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Epidemic Intelligence A new paradigm for surveillance

Epidemic Intelligence A new paradigm for surveillance. Denis Coulombier ECDC. Epidemic Intelligence Model. Epidemic Intelligence Framework. Event -based surveillance. Indicator-based surveillance. EWRS MS DSN’s EWGLI Enternet EISS… BSN EMEA, EFSA MedISys GPHIN WHO-OVL Promed OIE

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Epidemic Intelligence A new paradigm for surveillance

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  1. Epidemic IntelligenceA new paradigm for surveillance Denis Coulombier ECDC

  2. Epidemic Intelligence Model

  3. Epidemic IntelligenceFramework Event-based surveillance Indicator-based surveillance • EWRS • MS • DSN’s EWGLI Enternet EISS… BSN • EMEA, EFSA • MedISys • GPHIN • WHO-OVL • Promed • OIE • FAO • … • DSN’s BSN • Laboratory network Report Data CaptureFilterVerify CollectAnalyseInterpret • EWRS • MS • Commission • Other heath related EU agencies • WHO-IHR? Signal Assess Disseminate Public health alert Investigate Control measures

  4. Epidemic IntelligenceDefinition « 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. »

  5. 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

  6. Epidemic intelligence Event detection

  7. 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

  8. Event Status Decision Is the event relevant? Process Yes Immediateverificationrequired? No Yes No Verification Verification within 24 hours Irrelevant event Signal Event not verified Event verification

  9. Year Events recorded Events verified (%) 1998 164 95 (58) 1999 146 104 (71) 2000 235 161 (68) 2001 199 129 (65) 2002* 68 46 (68) Total 812 535 (66) Median days to verification = 2 Range 0 to 109 days * Up to March 31, 2002 The WHO ExperienceRecorded and Verified Events by Year

  10. Signal assessment Signal Status Decision Significant public healthimpact? No Yes Risk of Europeanspread? Alert not confirmed No Insufficientnational capacity for response? No Yes Need for Europeaninformation? Yes Yes No Alert of National scope Alert of National scoperequiring European information Alert of national scoperequiringEuropean support Alert of European scope Requiring European coordination

  11. 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

  12. Standard operating proceduresDaily 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

  13. Event verification list, Olympic Games EWAR system, Athens, Greece, August 2004

  14. Feedback at European Level • ECDC threat assessment weekly bulletin • European commission commisionner briefing • Early Warning and Response System • Eurosurveillance • ECDC website

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