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Let’s talk about protection ECDC and vaccine preventable diseases, especially measles. Irina Dinca Public Health Capacity and Communication Unit (PHC), ECDC Sofia, 17 October 2014. Structure of the presentation. About ECDC
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Let’s talk about protectionECDC and vaccine preventable diseases, especially measles Irina Dinca Public Health Capacity and Communication Unit (PHC), ECDC Sofia, 17 October 2014
Structure of the presentation • About ECDC • Measles situation in EU/EEA and WHO measles and rubella elimination targets by 2015 • Let’s talk about protection • Conclusion
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
ECDC facts • In Stockholm, Sweden • Budget 2014: EUR 59.8 million • Staff: 350 from all EU MS • Epidemiology, infectious diseases, microbiology, public health
Core functions of ECDC Every working day at 11:30 a.m., a roundtable meeting in ECDC’s Emergency Operations Centre assesses threats, official alerts and epidemic intelligence. • Disease surveillance • Epidemic intelligence • Risk assessments • Scientific advice and guidance • Response support • Preparedness • Capacity support on prevention • Training Photo: ECDC
Europe got measles! Notified cases (per million), July 2013-July 2014 Measles images courtesy of Hardin MD/University of Iowa and CDC • Source:ECDC Measles and rubella monitoring report, July 2014
Age-specific notification rate of Measles (cases per million) EU/EEA countries, July 2013 – June 2014 Source: EUVAC.NET
, victim of Subacute Sclerosing Pan-Encephalitis Max, 18 year old December 2004 October 2012
Size is not all that matters • The issue of geographical clustering and why disaggregating data is important. Susceptible Immune
Measles outbreaks (clusters) associated with Roma and Travellers 2004-10 Travellers: UK, Slovenia, Ireland, Norway (n=4) Roma: Romania, Portugal, Spain, Italy, Bulgaria, Poland, Greece, Germany (n=8) Source: VENICE II
The Vaccination Paradox vaccine safety vaccine coverage disease incidence Public trust Doctors’ trust
WHO goals – to ELIMINATE measles and rubella • by end 2015 to achieve regional measles and rubella elimination goals (WHO-EURO) • by end 2020 to achieve measles and rubella elimination in at least five regions Elimination is defined as the absence of endemic measles transmission in a defined geographic area (e.g. region) for ≥12 months in the presence of a well-performing surveillance system. Source: WHO Global measles and rubella strategic plan 2012-2020; Strengthening National Surveillance Systems towards Measles and Rubella Elimination in the WHO European Region Meeting Report Germany (2011)
EU Council Conclusion on childhood immunisation • Coordination of policies and programmes • Network for epidemiological surveillance and control of CDs • Invites MS and the Commission to act • ECDC supports with epi surveillance, training, EWR mechanisms, foster exchange of good practices and experiences
ECDC: measles action plan with five key-stone activities • Evidence-based communication (behaviour change communication for MMR uptake) • communication toolkits and guidance • awareness-raising among policy makers and other key audiences about the threat to public health from continued measles transmission • advocacy for increased resources for achieving measles and rubella elimination in the EU. • audiovisualmaterial for communicating both to general public and professionals (videoclips, Euronews on parent’s stories) • support to European immunization week
Cultural adaptation in pilot MS • in: Bulgaria, Czech Republic, Hungary, Romania • content and format adaptation of the guide and flip book • + methodology of adaptation
Messages from parents and carers • Do what you recommend others to do. • Teach us about the risks of non-vaccination. • Tell stories as well as sharing scientific facts. • Take time to listen to our concerns and tell us about possible side effects and risks. • Don’t ignore those of us who get immunised – we need reassuring and valuing as champions. • Don’t be put off by our efforts to find out more. • Make vaccination easier to access and less stressful. • Redefine success (recognise that some may need more time than others to decide). • Help enhance our vaccination health literacy.
Messages from health promoters ,social marketers and communicators • Focus on behaviour and it’s determinants - not just ‘messages’. • Develop accessible, friendly and adapted service settings. • Make the discussion about ‘being protected’ rather than about vaccine safety. • Make those who accept vaccination more visible – build on and reinforce vaccination as a social norm. • Show how refusing vaccination is socially unacceptable. • Ensure any decision to remain unprotected is an active decision. • Use all media to advocate for the need to be protected and to protect. • Actively counter misinformation.
Messages from experts • Keep your immunisation knowledge current. • Strengthen your communication skills. • Use the team and other settings to provide information and address concerns. • Maintain your skills to ensure safe vaccine administration. • Guide parents to reliable information sources.
Messages from underserved groups • Know more about us. • Reframe ‘hard-to-reach’ as ‘poorly-reached’ system failures. • View immunisation as one part of larger health challenges. • Integrate us into mainstream programmes. • Involve us in all stages of programmes aimed at enhancing our inclusion and health. • Adapt governance and health systems to be more inclusive. • Health Mediators and other community health workers are critically important resources – they need to be supported. • Be accessible and respectful. • Beware of incentives that could be viewed as bribes for compliance.
The multifaceted intervention pilot project in Bulgaria (1) • Raise awareness of healthcare professionals (HCP) and health mediators (HM) on MMR related aspects • Training sessions • Test the usefulness of “Let’s talk about protection” guide and associated materials among HCP and HM • Intervention activities • Develop and implement an evaluation component • Pre- and post-intervention research
Conclusion • Knowledge from research can and should be used in practice • Equally, users and producers of research should propose research priorities that will increase usable knowledge • The collaboration among various levels of the healthcare systems and especially PHC and PH has a lot of potential for improvement in the future