Stocktaking on Europ

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European Parliamentary Group June 12th 2007
Stock-taking on Europes pandemic preparedness
Zsuzsanna Jakab Director European Centre for
Disease Prevention and Control (ECDC)
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Bird Flu Threat to the European Union Much
Reproduced Cartoon from Autumn 2005
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Highly pathogenic avian influenza in wild
birdsin Europe (Autumn 2005 to 2 August 2006)
Source European Commission D1
http//ec.europa.eu/food/animal/diseases/adns/map/
20060802/europe.htm
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Animal Disease Notification System summaryreport
for highly pathogenic avian influenza inwild
birds (1 February to 9 November 2006)
Source http//ec.europa.eu/food/animal/diseases/a
dns/adns_wildbirds_09112006.pdf
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(No Transcript)
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Animal Disease Notification System summaryreport
for highly pathogenic avian influenza inwild
birds (1 February to 9 November 2006)
Source http//ec.europa.eu/food/animal/diseases/a
dns/adns_wildbirds_09112006.pdf
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H5N1 in the UK and Hungary February 2007
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ECDC Report on EU preparedness for the
CommissionSee http//www.ecdc.europa.eu/pdf/Pande
mic_preparedness.pdf A short Eurosurveillance
article on the Report http//www.eurosurveillance.
org/ew/2007/070222.asp1
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Acknowledgements-1

• Marja Esveld, Centre for Infectious Disease
  Control, National Institute for Public Health and
  Environment, Netherlands
• Ralf Reintjes, Department of Public Health,
  Faculty of Life Sciences, Hamburg University of
  Applied Sciences, Germany
• Jane Leese, Department of Health. Immunisation
  Policy, Monitoring Surveillance, UK 
• Bernardus Ganter, World Health Organization
  Regional Office for Europe
• Michala Hegermann-Lindencrone, World Health
  Organization Regional Office for Europe
• Angus Nicoll, European Centre for Disease
  Prevention and Control
• Reinhard Kaiser, European Centre for Disease
  Prevention and Control
• Dr Sophie Maes, Scientific Institute of Public
  Health (IPH), Belgium
• Dr Emmanuel Robesyn, Agency of Care and Health,
  Belgium
• Dr Sigrid Poulsen, National Board of Health,
  Denmark
• Dr Steffen Glismann, Statens Serum Institut,
  Denmark
• Dr Argo Parts, Dept of Public Health, Estonia
• Dr Kuulo Kutsar, Health Protection Inspectorate,
  Estonia
• Dr Petri Ruutu, National Public Health Institute,
  Finland
• Dr Tuula Putus, Ministry of Social Affairs
  Health, Finland
• Dr Pierrette Huberty-Krau, Ministry of Health,
  Luxembourg
• Dr Isabelle Welter, High Commission, Luxembourg
• Mr Andre Jacobi, VWS, Netherlands
• Dr Philip van Dalen, Ministry of Health, Welfare
  Sport, Netherlands

• Ms Gudrun Sigmundsdottir, Directorate of Health,
  Iceland
• Dr Bjorn Iversen, Norwegian Institute of Public
  Health, Norway
• Ms Iris Marelsdottir, RLS, Iceland
• Dr Farmasoyt Ragnar Salmen, Directorate for
  Health Social Affairs, Norway
• Dr Reinhild Strauss, Ministry for Health and
  Women, Austria
• Dr Chrystalla Hadjianastassiou, Medical and
  Public Health Services, Cyprus
• Dr Olga Kalakouta, Medical and Public Health
  Services, Cyprus
• Dr Jan Kyncl, National Institute of Public
  Health, Czech Republic
• Dr Reinhard Kaiser, European Centre for Disease
  Prevention and Control (ECDC)
• Dr Angus Nicoll, European Centre for Disease
  Prevention and Control (ECDC)
• Dr Karoline Fernandez de la Hoz, European Centre
  for Disease Prevention and Control (ECDC)
• Dr Sarah de Martin, European Centre for Disease
  Prevention and Control (ECDC)
• Dr Amanda Ozin, European Centre for Disease
  Prevention and Control (ECDC)
• Dr Carmen Varela, European Centre for Disease
  Prevention and Control (ECDC)
• Dr Paula Vasconcelos, European Centre for Disease
  Prevention and Control (ECDC)
• Dr Kornelia Molnar, Chief Medical Officers
  Bureau, Hungary
• Dr Agnes Csohan, National Institute of
  Epidemiology, Hungary
• Dr Derval Igoe, Health Protection Surveillance
  Centre, Ireland
• Ms Teresa Cody, Ministry of Health and Children,
  Ireland

