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ECDC. Annual Threat Report 2009

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  • ECDC. Annual Threat Report 2009

    Annual Threat Report 2009 (ECDC, 10/04/10, preface and introduction, edited)

    [Source: European Centre for Disease Prevention and Control (ECDC), full free PDF Document (LINK). Preface and Introduction, edited.]

    European Centre for Disease Prevention and Control (ECDC)

    Postal address:
    ECDC, 171 83 Stockholm, Sweden
    Visiting address:
    Tomtebodavägen 11a, Solna, Sweden
    Phone +46 (0)8 58 60 1000
    Fax +46 (0)8 58 60 1001

    An agency of the European Union

    Annual Threat Report 2009

    The authors would like to thank the Competent Bodies for Threat Detection in the Member States of the European Union for the review of selected threats related to their countries, namely Mike Catchpole, Robert Muchl, Márta Melles, Krisztalovics Katalin, Filomina Raidou, Assimoula Economopoulou, Rezza Giovanni, Florin Popovici, Andreas Gilsdorf, Radosveta Filipova, Paul McKeown, Derval Igoe, Suzanne Cotter, Marianne AB van der Sande, and José Sierra Moros.

    Suggested citation for full report: European Centre for Disease Prevention and Control. Annual Threat Report 2009. Stockholm: ECDC; 2010.

    Cover picture © Getty

    ISBN 978-92-9193-217-7
    ISSN 1831-9289
    DOI 10.2900/33498

    © European Centre for Disease Prevention and Control, 2010. Reproduction is authorised, provided the source is acknowledged.


    ECDC exists to help the EU and its Member States protect Europeans from infectious diseases. In order to do this, ECDC and its partners need to be constantly vigilant against the emergence of new epidemics and other such health threats. Epidemic intelligence officers in ECDC, together with our national and international counterparts, are therefore exchanging information and monitoring for unusual patterns of illness, seven days a week, 52 weeks a year.

    Most years, this work is largely invisible. Small-scale multicountry disease outbreaks happen pretty much every week in Europe: Legionella bacteria are found in the water pipes in a large holiday hotel, and tourists from two or three different countries are identified as having being exposed to them. A food processing plant in one country seems to be the source of salmonella infections in a neighbouring country. EU-level information sharing enables us to quickly identify and assess these sorts of threats.

    National health authorities then work together with ECDC, the European Commission and each other to resolve the situation and protect the people at risk. These sorts of outbreaks rarely make headlines or command the attention of policy makers.

    However, they can have a profound impact on the people affected. Both the pathogens I mentioned earlier, and many others that we deal with, can cause severe illness and even death. The value of ECDC’s work on rapid detection and assessment of health threats, then, is that it can help national authorities to save lives. This is happening day after day, week after week in Europe.

    2009 was unusual in that a multi-country disease outbreak occurred that did, in fact, grab the attention of policy makers and the media in Europe, and indeed around the world. I am talking, of course, of the 2009 influenza A(H1N1) pandemic. The pandemic virus emerged in Mexico and the US in late April 2009, and within a matter of days, cases were being seen in EU countries. One of the key findings of this report is that the infrastructure and systems in place in the EU for dealing with health threats were heavily used by Member States during the 2009 pandemic, and proved to be very useful. National authorities shared a lot of information with each other on the situation in their countries and benefited from authoritative epidemiological analyses, risk assessments and scientific guidance from ECDC.

    The 2009 influenza A(H1N1) pandemic, thankfully, proved to be less deadly than had first been feared. Nonetheless, as of 3 May 2010 nearly three thousand people in the EU were confirmed as having died from this virus, with the total death toll (i.e. including people who died from the virus, but were never tested for it) likely to be much higher. Even a relatively benign multi-country outbreak has some fatal consequences. This is something the health professionals in ECDC, the European Commission and their national counterparts are well aware of. It is why we strive each year to be vigilant against health threats and work together effectively to protect EU citizens from them.

    I hope you will find this report interesting and useful.

