of Guinea, East-Timor, Pakistan) • SARS (Hong Kong) • Retrospective Mortality Survey (Darfur, Sudan) • Nutritional survey (Niger, East-Timor) • Early warning system (Pakistan after Earthquake) • Avian influenza (Georgia, Azerbaijian)

24. Read more • www.epiet.org