Disease prevention and control in Europe

1. 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

2. Expanded Europe – the five freedoms in the EU 1. Free movement of people* Free movement of services* Free movement of goods* 4. Free movement of monies* 5. Free movement of microbes * Adapted from Summary of Legislation — Internal Market http://europa.eu.int/scadplus/leg/en/s70000.htm

3. 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

4. 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

5. What is ECDC? • 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. "An independent agency, named the European Centre for Disease Prevention and Control …" — ECDC Founding Regulation (851/2004)

6. What is the role of ECDC? • 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 Identify, assess and communicate current and emerging health threats to human health from communicable diseases. — ECDC Founding Regulation (851/2004), Article 3

7. 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

8. MRSA 2007 Antimicrobial resistance • 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). 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. Faroe Islands stamp commemorating Alexander Fleming

9. 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.

10. 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 HIV-positive persons in the EU continue to be unaware of their situation. Joint surveillance with WHO

11. Influenza • Annual seasonal influenza epidemic (see map). • Avian influenza Joint surveillance with WHO since 2008–2009 influenza season Animated slide: Press space bar.

12. A pandemic strain emerging in the Americas. Immediate virus sharing so rapid diagnostic and vaccines. Based on A(H1N1) currently not that pathogenic and without pathogenicity markers. Residual immunity in much of a large group (older people). Sustained susceptibity to oseltamivir. Good data and information came out of North America and the southern hemisphere. Arriving in Europe in the summer. Mild presentation in most people infected. High immunogenicity for vaccine The 2009 pandemic – it could have been a lot worse for Europe! (Situation circa March 2010) A pandemic emerging in a developing country Delayed virus sharing Based on a more pathogenic strain, e.g. A(H5N1) No residual immunity Inbuilt antiviral resistance Minimal data until transmission reached Europe Arriving in the late autumn or winter Contrast with what might have happened but what could still go wrong Severe presentation immediately

13. 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

14. 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.

15. Who are ECDC's strategic partners? Council Commission MemberStates EuropeanParliament ECDC EU agencies Networks CDCs WHO Researchcommunity Other countries NGOs Industry

16. Advisory Forum

17. Management Board

18. 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.

19. Working with the European Commission

20. European Parliament and ECDC

21. Collaborating with WHO

22. Working with the EU presidencies

23. Together we can make sureour citizens sleep safe and sound!

24. Relevant Links • ECDC www.ecdc.europa.eu • Job listing http://www.ecdc.europa.eu/en/aboutus/jobs/Pages/JobOpportunities.aspx • EPIET http://ecdc.europa.eu/en/epiet/Pages/HomeEpiet.aspx • Traineeships • http://www.ecdc.europa.eu/en/aboutus/jobs/Pages/Traineeships.aspx • EuropassCV https://europass.cedefop.europa.eu/europass/home/vernav/Europass+Documents/Europass+CV.csp