Giuseppe
Emeritus
[EUROPEAN CENTRE OF DISEASES PREVENTION AND CONTROL - INFLUENZA NEWS - JULY 17, 2008 - EXCERPTS]
1a) Strategies to improve global influenza surveillance: a decision tool for policymakers
Moore M et al. BMC Public Health. 2008 May 28;8:186
Description:
This article describes a quantitative decision tool for assessing the relative effects of improving different attributes of influenza surveillance systems on the ability of the system to efficiently detect an early case or cluster of novel human influenza disease.
The development of the tool required the conduction of a literature review in order to identify evidence based strategies more likely to be effective to improve early case/cluster detection capacity.
Three core surveillance areas (coverage, quality and timeliness) and thirteen strategies to improve surveillance in these areas were identified through the literature review.
For example strategies for improving surveillance coverage included increasing the number and types of reporting sites while strategies for improving timeliness included, expedited transport of specimens, streamlined notification and analysis, implementation of active surveillance when appropriate, wide deployment of more accurate rapid diagnostic tests, deployment of trained rapid response teams to investigate suspicious cases or clusters.
Subsequently the researchers developed a process model (flow diagram) depicting nine major pathways through which a case in the community could be detected and confirmed, and mapped the improvement strategies onto this model.
Each strategy could affect one or more steps in the model by increasing the probability that a step occurs and/or decreasing the time required to complete it.
The tool was made interactive and input values for each step could be varied by users to assess the effects of different improvement strategies, alone or in combination.
A theoretical application of the tool in which all of the 13 surveillance improvement strategies were implemented over the course of a year suggested that traditional efforts to build epidemiology and laboratory capacity are efficient strategies.
Also effective proved some more focused strategies including targeted laboratory testing, expedited specimen transport, use of technologies to streamline data flow, and improved reporting compliance. Other promising strategies stem from community detection - better harnessing of electronic data mining and establishment of community-based monitoring.
The authors conclude that their practical tool can be useful for policymakers to evaluate, using their own parameters, which interventions are more likely to be effective to improve the probability and timeliness of detecting early human cases/clusters of novel influenza virus disease.
ECDC comment (16/07/08):
This article describe an original approach to evaluate the effectiveness of different interventions to improve influenza surveillance and especially the ability to detect and investigate cases of novel influenza viruses, using a model derived from work in engineering.
Although some assumptions made for developing the described model are not really evidence based and this model focuses only on one of the very many aspects of influenza surveillance, e.g. the early detection and identification of novel influenza viruses, such initiatives go in the right direction of raising the attention towards surveillance in an influenza pandemic and of increasing the tools available to improve surveillance quality.
Surveillance will certainly play a crucial role during a pandemic providing information that would be essential for prevention and control purposes.
It is unclear whether the current surveillance systems tailored on seasonal influenza epidemics would be able to provide all the information that would be needed in a pandemic and whether such systems are sustainable in case of a particularly ?severe? pandemic.
Efforts are being made at national and international level to plan in advance for how and which type of surveillance data should be collected and shared during an influenza pandemic.
See:
1 - WHO consultation on priority public health interventions before and during an influenza pandemic ? Working Group 1: Surveillance for pandemic preparedness
2 - Influenza Surveillance in a Pandemic - Paper from ECDC Working Group
Nicoll A, Influenza team (ECDC). Public Health Measures in an Influenza Pandemic ? the importance of surveillance. Euro Surveill. 2007;12(44)
ii=3300. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=3300
1b) Science into policy: preparing for pandemic influenza
D. R. Harper, et al. J Public Health (Oxf). 2008 Jul 4 [Epub ahead of print]
Description:
The UK Department of Health has announced the publication of the scientific papers which have informed the current UK pandemic preparedness plans.
Five scientific papers dealing with the main clinical countermeasures (antivirals, pre-pandemic and pandemic specific vaccines, antibiotics and facemasks) and the risk of a pandemic originating from an A(H5N1) virus have been published.
These evidence based papers were reviewed and revised by additional national and international expert scientific reviewers and discussed by a team of scientific experts.
Revised papers were then submitted to the Scientific Advisory Group for final endorsement as reflecting an accurate and comprehensive summary of the state of knowledge in June 2007.
In the editorial accompanying this announcement, Dr David Harper and his colleagues note how this work underpins policy development on countermeasures within their national pandemic influenza preparedness programme and can be of use to other countries developing pandemic preparedness plans as well.
This widely agreed scientific state of the art offers a firm foundation for complex and potentially expensive policy and procurement decisions on pandemic countermeasures.
The papers are available at: http://www.advisorybodies.doh.gov.uk/spi/evidence.htm.
And can be downloaded from here:
Use of antiviral drugs in an influenza pandemic (PDF, 395K)
Pre-pandemic and pandemic influenza vaccines (PDF, 210K)
The use of antibiotics for pandemic influenza (PDF, 406K)
Tables 14.1 and 14.2 from the antibiotics paper (PDF, 108K)
The use of face masks during an influenza pandemic (PDF, 206K)
Risk of a human influenza pandemic emerging from avian H5N1 viruses (PDF, 233K)
1c) ECDC launches a call for tender to develop training programmes on the prevention and control of human seasonal influenza.
