SURVEILLANCE

OF COMMUNICABLE DISEASES
IN THE EUROPEAN UNION

A long-term strategy: 2008–2013

ecdc.europa.eu
Surveillance of communicable diseases in the European Union
A long-term strategy | 2008–2013

TABLE OF CONTENTS
Note. This document has been edited for readability. The original content has not been
altered or modified.
Introduction................................................................................................................................. 2
Executive Summary ...................................................................................................................... 2
Background ................................................................................................................................. 4
Definition and scope ..................................................................................................................... 4
Situation in 2007 .......................................................................................................................... 7
Strategic Information for Disease Prevention and Control................................................................. 8
Basic surveillance...................................................................................................................................8
Enhanced surveillance ...........................................................................................................................8
Behavioural and risk-factor surveillance................................................................................................8
Epidemic intelligence .............................................................................................................................9
Alternative surveillance methods...........................................................................................................9
Monitoring and evaluation .....................................................................................................................9
Vision for 2013............................................................................................................................. 9
Event-based surveillance .......................................................................................................................9
Indicator-based surveillance................................................................................................................10
For both event-based and indicator-based surveillance components: ................................................10
Goals and objectives of infectious disease surveillance At the European level................................... 10
Surveillance goals ................................................................................................................................10
Surveillance objectives ........................................................................................................................12
added value of European surveillance .......................................................................................... 13
Organisational Requirements of Surveillance in the EU................................................................... 14
Integrated European indicator-based surveillance system..................................................................14
Integrated European event-based surveillance system.......................................................................14
Case definitions for surveillance at the EU level..................................................................................15
Principles of collaboration: data exchange, access and publication....................................................15
Links to other international databases ................................................................................................18
Review of diseases under EU-wide surveillance..................................................................................18
Integration of data from laboratories and ways of collaborating with them.......................................18
National reference level laboratories (NRLs).......................................................................................20
Data analysis methods ........................................................................................................................21
Communicating the results – information for action ...........................................................................22
Support for Member States to meet the demand (needs assessment and ways to strengthen national
systems).................................................................................................................................... 22
Quality management and assurance process......................................................................................22
Annual review of objectives and priorities...........................................................................................23
External evaluation of ECDC, surveillance activity ..............................................................................23
Roadmap for implementation of the long-term strategy ................................................................. 24
Transition and transfer of the current Dedicated Surveillance Networks — 2010 .............................24
Consolidation of surveillance activities — 2010–2013.........................................................................25
Partnerships and collaboration ............................................................................................................25
Annex 1. Roadmap for ECDC’s long-term surveillance strategy ....................................................... 27

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 Surveillance of communicable diseases in the European Union
A long-term strategy | 2008–2013

INTRODUCTION
In 2005, a strategy for infectious disease surveillance in Europe was developed, outlining the
transition from the then project-based approach led by the Commission to a more
coordinated, sustained approach managed by ECDC. This strategy was approved by the ECDC
Management Board in October 2005, together with a plan to develop a long-term vision for
the future surveillance of communicable diseases in the EU.

EXECUTIVE SUMMARY
This long-term vision and strategy on the future surveillance of communicable diseases in the
EU has been developed to help direct the decisions for the long-term development of the
European surveillance system. This strategy covers the years until 2013, which aligns it with
ECDC’s multi-annual strategic plan (approved by the ECDC Management Board in June 2007).
Moreover, synergetic effects with ECDC’s laboratory strategy are foreseen.
The strategy attempts to define the terms and scope of surveillance, its aims and objectives,
and its organisational requirements. It also outlines ways to support the Member States and
presents an implementation roadmap.
The overall goal is to contribute to reducing the incidence and prevalence of communicable
diseases in Europe by providing relevant public health data, information and reports to
decision makers, professionals and health care workers in an effort to promote actions that
will result in the timely prevention and control of communicable diseases in Europe. High
validity and good comparability of communicable disease data from the Member States are
imperative to reach this goal.
A more coordinated approach to surveillance will
● improve the regional comparability of data;
● reduce the complexity in surveillance across Europe;
● allow to tackle surveillance in a synergistic way;
● avoid duplication of work;
● provide better quality public health evidence in the long term, thanks to more relevant
and reliable data;
● make it easier to strengthen the national surveillance systems;
● most likely be economically more efficient and sustainable;
● allow easier access to, and use of, the data;
● enhance the detection and monitoring of international outbreaks;
● contribute to capacity building; and
● ensure the inclusion of diseases into surveillance and research agendas according to
European priorities.
ECDC is developing a system for infectious disease indicator-based surveillance at the
European level, dubbed ‘The European Surveillance System (TESSy)’. TESSy will be a valuable