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Acknowledgements-2

• Dr Marija Seljak, Ministry of Health, Slovenia
• Dr Alenka Kraigher, Institute for Public Health,
  Slovenia
• Dr Patricia Santa Olalla Peralta, Ministry of
  Health and Consumer Affairs, Spain
• Dr Maria Jose Sierra Moros, Ministry of Public
  Health, Spain
• Dr Frank Karcher, DG SANCO, European Commission
• Dr Bernardus Ganter, World Health Organization
  Regional Office for Europe
• Dr Dragan Jankovic, World Health Organization
  Regional Office for Europe
• Inge Jooris, Interministerial Commissariat
  Influenza, Belgium
• Jan Eyckmans, Interministerial Commissariat
  Influenza, Belgium
• Demetris Constantinou, Ministry of Health, Cyprus
• Kirsten Bohl, Danish Board of Health, Denmark
• Ben Duncan, European Centre for Disease
  Prevention and Control (ECDC)
• Andrea Würz, European Centre for Disease
  Prevention and Control (ECDC)
• Alun Jones, European Food Safety Authority (EFSA)
• Mart Soonik, Ministry of Social Affairs, Estonia
• Angus Nicoll, European Centre for Disease
  Prevention and Control (ECDC)
• Marie-Paule Benassi, DG SANCO, European
  Commission
• Carmen Marqués Ruiz, DG SANCO, European
  Commission
• Ewa Hedlund, DG COMM, European Commission

• Cornelius Bartels, Robert Koch-Institut, Germany
• Andreas Deffner, Federal Ministry of Health,
  Germany
• Anna Maria Leoutsi, Hellenic Centre for Diseases
  Control and Prevention (HCDCP), Greece
• Mitrou Kostas, Hellenic Centre for Diseases
  Control and Prevention (HCDCP), Greece
• Ilona Tasary, National Public Health and Medical
  Officer Service, Hungary
• Timea Kiss, National Public Health and Medical
  Officer Service, Hungary
• Helgi Mar Arthusson, Ministry of Health and
  Social Security, Iceland
• Zaiga Barvida, Ministry of Health, Latvia
• Natalja Keturkiene, Ministry of Health, Lithuania
• Celine Flammang, Service Information et Presse du
  Gouvernement Luxembourgeois, Luxembourg
• Jovanka Kostovska, Ministry of Health, FYROM
• Saso Stafanovski, Ministry of Health, FYROM
• Brian Cassar, Health Division MHEC, Malta
• Lynette Wijgergangs, National Institute for
  Public Health and the Environment, Netherlands
• Cecile Groenhaug, Directorate for Health and
  Social Affairs, Norway
• Pawel Trzcinski, Ministry of Health, Poland
• Ana Morais, General Directorate of Health UESP,
  Portugal
• Cristina Perez Canto, Ministry of Health, Spain
• Sara Johansson, National Board of Health and
  Welfare, Sweden

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(No Transcript)
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H7N2 Outbreak in Wales and England May 2007 3
in hospital and hundreds of adults and children
on antivirals http//www.eurosurveillance.org/ew/
2007/070215.asp3
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Who is at Direct Risk from Avian Influenza in
the EU

• Group 1 - Low but Real Risk Precautions
  Obligatory
• The risk of infection is almost entirely
  confined to people who have close contact with
  domestic poultry (chickens, ducks etc) or their
  droppings. Human cases have almost entirely been
  in this category
• People with small domestic and hobby flocks are
  most at risk as they are less likely to be able
  to take precautions than those working in
  industry
• ECDC Risk Assessment non-H5N1
• avian influenzas June 2007

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Direct Infection of Humans andReassortment to
for a Pandemic Strain
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Estimated additional deaths if a 1918-1919
Pandemic occured now (Murray et al - Lancet 2006
368 2211-2218 )
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Preparing for a Pandemic -Some Givens

• A pandemic is inevitable
• We cannot predict when, what virus type or how
  severe it will be
• Even milder pandemics like those of 1957 and
  1968 will disrupt societies and result in many
  avoidable deaths
• By preparing we can save lives, and avoid
  disruption
• After two years of preparations EU citizens
  probably now expect us to be prepared!