ECDC has recently launched a call for tender to develop reference curriculum, training materials and a pilot course on ?Design and implementation of programmes of human seasonal influenza prevention and control?.
Details of the call for tender, including technical specification, and deadlines for applications are available on the ECDC website.
See http://ecdc.europa.eu/Competitions/PROC_2008_010/index.html
1d) Meetings and workshops - Birdflu2008: Avian Influenza and Human Health, Oxford, UK. 10-11 September 2008
The first annual Oxford avian influenza conference, BirdFlu2008, will address most aspects of basic and applied research on avian influenza viruses and their potential health and socio-economic impact on humans.
Conference information can be found at: http://www.libpubmedia.co.uk/Conferences/BirdFlu2008/Home.htm
1e) 3rd ESWI European Influenza Conference, Vilamoura, Portugal. 14-17 September 2008.
The European Scientific Working group on Influenza (EWSI) - an independent group of European scientists promoting the study of influenza ? will hold its third European Influenza Conference in the autumn of 2008.
Conference information can be found at: http://www.eswiconference.org/
1f) International Ministerial Conference on Avian and Pandemic Influenza, Sharm el-Sheikh, Egypt. 24-26 October 2008.
This meeting organised by the Government of Egypt is the sixth in a series of high level meetings that began in Washington in October 2005, followed by Beijing (January 2006), Vienna (June 2006) Bamako (December 2006) and Delhi (November 2007).
The Delhi meeting established a Road Map for countries to progress AI prevention and pandemic planning during 2008.
The Ministerial meeting in Egypt is supported by many bodies including the European Union, United Nations, WHO, United States international aid (USAID), the World Bank, the two major global animal health organisations (OIE & FAO) and the African Union.
The focus is to assess the current epidemiological situation and progress since Delhi, and review the effectiveness of the strategies applied and remap the way forward in global avian and pandemic flu preparedness and response for 2009.
A group from the UN Development programme (UNDP) is in the process of preparing a report for the meeting. Its last report is available at http://www.undg.org/docs/8097/12-18-07-UN-WB-AHI-Progress-Report-final.doc
A web-site for the conference in Egypt has now been activated http://www.imcapi2008.gov.eg/
-
http://www.ecdc.europa.eu/Health_topics/influenza/news/news_Influenza_080717.html
-----
1a) Strategies to improve global influenza surveillance: a decision tool for policymakers
Moore M et al. BMC Public Health. 2008 May 28;8:186
Description:
This article describes a quantitative decision tool for assessing the relative effects of improving different attributes of influenza surveillance systems on the ability of the system to efficiently detect an early case or cluster of novel human influenza disease.
The development of the tool required the conduction of a literature review in order to identify evidence based strategies more likely to be effective to improve early case/cluster detection capacity.
Three core surveillance areas (coverage, quality and timeliness) and thirteen strategies to improve surveillance in these areas were identified through the literature review.
For example strategies for improving surveillance coverage included increasing the number and types of reporting sites while strategies for improving timeliness included, expedited transport of specimens, streamlined notification and analysis, implementation of active surveillance when appropriate, wide deployment of more accurate rapid diagnostic tests, deployment of trained rapid response teams to investigate suspicious cases or clusters.
Subsequently the researchers developed a process model (flow diagram) depicting nine major pathways through which a case in the community could be detected and confirmed, and mapped the improvement strategies onto this model.
Each strategy could affect one or more steps in the model by increasing the probability that a step occurs and/or decreasing the time required to complete it.
The tool was made interactive and input values for each step could be varied by users to assess the effects of different improvement strategies, alone or in combination.
A theoretical application of the tool in which all of the 13 surveillance improvement strategies were implemented over the course of a year suggested that traditional efforts to build epidemiology and laboratory capacity are efficient strategies.
Also effective proved some more focused strategies including targeted laboratory testing, expedited specimen transport, use of technologies to streamline data flow, and improved reporting compliance. Other promising strategies stem from community detection - better harnessing of electronic data mining and establishment of community-based monitoring.
The authors conclude that their practical tool can be useful for policymakers to evaluate, using their own parameters, which interventions are more likely to be effective to improve the probability and timeliness of detecting early human cases/clusters of novel influenza virus disease.
ECDC comment (16/07/08):
This article describe an original approach to evaluate the effectiveness of different interventions to improve influenza surveillance and especially the ability to detect and investigate cases of novel influenza viruses, using a model derived from work in engineering.
Although some assumptions made for developing the described model are not really evidence based and this model focuses only on one of the very many aspects of influenza surveillance, e.g. the early detection and identification of novel influenza viruses, such initiatives go in the right direction of raising the attention towards surveillance in an influenza pandemic and of increasing the tools available to improve surveillance quality.
