Giuseppe
Emeritus
Surveillance and studies in a pandemic in Europe (ECDC, summary, edited)
Surveillance and studies in a pandemic in Europe
TECHNICAL REPORT
[Full Document: LINK. EDITED.]
Summary
Surveillance and Studies in a Pandemic (SSiaP) is a complex topic including, as defined here, four distinct components:
A pandemic is unlikely to emerge in Europe, and so early detection and investigation will probably take place elsewhere, but Europe will need to undertake the other three processes. Laboratory-based (microbiological) surveillance will be essential to all components but usually will be integrated with epidemiological and clinical surveillance.
Early assessment (component 2) is vital because of the number of important parameters of the next pandemic that cannot be anticipated. However, early assessment does not need to be undertaken in every country. Optimally, it will be best done by the earliest affected European countries, with support from the European Centre of Disease Prevention and Control (ECDC) and the World Health Organization (WHO), and confined to determining the ?strategic parameters?. The values for these represent which is the information that will determine which public health and clinical measures are most likely to be successful. The results from a few countries would then be immediately conveyed to all other countries.
An estimate of the severity of the pandemic will be part of the early assessment. It will be difficult but is essential as some national European plans envisage triggering more disruptive interventions in the event of a severe pandemic. WHO leadership is anticipated for this assessment. However, the detail will require a European view tied to a risk assessment because the complexity of the concept of severity makes it difficult to reduce to a single measure. All European countries will need to perform monitoring (component 3) for the proper management of their own healthcare systems and other services. The information that central authorities in countries might like to have for monitoring is legion but should be limited to what is essential for decisions and key communications.
Monitoring should be tested for feasibility in influenza seasons, but also will need to consider how routine surveillance systems will change or cease to deliver during a pandemic. International monitoring (reporting upwards to WHO and European authorities) should be kept simple, as many countries will find it difficult to provide routine information to international bodies as well as undertaking internal processes. Also, not every country will be able to supply the detail that European authorities might like to have.
Investigations of the impact of public health measures (and the safety of pharmaceutical countermeasures) (component 4) is another process that only needs to be undertaken in some countries. It is unlikely that it will become clear whether and which public health measures have been effective during the pandemic itself.
WHO and ECDC has been working with European Member States to develop procedures and ?mock-up protocols? for component 2, the early assessment process, and it was planned that these will be tested for acceptability in exercises and field tested in the 2009?2010 influenza season. The emergence of the novel influenza A(H1N1) means that these will be tested against a real pandemic strain. Piloting of methods of estimating influenza vaccine effectiveness (part of component 4) in Europe is underway. At the national level, it is important that authorities plan how they will undertake components 2 to 4, including working with academic bodies and staff, and resource them realistically in the pandemic itself.
Background
Since at least 2005, governments in industrialised countries and a number of international health bodies have intensified planning and preparations for the next pandemic (WHO 2005, European Commission 2005, Mounier-Jack 2006). All European countries now have pandemic plans, usually conforming to the original WHO 2005 health sector template which has been updated with a suite of supporting documentation this year (WHOa 2009).
An important new component of suite are draft standard operating procedures for SSiaP, which WHO has been developing through expert consultations (WHO 2009b). In turn, ECDC has been developing European thinking with EU/EEA Member States through a series of meeting and papers going back to 2006 (ECDC 2007, Nicoll & ECDC Flu team 2007), which have also included the important contribution of modelling (ECDC 2008). It has become apparent that this involves not just classical surveillance but also supporting studies, hence the phrase Surveillance and Studies in a Pandemic and the acronym SSiaP.
Objective
The objective of this paper is to summarise current thinking on SSiaP in Europe taking a broad definition to include early assessment, monitoring and the investigation of impact and safety of public health countermeasures (including the use of antivirals and vaccines). Such a broad approach goes beyond what some authorities would term surveillance. This is deliberate as often the same departments and staff are expected to perform or oversee all three processes and it is important to identify the extent of their tasks.
Limitations
The paper does not include clinical research, for example, evaluating the impact of treatments outside their public health role, or antivirals and human avian influenza vaccines (HAIVs) in reducing transmission (Ferguson 2006, Jennings 2008). Neither does it include the vital work of monitoring public perceptions nor working with the media or work after a pandemic to finally determine which of the public health measures were effective (ECDC 2007).