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Findings the Good News

• EU overall made considerable progress since 2005
  in pandemic preparedness
• High level political commitment
• All countries have made major efforts to develop
  national preparedness plans
• Health sector priorities well addressed
• Work underway to operationalise these plans
• Much good practice
• Innovative approaches

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A Few of Many European Influenza Control
Innovations

• Communicating with the public and children UK
  and Portugal,
• Cascade training of health care staff France,
• Getting Businesses to Prepare for a Pandemic
  Ireland
• Exercises to help get hospitals prepared parts
  of Spain
• Communicating with poor rural communities
  Poland
• Stimultating multi-sectoral planning going at the
  local level Sweden

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A Few of Many European Influenza Control
Innovations

• Communicating with the public and children
• Cascade training of health care staff
• Getting Businesses to Prepare for a Pandemic
• Exercises to help get hospitals prepared
• Communicating with poor rural communities
• Stimultating multi-sectoral planning going at the
  local level

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The Member State to Member State Approach

• A Theme of the 4th European Pandemic Preparedness
  Workshop in Luxemburg September 24-28th

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Havent we Done Enough?Shouldnt ECDC be Doing
Other Things Now?
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Havent we Done Enough? No!Shouldnt ECDC be
Doing Other Things Now?- Yes but as well not
instead of
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Further 2 to 3 years effort needed for EU
countries to be confident they can respond well
to a pandemic especially from their citizens
point of view
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Published targeted levels of antiviral stockpiles
gt 5 Published Data Assembled by Roche - in of
total population based on treatment
Sources Media / National pandemic plans (as of
April 1, 2007) 1. This represents the number of
treatments in percentage of total population that
governments have stockpiled or intend to
stockpile and that governments have made publicly
available either in their pandemic plans or
through media releases. 2. This is not (but can)
be a reflection of actual stockpiles. Some
governments might have more, but have not
publicly communicated, others might have less,
but intend to increase to reach a greater
coverage. 3. The slide only shows countries that
have or intend to stockpile for more than 5 of
their population and have made this publicly
available. 4. In some of the cases the coverage
includes Tamiflu and Relenza, in others only
Tamiflu.
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Some specific weaknesses from the ECDC Indicators
(Items where less than 80 of Member States were
able to self-report - yes we have done that)

• Planning document for local health services
  including planning assumptions (no such document
  22)
• National strategy on non-pharmaceutical
  interventions (22)
• National pandemic vaccination strategy developed
  (25)
• National communication strategy (30)
• Public education material on pandemic influenza
  (35)
• National health sector exercise undertaken (42)
• National contingency plan for maintinance of
  non-health essential services (50)

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Five Key areas where further efforts needed

• Integrated planning across governments.
• Extending influenza research
• Interoperability at the national level
• Making plans operational at the local level
• Stepping up prevention efforts against seasonal
  influenza

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Being prepared locally the ECDC Acid
Testshttp//www.ecdc.eu.int/Influenza/AssessmentT
oolPandemicInfluenzaPreparedness_13_9_2006.pdf

• Can you ensure? Some examples from the tests
• At Primary Health Service level
• Timely deliver antiviral treatments for all with
  symptoms within 24 or 48 hours of symptoms
  starting
• Hospitals
• Deliver acute care for influenza patients
• Continue to provide essential treatment for
  non-influenza related conditions
• Essential services continue to function locally
• Power
• Food
• Fuel supplies
• Pandemic vaccine will arrive within 6 months of
  start of pandemic at primary care

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Estimated Elderly Population Immunized
(Percentage) N 18 EU countries Forty Fold
Variation 2 to 80ECDC Survey April 2006
Source Population (2003) Data Eurostat
http//epp.eurostat.cec.eu.int/portal/page?_pageid
1996,45323734_dadportal_schemaPORTALscreenw
elcomerefopen/productEU_MAIN_TREEdepth1
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Street Hand-Washing Facilities USA and Hong Kong
in the EU?
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Hong Kong and Influenza Prevention
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Conclusions

• A lot done, but not yet ready and a lot more to
  do.
• Two to three years more hard work needed in the
  five areas
• Integrated planning across governments.
• Extending influenza research
• Interoperability at the national level
• Making plans operational at the local level
• Stepping up prevention efforts against seasonal
  influenza
• We need your help to keep governments on track

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Thank you for your Attention