Surveillance will certainly play a crucial role during a pandemic providing information that would be essential for prevention and control purposes.
It is unclear whether the current surveillance systems tailored on seasonal influenza epidemics would be able to provide all the information that would be needed in a pandemic and whether such systems are sustainable in case of a particularly ?severe? pandemic.
Efforts are being made at national and international level to plan in advance for how and which type of surveillance data should be collected and shared during an influenza pandemic.
See:
1 - WHO consultation on priority public health interventions before and during an influenza pandemic ? Working Group 1: Surveillance for pandemic preparedness
2 - Influenza Surveillance in a Pandemic - Paper from ECDC Working Group
Nicoll A, Influenza team (ECDC). Public Health Measures in an Influenza Pandemic ? the importance of surveillance. Euro Surveill. 2007;12(44)
ii=3300. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=3300 1b) Science into policy: preparing for pandemic influenza
D. R. Harper, et al. J Public Health (Oxf). 2008 Jul 4 [Epub ahead of print]
Description:
The UK Department of Health has announced the publication of the scientific papers which have informed the current UK pandemic preparedness plans.
Five scientific papers dealing with the main clinical countermeasures (antivirals, pre-pandemic and pandemic specific vaccines, antibiotics and facemasks) and the risk of a pandemic originating from an A(H5N1) virus have been published.
These evidence based papers were reviewed and revised by additional national and international expert scientific reviewers and discussed by a team of scientific experts.
Revised papers were then submitted to the Scientific Advisory Group for final endorsement as reflecting an accurate and comprehensive summary of the state of knowledge in June 2007.
In the editorial accompanying this announcement, Dr David Harper and his colleagues note how this work underpins policy development on countermeasures within their national pandemic influenza preparedness programme and can be of use to other countries developing pandemic preparedness plans as well.
This widely agreed scientific state of the art offers a firm foundation for complex and potentially expensive policy and procurement decisions on pandemic countermeasures.
The papers are available at: http://www.advisorybodies.doh.gov.uk/spi/evidence.htm.
And can be downloaded from here:
Use of antiviral drugs in an influenza pandemic (PDF, 395K)
Pre-pandemic and pandemic influenza vaccines (PDF, 210K)
The use of antibiotics for pandemic influenza (PDF, 406K)
Tables 14.1 and 14.2 from the antibiotics paper (PDF, 108K)
The use of face masks during an influenza pandemic (PDF, 206K)
Risk of a human influenza pandemic emerging from avian H5N1 viruses (PDF, 233K)
1c) ECDC launches a call for tender to develop training programmes on the prevention and control of human seasonal influenza.
ECDC has recently launched a call for tender to develop reference curriculum, training materials and a pilot course on ?Design and implementation of programmes of human seasonal influenza prevention and control?.
Details of the call for tender, including technical specification, and deadlines for applications are available on the ECDC website.
See http://ecdc.europa.eu/Competitions/PROC_2008_010/index.html
1d) Meetings and workshops - Birdflu2008: Avian Influenza and Human Health, Oxford, UK. 10-11 September 2008
The first annual Oxford avian influenza conference, BirdFlu2008, will address most aspects of basic and applied research on avian influenza viruses and their potential health and socio-economic impact on humans.
Conference information can be found at: http://www.libpubmedia.co.uk/Conferences/BirdFlu2008/Home.htm
1e) 3rd ESWI European Influenza Conference, Vilamoura, Portugal. 14-17 September 2008.
The European Scientific Working group on Influenza (EWSI) - an independent group of European scientists promoting the study of influenza ? will hold its third European Influenza Conference in the autumn of 2008.
Conference information can be found at: http://www.eswiconference.org/
1f) International Ministerial Conference on Avian and Pandemic Influenza, Sharm el-Sheikh, Egypt. 24-26 October 2008.
This meeting organised by the Government of Egypt is the sixth in a series of high level meetings that began in Washington in October 2005, followed by Beijing (January 2006), Vienna (June 2006) Bamako (December 2006) and Delhi (November 2007).
The Delhi meeting established a Road Map for countries to progress AI prevention and pandemic planning during 2008.
The Ministerial meeting in Egypt is supported by many bodies including the European Union, United Nations, WHO, United States international aid (USAID), the World Bank, the two major global animal health organisations (OIE & FAO) and the African Union.
The focus is to assess the current epidemiological situation and progress since Delhi, and review the effectiveness of the strategies applied and remap the way forward in global avian and pandemic flu preparedness and response for 2009.
A group from the UN Development programme (UNDP) is in the process of preparing a report for the meeting. Its last report is available at http://www.undg.org/docs/8097/12-18-07-UN-WB-AHI-Progress-Report-final.doc
A web-site for the conference in Egypt has now been activated http://www.imcapi2008.gov.eg/
-
http://www.ecdc.europa.eu/Health_topics/influenza/news/news_Influenza_080717.html
-----