Epidemic Intelligence

A new paradigm for surveillance

Denis CoulombierECDC

Epidemic Intelligence Model

Yes

YesYes

Public health significance?

Unusual disease pattern?

Internationalconcern?

Investigation& control

Yes

Signal

RumourMediaReport

CommunityConcern

Priority disease

notification

LabReport

ClinicianConcern

Early Warning Response

Event verified?

Case-based surveillance data

Public HealthAlert

Event-based surveillance

reports

Process

Decision

Status

Source

Public Health Emergency of International

Concern

Notification to WHO

Epidemic IntelligenceFramework

Report DataCaptureFilterVerify

CollectAnalyseInterpret

Assess

Investigate

Signal

EWRSMSDSN’s

EWGLIEnternet EISS…

BSNEMEA, EFSAMedISysGPHINWHO-OVLPromedOIEFAO…

Event-based surveillance

DSN’s BSNLaboratory network

Indicator-based surveillance

Control measures

Public health alert

EWRSMSCommissionOther heath related EU agencies

WHO-IHR?

Disseminate

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. »

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

Epidemic intelligence Event detection

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

Event verification

No

Is the event relevant?

Yes

Immediateverificationrequired?

Status

Decision

Process

Irrelevant event

Event

No

Verification within 24 hours

Event not verified

Yes

Verification

Signal

The WHO ExperienceRecorded and Verified Events by Year

95 (58)104 (71)161 (68)129 (65) 46 (68)

535 (66)

Median days to verification = 2

Range 0 to 109 days

Year Events recorded Events verified (%)

1998 1641999 1462000 2352001 1992002* 68

Total 812

* Up to March 31, 2002

Signal assessment

No

No

Yes

No

Yes

Yes

No

Yes

Signal

Alert of National scoperequiring

European informationAlert of National scope

Alert of national scoperequiring

European support

Alert of European scopeRequiring

European coordination

Significant public health

impact?

Insufficientnational capacity

for response?

Risk of Europeanspread?

Need for Europeaninformation?

Status

Decision

Alert not confirmed

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

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

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

Feedback at European Level

• ECDC threat assessment weekly bulletin

• European commission commisionner briefing

• Early Warning and Response System• Eurosurveillance• ECDC website