Health ministers wish to strengthen the network approach in response to bioterrorism threat
European health ministers are planning to strengthen and extend the existing European Union's (EU) communicable diseases network so that it can be used in the event of bioterrorist attacks (1). The network already links national surveillance institutes, and EU legislation lists the communicable diseases that need to be placed under community wide surveillance by using standardised collection and analysis of data (2). The box shows diseases to be included in the surveillance network.
| Diseases preventable by vaccination: diphtheria – infections with haemophilus influenzae group B – influenza – measles – mumps – pertussis – poliomyelitis – rubella
Sexually transmitted diseases: chlamydia infections – gonococcal infections – HIV infection – syphilis
Viral hepatitis: hepatitis A – hepatitis B – hepatitis C
Food and water borne diseases and diseases of environmental origin: botulism – campylobacteriosis – cryptosporidiosis – giardiasis – infection with enterohaemorrhagic Escherichia coli – leptospirosis – listeriosis – salmonellosis – shigellosis – toxoplasmosis – trichinellosis – yersiniosis
Diseases transmitted by non-conventional agents: transmissible spongiform encephalopathies, variant Creutzfeldt-Jakob disease
Air borne diseases: legionellosis – meningococcal disease – pneumococcal infections – tuberculosis
Zoonoses: brucellosis – echinococcosis – rabies
Serious imported diseases: cholera – malaria – plague – viral haemorrhagic fevers
Special health issues: nosocomial infections – antimicrobial resistance
|
Infection specific surveillance networks for certain diseases are already in place with coordinating hubs hosted by a national public health institute. For example, the Institut de Veille Sanitaire in Paris acts as the hub for EU wide surveillance of tuberculosis and HIV and AIDS, and the Public Health Laboratory Service Communicable Disease Surveillance Centre in London manages the surveillance of legionellosis and infection with salmonella and Escherichia coli O157.
Similar networks are also in place to monitor influenza transmission, viral haemorrhagic fevers, antimicrobial resistance, and nosocomial infections. The table provides details on infection specific networks that are operational and those currently being piloted, and institutes hosting the network hubs.
Infection specific networks
| Area covered |
Acronym |
Operating hub |
| OPERATIONAL |
|
|
| Legionellosis |
EWGLI |
Public Health Laboratory Service Communicable Disease Surveillance Centre (PHLS, CDSC), London |
| Salmonellosis, infection with E. coli O157 |
Enter-net |
PHLS, CDSC, London |
| Tuberculosis |
EuroTB |
Institut de Veille Sanitaire (InVS), Paris |
| HIV/AIDS |
Euro HIV |
InVS, Paris |
| Influenza |
EISS |
NederlandsInstituut Onderzoek van de Gezondheidszorg (Nivel) |
| Viral haemorrhagic fevers |
ENIVD |
Robert Koch-Institut (RKI), Berlin |
| Antimicrobialresistance |
EARSS |
Rijksinstituut voor Volksgezondheid en Milieu (RIVM) |
| Nosocomial infections |
Helics |
Université Claude Bernard Lyon I |
| PILOT PHASE |
|
|
| Hepatitis C (this project has ended and no continuation is planned at the moment) |
|
Smittskyddsinstitutet (SMI), Stockholm |
| Campylobacteriosis |
|
RKI, Berlin |
| Meningococcal disease |
|
PHLS, CDSC, London |
| Measles, pertussis, infection with H. influenzae |
|
Statens Serum Institut (SSI), Copenhagen / Istituto Superiore di Sanità, Rome |
| Brucellosis, rabies |
|
National Centre for Surveillance and Intervention, Athens |
| Basic surveillance network (collecting available basic national surveillance data and working on standards for surveillance of infectious diseases at the European Union level) |
|
SMI, Stockholm |
At their Brussels meeting in mid-November, EU health ministers agreed that efforts should be made to make the pilot networks fully operational.
The ministers also decided that the network could be developed to keep national authorities informed of any potential bioterrorist risks and to deploy joint investigation teams (3). It will now be used to disseminate information on Europe’s supplies of serums, vaccines, and antibiotics and on its capacity to produce the quantities that might be needed in the event of an attack.
To support the surveillance network, the Commission funds publications like Eurosurveillance (monthly) and Eurosurveillance Weekly as well as providing financial support for a training programme for field epidemiologists (EPIET). In addition to its surveillance role, the network approach also includes an early warning and response system – a sophisticated telematic system linking and alerting public health authorities to outbreaks of diseases that could quickly spread across national borders (http://hsscd.euphin.org/). This is designed to enable early consultation between experts on the risk management required to protect populations that could be in danger. The European Commission believes that the network is beginning to prove its worth and points to its use during recent outbreaks of paratyphoid fever in Turkey, legionnaires' disease in Belgium, and Lassa fever in Germany.