Public health: network for epidemiological surveillance and control of communicable diseases in the European Community EWRS

This report examines the operation of the EWRS during 2004 and 2005. Its conclusions are drawn from reports submitted to the Commission by the Member States as well as from experience learned during the operation of the EWRS during the period examined.

In the course of 2004 a total of 105 events were notified through the EWRS. Of the 105 messages, 30 were information messaged, 32 activation “Level 1” messages; 18 activation “Level 2” messages and 2 activation “Level 3” messages. Twenty one of these messages were related to influenza; eight to legionellosis; six to vCJD; five to acute diarrhoea; four to tuberculosis and meningitis; three to cholera and hepatitis; two to anthrax, encephalitis, malaria, rabies, haemorrhagic fever, dengue fever, measles and fever; and one concerning diphtheria shigellosis and mumps.

Only a few events, however prompted specific measures at Community level and most were controlled by applying public health measures at national level. Nine events required a more complex response, including: two outbreaks of legionellosis in Italy and Germany; six messages and 55 comments on the notification of the first human cases of the highly pathogenic avian influenza virus type A/H5N1 in Vietnam; two events associated with the West Nile virus infection which were notified by Ireland and France; one event associated with a rabid dog in France; an outbreak of hepatitis A that clustered in an Egyptian resort and which was notified by Germany; the reporting by Belgium of two birds of prey coming from Thailand and which were infected with the highly pathogenic avian influenza virus type A/H5N1 virus; and the notification of SARS related events.

In the course of 2005 six events required a co-ordinated response involving contact between health authorities in the Member States. Four of them were related to the propagation of the avian influenza threat to the European region (Romania, Russian, Ukraine and Turkey). These six events include: notification of the highly pathogenic avian influenza virus type A/H5N1, which entered Russia in 2005; passing on information regarding a large outbreak of Marburg hemorrhagic in Angola and helping Member States prepare special isolation units in hospitals to quarantine the contacts and to ship or transport samples for laboratory diagnosis across the EU; and the circulation of an EWRS message concerning an event related to a mistakenly distributed samples of live influenza A/H2N2 to carry out quality control tests.

To conclude, the Commission finds that the EWRS system is being used more and more by the Member States. It is deemed an appropriate tool for the rapid dissemination of information as well as a useful tool for the co-ordination of measures and risk management at a Community level. The total number of notifications circulated through the EWRS has doubled in 2004 and 2005 compared with previous years and the new Member States have managed to utilise the EWRS efficiently.

However, further analysis of the use of “information” and Level 1 messages shows that a number of them were focused on risk assessment issues and that a large part of them were requests to know if events similar to those which have been notified were identified in other Member States. Future involvement of the ECDC in assisting the Commission to operate the EWRS should improve the situation.

There are still too many messages listed in the “non-applicable”; “unknown” and “unlisted” categories. Nevertheless, the new application for the EWRS is appreciated by the Member States and has resulted in real improvements in the performance of the system.