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tool to improve the collection, validation, storage and dissemination of surveillance data from
the EU Member States and EEA countries. Initially, TESSy will collect a reduced set of core
variables important for the routine surveillance of infectious disease cases. Once TESSy is
generally accepted and used as the regional standard database, ECDC’s long-term goals of
further reducing the complexity and workload for all participants will be supported by
● standardising data collection on infectious disease surveillance;
● providing a ‘one-stop shop’ for reporting and retrieving data for the Member States;
● standardising the reports based on surveillance data; and by
● providing a consistent and easily available overview of the current situation in the EU.
The current problem of double reporting of some diseases, with various regional
organisations involved in the surveillance of diseases — like WHO/Europe or EMCDDA — will
also be addressed, with the aim to reduce and possibly eliminate the duplication of efforts.
An interim procedure on the principles of collaboration on data exchange between ECDC and
Member States as well as ECDC and the Dedicated Surveillance Networks (DSNs) will have to
be established to clearly define the role of data providers and data users, both in Member
States and ECDC (and other parties, e.g. WHO). This interim procedure should also include
the procedures for publishing the results of data analysis, among other details. Based on the
experience with this interim procedure, a more detailed, final, longer-term procedure will be
established with the involved stakeholders.
The future collaboration with the disease-specific experts (nominated by the Competent
Bodies) will be structured in the following way: the diseases/pathogens will be divided into six
main groups. Where necessary, more focussed (disease-specific) subgroups will be
established within any of these six groups or task forces. There will be annual meetings for
each of these six main groups where issues pertinent to the surveillance of the whole disease
group will be discussed. If necessary, more disease-specific ‘parallel session’ symposia can be
held at the same time. For each of the six main disease groups/task forces, a coordinating
group will be established, and these groups will take over many of the functions carried out
by the former DSN steering groups.
Good laboratory services in the countries are essential for strengthening EU-level surveillance.
ECDC will build on the work already done and support the strengthening of laboratory
capacity in the Member States, EEA-EFTA countries and the candidate countries in
collaboration with the Commission, the ECDC Competent Bodies, and the Member States’
National Microbiology Focal Points.
ECDC will work hard to ensure that every country has national reference level laboratory
(NRL) services available, either directly or indirectly, enabling all countries to confirm the
diagnosis, isolation and further characterisation of pathogens — as a basis for reporting
confirmed and probable cases during normal times and emergencies. ECDC will link with
these NRLs and help them to integrate their data with the epidemiological (and clinical) data
at the national level. Quality assurance of laboratory methods is essential to ensure valid and
accurate data, and European standards will also be promoted over this period.
ECDC will implement its surveillance strategy in two phases: phase one is a transition period
that will last until 2010, with its main focus on the gradual integration of the current DSNs

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 Surveillance of communicable diseases in the European Union
A long-term strategy | 2008–2013

with ECDC; during phase two (2010–2013), ECDC will have taken over full responsibility of
surveillance and can subsequently focus on developing and consolidating the highest quality
systems possible for Europe.
In order to keep this strategy and its objectives relevant and up-to-date, it will be re-visited
by Member States and key stakeholders, so that emerging strategies and new evidence can
be incorporated as required.

BACKGROUND
For the development of this long-term strategy, the following documents have been taken
into account: MB4-10-9: Surveillance Strategy (2006–2008), MB10-7: Strategic Multi-annual
Programme, MB11-11: Strategy: collaboration with laboratories, and the Report from the
TESSy Working Group meeting from 14 to 15 February 2007.
In 2005, a strategy for infectious disease surveillance in Europe was developed, outlining the
transition from the then project-based approach led by the Commission to a more
coordinated, sustained approach managed by ECDC. This strategy was approved by the ECDC
Management Board in October 2005, together with a plan to develop a long-term vision for
the future surveillance of communicable diseases in the EU. It will be instructive in making
the appropriate decisions for the long-term development of the European surveillance system.
This long-term strategy covers the years until 2013, which aligns it with ECDC’s multi-annual
strategic plan (approved by the ECDC Management Board in June 2007). Moreover, synergetic
effects with ECDC’s laboratory strategy are foreseen.

