This report is intended to inform the Council and Parliament about the events due to communicable diseases of Community relevance notified during 2006 and 2007 through the Early Warning and Response System (EWRS) under Decision 2119/98/EC of the Council and Parliament and Commission Decision 2000/57/EC.

During 2006 a total of 138 messages were posted (2.6 messages/week), with 223 comments. 43 events were related to influenza; 18 to acute diarrhoea; eight to diarrhoea and salmonellosis; 7 to measles; 6 to legionellosis; 5 to tuberculosis; 2 to cholera, death of unexplained origin, fever, food poisoning, haemorrhagic fever, hepatitis, haemolytic uremic syndrome, mumps or vCJD; and 1 each to campylobacteriosis, leptospirosis, listeriosis, septicaemia, shigellosis, soft tissue infection, sexually transmitted infection, and typhoid fever.

During 2007 a total of 85 messages were posted (1.6 messages/week), with a total of 300 comments. 10 events were related to tuberculosis and influenza; 7 to legionellosis; 5 to diarrhoea and salmonellosis; 4 to cholera and measles; 3 to acute diarrhoea; 2 to fever, food poisoning, haemorrhagic fever and multi-drug resistant tuberculosis; and 1 each to cryptosporidiosis, laryngitis, melioidosis, meningitis, mumps, pneumonia, rabies, septicaemia, shigellosis, syphilis, trichinosis and vCJD.

The Commission details the response and follow up to the main events for these years.

It notes that figures for the EWRS in 2006 and 2007 confirm previous years' trends. The number and typology of messages notified were comparable to 2004 and 2005. ‘Information level’ messages accounted for most of the EWRS messages. The total number of messages circulated in 2007 was fewer than in 2006. This most probably results from the higher number of messages related to avian influenza events notified in 2006 rather than from a change in the notification process. Additional analysis of the messages notified since the EWRS IT tool was launched (1999) is planned and should generate further evidence on the trend of EWRS use over time and will be instrumental in streamlining the use of the system, focusing more on management issues than on assessment.

As in previous years, only a limited number of the events reported in 2006 and 2007 required Community-wide coordination. This report has focused on the events which triggered such responses at different levels and which have spotlighted a number of specific areas calling for closer attention.

The Chikungunya outbreak in Italy highlighted the potential role of climate change in modifying vector-borne disease epidemiology in the EU and the need for a regional approach to monitoring and responding to these diseases (e.g. West Nile virus). In particular, it demonstrated that a disease that has never been reported in the EU can always challenge the capacities to respond and coordinate at Community level.

The upsurge of measles cases reported by a number of Member States highlights the importance of having a coordinated approach to achieving and maintaining a high level of vaccination coverage throughout Europe, with a view to the elimination of measles targeted for 2010.

Contact tracing procedures were implemented on several occasions. The results revealed that, although coordination procedures were swiftly put in place, mechanisms should be strengthened so as to trace rapidly the persons concerned and at the same time comply with current legislation on the protection of personal data. The major difficulties in obtaining data from airlines still persist.

A number of events required agreement on media messages addressed to large audiences. Coordination meetings of the EWRS authorities in Member States proved particularly useful for sharing common lines to be taken with the media. However, it was clear that further work is still needed to develop a more structured form of response.

The Commission and Member States, assisted by the ECDC, adapted swiftly to the challenge of the new International Health Regulations which entered into force on 15 June 2007. Existing legislation on communicable diseases has already been adapted and will be followed in 2010 by a proposal for a package of legal instruments covering health threats from non-communicable diseases. In the short term, specific instruments to strengthen contact tracing for public health purposes will be proposed. Mechanisms to address the global dimension of events reported outside the EU but with possible impact at Community level were activated, when needed, in order to facilitate and strengthen the management of those events taking stock of the available resources like the European Programme for Intervention Epidemiology Training (EPIET), that is now coordinated by the ECDC with close collaboration of the WHO.

A substantial upgrade of the EWRS IT application is planned in order to achieve consistency with the new communication platforms which the Commission and the ECDC are developing. In particular, the link with the ECDC EPIS platform will provide solid ground for exchanging epidemiological information on specific events. The Commission’s tools for helping Member States to share data and information during crisis situations will help the EWRS to work smoothly whenever a large number of messages are posted through the system.

Lastly, some minor modifications to the ‘simple search’ application (closure of events, message content, syndrome/disease, pathogen, reporting reason, and country of occurrence) are necessary and will be introduced soon. The need for these ‘minor’ modifications was identified in the previous report too, but the EWRS transfer phase prevented this kind of upgrading.

COM(2009)0228
EUR-Lex

C(2008)1589

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.

COM(2007)0121
EUR-Lex

The European Commission has presented its report on the operation of the early warning and response system of the Community network for the epidemiological surveillance and control of communicable diseases (Decision 2000/57/EC) during 2002 and 2002.

The Annual Reports from the Member States and the preparation of the related Commission report 2002 were delayed due to the work overload caused by the SARS event which developed abruptly starting on mid March 2003.

