The European Union鈥檚 disease surveillance network needs urgent improvement if future international outbreaks of infectious disease are to be successfully managed, say a group of European experts.
The team, led by Julius Weinberg at City University, London, evaluated responses to five outbreaks of communicable disease, which involved more than one EU nation. They found critical 鈥渋nadequacies鈥� in national detection of disease cases, reporting of cases, funding of the national surveillance networks and coordination between different countries.
The current network would be slow to identify a low-level bioterrorist attack, adds Weinberg. And while he thinks it would quickly identify a highly unusual large-scale outbreak, it would be poorly equipped to investigate it. 鈥淚t is not at all clear who should investigate an international outbreak, and where the funding for that would come from,鈥� he says.
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Lyle Petersen of the US National Center for Infectious Diseases and Mike Catchpole of the UK鈥檚 Public Health Laboratory Service Communicable Disease Surveillance Centre suggest in the British Medical Journal that a 鈥榮limline鈥� central EU monitoring centre could be key to improving performance. No central body exists at present.
National failure
Weinberg鈥檚 team gathered all published and unpublished information and conducted fresh interviews on five past outbreaks of infectious disease. These included outbreaks of influenza, meningitis and Legionnaire鈥檚 disease. They also conducted a postal survey to investigate the EU鈥檚 preparedness for an influenza pandemic.
The team found that national detection rates for common diseases and national responses to outbreaks varied widely. The surveillance system in one nation failed to pick up 60 per cent of cases of Legionnaire鈥檚 disease. 鈥淚t is likely that the coverage achieved in other surveillance systems is similar or lower,鈥� the researchers write in the BMJ.
The team also found that fewer than half the 28 national influenza laboratories and surveillance institutes that responded to their survey had plans in place at the time of the influenza outbreak to respond to a pandemic.
There was also no EU flu pandemic plan in place. 鈥淭his is ironic, considering that there is a plan in place to deal with a pandemic of avian flu in animals,鈥� says Weinberg.
Tip of the iceberg
The number of cases of many common infectious 鈥� such as salmonella food poisoning 鈥� reported to national surveillance centres represent only the tip of the iceberg in many countries, including the UK, Weinberg notes. Extra funding for primary care doctors is essential if reporting is to improve, he says.
The team also recommend that the European Commission formulates a long-term programme to improve existing networks. This should involve substantial funds for training of surveillance personnel. 鈥淚n the EU, there are remarkably few people working in this area,鈥� says Weinberg.
He agrees there is a need for a small EU centre responsible for coordinating information exchange and the response to a multinational outbreak of disease.