DEFINITION AND SCOPE

Public health surveillance has been referred to as the epidemiological foundation for modern
public health.
Surveillance of health and disease has been defined by a number of authors1, 2, 3 with some
variation, but all definitions incorporate the main elements of ongoing data collection,
analysis to convert this data into statistics, interpretation of this analysis to produce
information and dissemination of information to those who can take appropriate action. The
most basic example of the practical utility of this work would be a surveillance system
detecting an unusual number of infections from a specific strain of pathogens which triggers
an alert and then leads to the early detection of an outbreak of disease and the
communication of this outbreak to the public health authorities who have the legal mandate

1
Heymann DL (editor). Control of Communicable Diseases Manual, 18th ed. APHA, 2004.
2
Eylenbosch WJ, Noah ND, (editors). Surveillance in Health and Disease. Oxford University Press,
1988.
3
Last JM (editor). A Dictionary of Epidemiology, 4th ed. Oxford University Press, 2001.

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A long-term strategy | 2008–2013

to take action to control the source of the outbreak, preventing further infections, morbidity
— in some cases mortality — and negative economic consequences.
Although the original surveillance methods were developed mainly for the control of
transmission of infections and early detection of outbreaks, today the scope of surveillance is
recognised to be much broader then just analysing communicable disease notification data
(mainly measuring the impact of interventions or establishing a platform for research).
A good surveillance system could also link with — or incorporate — other sources such as
● mortality data (particularly useful for rapid surveillance during major outbreaks or
surveillance in a pandemic);
● morbidity reports from health service patient records or hospital discharge data
(especially in the surveillance of severe disease and infections such as severe acute
respiratory infection [SARI]);
● laboratory data and activity (including serological status and molecular studies);
● outbreak data and field reports (linking outbreaks);
● vaccine and drug utilisation (AIDS was first discovered due to the abnormally high
demand for a rarely used drug to treat Pneumocystis carinii);
● primary care surveillance (including sentinel systems, especially good for early warning
signs of seasonal disease);
● various other sources like sickness absence data, sentinel system data, data on
determinants of health and disease (including individual and population behavioural
aspects); and, in certain circumstances,
● systematic survey data.
Linking this data to other systems, such as animal health data, enhances the effectiveness of
the surveillance of health and disease even further.
Presently, the main difficulty lies with the fact that most of these additional data are not
readily available to the Member States’ institutes in charge of disease surveillance. There is a
clear general trend among national databases to provide more and more record linkages at
the national level, and this trend offers an exciting potential for enhancing the routine
surveillance data over the coming years. However, ECDC will always discuss the usefulness
and feasibility of such linkages with the Member States before extending its data collection
activities beyond the usual surveillance level.
The traditional approach to surveillance of communicable disease consists of routinely
collecting data from health care providers about the occurrence of predefined diseases or
conditions. This notification process relies on case definitions for surveillance in order to
ensure optimal comparability of the data across health care providers. The notifications are
routinely compiled and analysed in order to produce indicators that point towards the
existence of a threat. In some cases, a public health intervention may result from a single
case of the disease, while in other situations a threshold may be applied to an indicator in
order to detect an unusual incidence of the disease in a given community. This ‘indicator-
based’ approach has proven to be very effective in monitoring threats related to known risks
and in ensuring the prompt implementation of public health measures.