The report concludes by stating that the analysis of the content of messages transmitted through EWRS indicates that notifications are sometimes delayed with respect to the date of onset of the event. This is because Member States have to be certain about the facts and about Community relevance before making formal notifications via the EWRS. Analysis of the content of messages transmitted through EWRS in 2002 and 2003 indicates that a gradual but clear improvement in the notification process is taking place. To improve timeliness of notifications, a check-list of criteria for the assessment of Community-relevant events was introduced in 2003. Application of the list facilitates a more uniform and timely notification of events to EWRS. The notification to EWRS of cases of SARS, an event which dominated EWRS activity during 2003, with clear Community relevance, was very rapid.

The SARS event represented a significant test for the usefulness of EWRS. EWRS fulfilled effectively its institutional function, not only with the timely circulation of the alert among the national authorities, but also by facilitating the exchange of information, the provision of technical-scientific advice and the formulation of common positions among the national public health authorities.

The SARS outbreak also demonstrated the utility and flexibility of the new mechanism of the Scientific Support to Policies present in the 6th Framework Programme for RTD.

The messages on the events notified in 2002 and 2003 do not indicate which criterion, among those indicated in Annex I of Decision 2000/57/EC, had been considered relevant by Member States when reporting. Indicating the relevant criterion for notification by the notifying authority is important for evaluating the relevance and functionality of the criteria as well as their consistent application. Efforts are being made to ensure that such indications are provided.

In 2003, the EWRS has been used occasionally by the national health authorities as a working tool for the exchange of different types of information, as exemplified by messages related to events 12 (poultry influenza in the Netherlands), 28 (West Nile virus in France), and 33 (influenza in EU). However, the use of EWRS as a practical tool to provide and receive information, with the aim of improving awareness and knowledge about events in a framework of co-operation among national public health authorities, was still not fully exploited. The reasons for this are being considered with the authorities of the Member States and conclusions will be drawn on improvements needed.

Analytical annual reports of the events and on the EWRS procedures applied and additional reports on specific events of particular significance have been provided by some Member States. There is clear preference for additional reporting on specific events only where there is added value besides that provided by the initial notification and report. This, together with a number of operational improvements that are deemed necessary are under active consideration.

EUR-Lex
COM(2005)0104

EUR-Lex
COM(2000)0471

Decision 1998/2119
OJ L 268 03.10.1998, p. 0001

OJ C 292 21.09.1998, p. 0053-0064
T4-0424/1998

T4-0424/1998

Commissioner Flynn welcomed the cooperation shown by Parliament and the Council in the conciliation procedure. He reiterated the statements made in this context by the Commission with regard to the appropriate staffing and structures needed to achieve the objectives of the decision in question and also the prudential use of the financial resources available to the committee which would assist the Commission.

Debate in Parliament

A4-0276/1998
OJ C 292 21.09.1998, p. 0005

A4-0276/1998

3615/1998

3615/1998

EUR-Lex
COM(1998)0079

OJ C 034 02.02.1998, p. 0057-0070
T4-0015/1998

T4-0015/1998

The rapporteur was keen to stress that setting up a European surveillance centre was central to ensuring effective action at European level. In reply, Commissioner Flynn rejected Amendment No 5 on a surveillance centre as there were already national centres which had acquired considerable experience in this field. The Commissioner then explained that it was clearly preferable to build upon what already existed and had proven to be working well instead of starting again from scratch. In addition, the Community had invested heavily in linking the national administrations in numerous areas, including the surveillance and control of communicable diseases. Citing the case of Asian bird flu, Mr Flynn argued that the European Union must have a network of links allowing Member State authorities to monitor new cases and, in particular in order to prevent chicken flu, to define and coordinate control measures for travellers coming from the Hong Kong region. The Commissioner informed Parliament, however, that he could accept Amendments Nos 2, 4, 6, 7-13, 15, 19, 20 and 22. As regards Amendments Nos 14, 18 and 21, the Commission was prepared to follow Parliament’s suggestions provided that the wording was improved. On the other hand, Amendments Nos 1, 3, 16 and 17 had to wholly rejected together with Amendment No 5.

Debate in Parliament

A4-0004/1998
OJ C 034 02.02.1998, p. 0004

A4-0004/1998

EUR-Lex
SEC(1997)1483

07873/1/1997
OJ C 284 19.09.1997, p. 0010

07873/1/1997

EUR-Lex
OJ C 103 02.04.1997, p. 0011
COM(1997)0031

EUR-Lex
COM(1997)0031

OJ C 362 02.12.1996, p. 0091-0108
T4-0586/1996

T4-0586/1996

Debate in Parliament

A4-0287/1996
OJ C 347 18.11.1996, p. 0004

CES1068/1996
OJ C 030 30.01.1997, p. 0001

A4-0287/1996

CDR0157/1996
OJ C 337 11.11.1996, p. 0067

1924

EUR-Lex
OJ C 123 26.04.1996, p. 0010
COM(1996)0078

EUR-Lex
COM(1996)0078