Epidemic intelligence activities among national public and animal health agencies: a European cross-sectional study

Abstract

Epidemic Intelligence (EI) encompasses all activities related to early identification, verification, analysis, assessment, and investigation of health threats. It integrates an indicator-based (IBS) component using systematically collected surveillance data, and an event-based component (EBS), using non-official, non-verified, non-structured data from multiple sources. We described current EI practices in Europe by conducting a survey of national Public Health (PH) and Animal Health (AH) agencies. We included generic questions on the structure, mandate and scope of the institute, on the existence and coordination of EI activities, followed by a section where respondents provided a description of EI activities for three diseases out of seven disease models. Out of 81 gatekeeper agencies contacted, 34 agencies (42%) from 26 different countries responded, out of which, 32 conducted EI activities. Less than half (15/32; 47%) had teams dedicated to EI activities and 56% (18/34) had Standard Operating Procedures (SOPs) in place. On a national level, a combination of IBS and EBS was the most common data source. Most respondents monitored the epidemiological situation in bordering countries, the rest of Europe and the world. EI systems were heterogeneous across countries and diseases. National IBS activities strongly relied on mandatory laboratory-based surveillance systems. The collection, analysis and interpretation of IBS information was performed manually for most disease models. Depending on the disease, some respondents did not have any EBS activity. Most respondents conducted signal assessment manually through expert review. Cross-sectoral collaboration was heterogeneous. More than half of the responding institutes collaborated on various levels (data sharing, communication, etc.) with neighbouring countries and/or international structures, across most disease models. Our findings emphasise a notable engagement in EI activities across PH and AH institutes of Europe, but opportunities exist for better integration, standardisation, and automatization of these efforts. A strong reliance on traditional IBS and laboratory-based surveillance systems, emphasises the key role of in-country laboratories networks. EI activities may benefit particularly from investments in cross-border collaboration, the development of methods that can automatise signal assessment in both IBS and EBS data, as well as further investments in the collection of EBS data beyond scientific literature and mainstream media.

Epidemic Intelligence in Europe: a users’ needs perspective to foster innovation in digital health surveillance

“…Our study showed that the infrastructures of EI systems and the strategies for early warning and surveillance of EIDs vary across European countries and between national and regional levels, despite recommendations of supranational agencies (7). The organization of surveillance and collaborations were different according to the disease as stated also in a recent cross-sectional study (12). Despite these differences, all countries in our study bene ted from the creation of a Health Information System (HIS) with different components that are common for many other European countries (6).…”

“…They combined mandatory communicable disease noti cations, sentinel surveillance network with local stakeholders, event-based surveillance, and syndromic surveillance during mass gatherings. The most interoperable and timely databases at national level were those from laboratories, whose importance for early warning have been recently con rmed, by a quantitative study, for many models (12), and the shared platforms were useful for intersectoral collaborations although they cannot be extended to all models. Inside EI, the practices and logics of users showed activities that span from detection to reporting, rather than siloed activities for epidemic preparedness and response as previously described by Barboza (17).…”

“…A recent quantitative description of the EI activities of national agencies (12) brought some new ideas about the trajectories of innovation of the national PH and AH agencies. A complementary qualitative assessment can provide insight in the causality links of problems to solve and expectations of the EI practitioners in terms of changes of practices.…”

Data governance and ethics in digital health surveillance for emerging infectious diseases

“…Similarly, for the societal context, events or restrictions can in uence the content and latest trends. These observations con rm the importance of semi-automatisation and the requirement of human supervision during machine learning and text extraction, especially during the pandemic when European disease surveillance agencies lack human resources (24). Unfortunately, Twitter data rst used as experimental ground were no longer used in PADI-Web but remained a valuable source of data for ProMED.…”