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Surveillance and studies in a pandemic in Europe
TECHNICAL REPORT
[Full Document: LINK. EDITED.]
Summary
Surveillance and Studies in a Pandemic (SSiaP) is a complex topic including, as defined here, four distinct components:
- early detection and investigation;
- comprehensive early assessment;
- monitoring; and
- rapid investigation of the effectiveness and impact of countermeasures (including the safety of pharmaceutical countermeasures) in achieving mitigation.
A pandemic is unlikely to emerge in Europe, and so early detection and investigation will probably take place elsewhere, but Europe will need to undertake the other three processes. Laboratory-based (microbiological) surveillance will be essential to all components but usually will be integrated with epidemiological and clinical surveillance.
Early assessment (component 2) is vital because of the number of important parameters of the next pandemic that cannot be anticipated. However, early assessment does not need to be undertaken in every country. Optimally, it will be best done by the earliest affected European countries, with support from the European Centre of Disease Prevention and Control (ECDC) and the World Health Organization (WHO), and confined to determining the ?strategic parameters?. The values for these represent which is the information that will determine which public health and clinical measures are most likely to be successful. The results from a few countries would then be immediately conveyed to all other countries.
An estimate of the severity of the pandemic will be part of the early assessment. It will be difficult but is essential as some national European plans envisage triggering more disruptive interventions in the event of a severe pandemic. WHO leadership is anticipated for this assessment. However, the detail will require a European view tied to a risk assessment because the complexity of the concept of severity makes it difficult to reduce to a single measure. All European countries will need to perform monitoring (component 3) for the proper management of their own healthcare systems and other services. The information that central authorities in countries might like to have for monitoring is legion but should be limited to what is essential for decisions and key communications.
Monitoring should be tested for feasibility in influenza seasons, but also will need to consider how routine surveillance systems will change or cease to deliver during a pandemic. International monitoring (reporting upwards to WHO and European authorities) should be kept simple, as many countries will find it difficult to provide routine information to international bodies as well as undertaking internal processes. Also, not every country will be able to supply the detail that European authorities might like to have.
Investigations of the impact of public health measures (and the safety of pharmaceutical countermeasures) (component 4) is another process that only needs to be undertaken in some countries. It is unlikely that it will become clear whether and which public health measures have been effective during the pandemic itself.
WHO and ECDC has been working with European Member States to develop procedures and ?mock-up protocols? for component 2, the early assessment process, and it was planned that these will be tested for acceptability in exercises and field tested in the 2009?2010 influenza season. The emergence of the novel influenza A(H1N1) means that these will be tested against a real pandemic strain. Piloting of methods of estimating influenza vaccine effectiveness (part of component 4) in Europe is underway. At the national level, it is important that authorities plan how they will undertake components 2 to 4, including working with academic bodies and staff, and resource them realistically in the pandemic itself.
Background
Since at least 2005, governments in industrialised countries and a number of international health bodies have intensified planning and preparations for the next pandemic (WHO 2005, European Commission 2005, Mounier-Jack 2006). All European countries now have pandemic plans, usually conforming to the original WHO 2005 health sector template which has been updated with a suite of supporting documentation this year (WHOa 2009).
An important new component of suite are draft standard operating procedures for SSiaP, which WHO has been developing through expert consultations (WHO 2009b). In turn, ECDC has been developing European thinking with EU/EEA Member States through a series of meeting and papers going back to 2006 (ECDC 2007, Nicoll & ECDC Flu team 2007), which have also included the important contribution of modelling (ECDC 2008). It has become apparent that this involves not just classical surveillance but also supporting studies, hence the phrase Surveillance and Studies in a Pandemic and the acronym SSiaP.
Objective
The objective of this paper is to summarise current thinking on SSiaP in Europe taking a broad definition to include early assessment, monitoring and the investigation of impact and safety of public health countermeasures (including the use of antivirals and vaccines). Such a broad approach goes beyond what some authorities would term surveillance. This is deliberate as often the same departments and staff are expected to perform or oversee all three processes and it is important to identify the extent of their tasks.
Limitations
The paper does not include clinical research, for example, evaluating the impact of treatments outside their public health role, or antivirals and human avian influenza vaccines (HAIVs) in reducing transmission (Ferguson 2006, Jennings 2008). Neither does it include the vital work of monitoring public perceptions nor working with the media or work after a pandemic to finally determine which of the public health measures were effective (ECDC 2007).
(...)
-
------