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