Europe’s top epidemiologists say that they’ve vastly improved their monitoring of emerging disease threats, including obscure ones, such as anthrax and plague. They also acknowledged, however, that the H1N1 pandemic may have resulted in less attention paid to other threats last year.
This week the European Centre for Disease Prevention and Control issued a report describing disease outbreaks and threats from 2009 – both within Europe and with the potential to affect Europe -- and assessing its response to each.
During the peak of the H1N1 pandemic in Europe, between April and September 2009, the agency noted a dip in reporting of other threats, particularly the type of food and waterborne diseases that tend to increase in the summer. This suggested that the member states’ attention to H1N1 may have resulted in under-monitoring and under-reporting of these threats to ECDC, according to Dr. Denis Coulombier, the head of the ECDC’s preparedness and response unit in Stockholm.
“It’s very clear that some of the other notifications that we should have received were not coming in,” Dr. Coulombier said in an interview. The dip seemed to be limited to the diarrheal illnesses and not the potentially graver threats on ECDC’s radar that year, such as the ongoing Q fever outbreak in the Netherlands, which saw more than 2,000 cases in 2009. “My main concern was to miss something else because of the pandemic,” Dr. Coulombier said. “Thankfully, I don’t think we missed much.”
The ECDC is a young organization, established in 2005 to increase information sharing among European Union member states and, to some degree, relieve them of their responsibilities in monitoring any global infectious disease threats, such as severe acute respiratory syndrome (SARS) and avian influenza, with the potential to impact Europe. Threats can include anything from a tuberculosis case on a plane to a multi-year threat such as West Nile virus, or even an endemic threat such as Q fever. Like criminal cases, the threats are considered open or closed. The vast majority are open for two weeks or less, while a small number of standing threats, such as avian influenza, remain open over a period of years.
Since instituting centralized monitoring, the agency noted in its report, the number of threats it has watched annually increased from 99 in 2005 (ECDC started monitoring in June of that year) to 251 in 2008. The increase, Dr. Coulombier said, was mainly due to the ECDC’s intelligence work on global threats, while threats reported by the member states remained relatively constant.
But in 2009, the number of threats dropped again —to 192, suggesting that the emergence of pandemic H1N1 may have siphoned off the attentions of the reporting countries and even the agency itself. “Events such as a pandemic require the extensive mobilization of public health resources, which seems to significantly reduce vigilance for other threats,” ECDC noted in its report.
While the most public threat of 2009, pandemic influenza H1N1, gobbled most of the headlines, the agency was also monitoring and helping to investigate outbreaks of Q fever, anthrax, measles, mumps, E. coli in petting zoos, an accidental exposure to Ebola, locally transmitted malaria, and a report of bubonic plague at a terrorist camp in Algeria, later deemed a hoax.
One threat from 2009, detailed in the report, involved a possible deliberate contamination of pool water in Italy. Dr. Coulombier said that the ECDC was “really strengthening the investigation” of cases involving the potential intentional release of pathogens and wants member states to be more vigilant about them. Last year the ECDC investigated a biosafety threat involving Ebola exposure in a lab and dealt with mysterious cases of anthrax among drug users in Scotland, issuing warnings to member states with protocols for handling patients, corpses, and biological or drug samples. The anthrax threat, believed to be linked to contaminated heroin, is considered ongoing.
Cases of Q fever rose from fewer than 20 notified cases annually to 168 in 2007, to 1,007 in 2008. In 2009, cases doubled. All the cases occurred in the Netherlands, and are likely related to goat and sheep farming near densely populated areas, the agency said in its threat report, but the disease has the potential to cross borders.
Dr. Coulombier said that the ECDC is continuing to monitor Q fever intensely, along with a panoply of obscure but real threats: vector-borne diseases such as dengue, malaria, West Nile disease, and Chikungunya fever, all of which occurred both last year and in 2010 in Europe.
But the polio epidemic in Tajikistan and Russia is considered one of the most serious emerging threats, with devastating potential for Europe, and Dr. Coulombier said the agency is urging member states not to lower their guard.
“This is a major one,” Dr. Coulombier said. “We have under-vaccinated populations in the EU. We know that the EU could be at risk of seeing the re-emergence of polio in these populations.”
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欧洲流行病学家称他们已经大大提高了对新发疾病威胁的监测，其中包括炭疽和瘟疫等罕见病，不过他们同时坦言，去年的H1N1大流行可能导致对其他疾病威胁的关注减少。
本周，欧洲疾病预防控制中心(ECDC)发布一则报告，描述了2009年以来欧洲范围内的疾病暴发和威胁并评估了对各种威胁的反应。据ECDC的Denis Coulombier博士称，在欧洲H1N1大流行高峰期间，即2009年4月~9月，ECDC注意到各国对其他疾病威胁的报告减少，尤其是食物和水传染病的类型，这类传染病在今年夏季有增加的趋势。这表明欧洲各成员国关注H1N1造成对这些疾病威胁监控不足和上报至ECDC的信息不足。报告不足的疾病似乎仅限于腹泻病，并未在当年ECDC重点监控的较严重威胁之列，其中包括荷兰的Q热暴发，不过Coulombier博士认为ECDC并没有疏漏很多工作。
ECDC是在2005年才成立的组织，其宗旨为在欧盟成员国范围内增加信息共享，这在某种程度上减轻了他们对全球传染病威胁的监控责任，如严重急性呼吸综合征(SARS)和禽流感，而威胁所涵盖的范围很广，从结核病至西尼罗河病毒，甚至是Q热。自成立ECDC以来，当局每年所监察的威胁疾病数由2005年的99增至2008的251，这主要归功于ECDC在全球疾病威胁方面的情报工作，而其成员国所报告的威胁数相对平稳。但在2009年，威胁数再次降至192，这表明大流行性H1N1流感的出现可能吸引了欧盟成员国及ECDC的注意力，因为像大流行性H1N1流感这类事件要求广泛动用公共卫生资源，而这可能明显降低了对其他威胁的警惕性。
2009年，ECDC在监控最严重的公共威胁——大流行性H1N1流感期间，也在监控和帮助调查Q热、炭疽、麻疹、腮腺炎、意外接触伊波拉病毒、地方性疟疾等传染病。鉴于以上各种传染病有着各自的特殊性，ECDC在切实加强对各种传染病的调查工作的同时，也希望成员国提高警惕性。尤其值得一提的是塔吉克斯坦和俄罗斯的脊髓灰质炎流行病，由于在欧洲有未接受该疫苗接种的人群，故当局正敦促各成员国切勿掉以轻心。
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