    Marc Sprenger


    When ECDC became operational in 2005, it started to ‘gather and analyse data and information on emerging public health threats’ (Article 9 of the Founding Regulations of the Centre1). According to Article 2(e), health threat ‘shall mean a condition, agent or incident which may cause, directly or indirectly, ill health’. Article 3(1) of the Founding Regulations further states that ECDC’s mission is to ‘identify, assess and communicate current and emerging threats to human health from communicable diseases’, while Article 8 adds that ECDC shall ‘assist the Commission by operating the early warning and response system’ and ‘analyse the content of messages received by it’. ECDC has been hosting the Early Warning and Response System (EWRS) application since November 2007 and assists the European Commission by operating the system2-9.

    This is the first Annual Threat Report published as a separate document. Previously, it was included in the ECDC Annual Epidemiological Report, where event- and indicator-based surveillance results were presented together.

    This document describes emerging threats that were either directly reported to ECDC through Member State notifications on EWRS according to defined criteria2, 3, or found through active screening of various sources, including national epidemiological bulletins, international networks (Program for Monitoring Emerging Diseases (ProMED), Global Public Health Intelligence Network (GPHIN)), media, and various additional sources, both formal and informal.

    The EWRS was implemented in 1998, based on Decision 2119/98/EC of the European Parliament and of the Council to set up a network for epidemiological surveillance and control of communicable diseases in the Community.

    The first message distributed in the EWRS was related to legionellosis and posted on 30 October 1998 (10). A new EWRS application was introduced on 17 May 2004 and has been hosted by ECDC since 17 November 2007. EWRS messages are labelled according to their activation level, where level 1 refers to ‘information exchange’, level 2 indicates a ‘potential health threat’ and level 3 a ‘definite public health threat’2. In the EWRS application, events can be posted as original messages (message threads) or as comments to original messages. In addition, messages can be posted as a selective exchange of information between Member States, e.g. if not all Member States are concerned or if confidential information is exchanged (e.g. contact tracing). It should be noted that the number of message threads, comments and selective exchange messages reported through the EWRS does not correspond to the threats monitored by ECDC in the course of its routine epidemic intelligence activities.

    All health threats identified through epidemic intelligence activities are documented and monitored by using a dedicated database, called the Threat Tracking Tool (TTT). All data analysed in this report are extracted from this tool. The analysis covers the period from June 2005, when the TTT was activated, until the end of 2009, with special emphasis on threats emerging in 2009.

    The expression ‘opening a threat’ refers to the way ECDC assesses threats during its daily threat review meetings, internally known as ‘roundtable meetings’. The roundtable consists of ECDC experts that evaluate potential threats and validate events which require further attention or action from ECDC due to their relevance for public health or the safety of EU citizens. The following criteria to open a threat and further monitor an event are used:
    • More than one Member State is affected.
    • A disease is new or unknown, even if there are no cases in the EU.
    • There is a request from a Member State or from a third party for ECDC to deploy a response team.
    • There is a request for ECDC to prepare a threat assessment of the situation.
    • There is a documented failure in an effective control measure (vaccination, treatment or diagnosis).
    • There is a documented change in the clinical/epidemiological pattern of the disease, including changes in disease severity, the way of transmission, etc.
    • The event matches any of the criteria under the IHR or EWRS.

    Following Decision No. 2000/57/EC of the European Parliament and of the Council, events are considered relevant to be reported to the EWRS if one or more of the criteria mentioned below are met2. After the revised International Health Regulations (IHR) entered into force on 15 June 2007, the decision was amended, and criteria now include both IHR notifications and the possible exchange of details following contact tracing3.

    EWRS criteria
    1. Outbreaks of communicable diseases extending to more than one Member State of the Community.
    2. Spatial or temporal clustering of cases of a disease of a similar type if pathogenic agents are a possible cause and there is a risk of propagation between Member States within the Community.
    3. Spatial or temporal clustering of cases of disease of a similar type outside the Community if pathogenic agents are a possible cause and there is a risk of propagation to the Community.
    4. The appearance or resurgence of a communicable disease or an infectious agent which may require timely coordinated Community action to contain it.
    5. Any IHR notification has to be reported also through EWRS.
    6. Any event related to communicable diseases with a potential EU dimension necessitating contact tracing to identify infected persons or persons potentially in danger may involve the exchange of sensitive personal data of confirmed or suspected cases between concerned Member States.

    Analysis is performed both quantitatively (e.g. comparing the number of threats) and qualitatively (describing the content of threats).