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However, while the traditional approach remains the backbone of public health surveillance
for communicable diseases, it has proven to be less effective in ensuring prompt recognition
of emerging problems. Therefore, several additional approaches have been used to
complement traditional surveillance in order to enhance its ability to detect public health
threats. Some of these approaches remain indicator-based systems, relying on the routine
collection of structured data, compiled as indicators, such as syndromic surveillance or activity
monitoring. However, a new approach has emerged which takes advantage of the availability
of advanced information technology. It continuously scans the Internet and other media to
detect certain information that may lead to the recognition of emerging threats. This ‘event-
based’ surveillance approach effectively complements the indicator-based surveillance
approach. It uses unstructured data which then need to be studied and verified and which
cannot be summarised as an indicator.
Both surveillance approaches — indicator-based and event-based — are referred to as the
two components of epidemic intelligence, which encompasses all activities regarding the
gathering of information relevant for the detection of emerging threats. It should be noted
that while event-based surveillance aims primarily at the detection of emerging threats,
indicator-based surveillance addresses additional objectives such as providing indicators
useful for monitoring the performance and impact of communicable disease programmes.
The framework of epidemic intelligence is best described by the figure shown below:

Figure 1. Schematic view of Indicator and Event Based Surveillance

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Surveillance of communicable diseases in the European Union
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This chart should not be misinterpreted: ECDC will not recommend that all these measures
should be implemented at the EU level, or that all Member States need to change their
systems in order to contribute to this system. This chart merely represents an outline of
possible activities.
In the context of ECDC’s remit, surveillance is defined as the ongoing collection, validation,
analysis and interpretation of health and disease data that are needed to inform key
stakeholders (in Member States and elsewhere) in order to permit them to take action by
planning and implementing more effective, evidence-based public health policies and
strategies relevant to the prevention and control of disease or disease outbreaks. The prompt
dissemination of information to those who need to know is as essential as ensuring the
quality, validity and comparability of the data.
The long-term surveillance strategy presented here primarily focuses on the indicator-based
component of public health surveillance.

SITUATION IN 2007
Each of the 27 Member States has its own surveillance system and its own practices —
sometimes long-established — that need to be taken into account. National surveillance
systems and methods are very diverse, and the quality of data collated varies. Different case
definitions (or interpretations of the same definition) and reporting systems (e.g. different
reporting levels, ranging from the local physician/laboratory level to the regional and national
level before reaching the international level), country-specific differences in health care
systems organisation, and variability in facilities and equipment available for diagnostics, all
contribute to the great diversity of national surveillance systems. Therefore, it is no surprise
that these different surveillance systems often produce data that are not comparable.
Especially for smaller countries, participation in European surveillance activities poses
particular pressures. Staff capacity in many of the Member States needs to be expanded to
maintain and update surveillance methods and practices.
In addition to the national surveillance systems, several EU-wide Dedicated Surveillance
Networks (DSNs) have been established before ECDC was founded; some of these networks
were set up in the early 1980s. They were funded during their research stage as concerted
actions by the Commission and later as action in the field of public health. As a result, the
surveillance networks differ in size, objectives, structure, and development phase. They have
developed their own reporting rules, their own data validity checks, and their own report
layouts. The networks receive data approved by their national members, usually sourced from
national surveillance systems and/or national reference laboratories. In general, laboratory
data — in particular the more advanced data such as molecular sub-typing — are not widely
linked to epidemiological information. In 2006, a total of 17 such networks was being funded
by DG SANCO. Their contracts will expire between 2006 and 2009, and ECDC will gradually
take over the responsibility for coordinating these networks (see below). An overall weakness
of the networks has been the poor sustainability of their essential surveillance components,

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due to expiring fixed-term contracts and, occasionally, decreasing community funding and the
subsequent need to add novel components in order to receive new funding.

STRATEGIC INFORMATION FOR DISEASE PREVENTION AND

CONTROL
It is important for the key stakeholders and partners to have a clear concept of the European
understanding of health and disease surveillance and its various elements, frequently referred
to under the term ‘strategic information’.
‘Strategic information’ is a term originating from the business sector that has found its way
into epidemiology and public health jargon. In this context, it is used in reference to
information produced following the analysis of surveillance data as well as other relevant data
(including economic data, survey data, etc.). This type of information is essential for those
who are in a position to take appropriate action in order to prevent or control disease.
There are several activities that fall under the broad term ‘strategic information’:

Basic surveillance
Basic surveillance systems aim to collect a minimum amount of data to provide a basic picture
of all the diseases under scrutiny. These data and variables are undergoing continual but
gradual refinement and expansion according to changing needs and objectives. All changes
and adjustments will have to be agreed upon by the Member States. This results in a core set
of indicators that can be compared across disease, time, place and person.

Enhanced surveillance
Certain agreed-upon priority diseases require the collection of more detailed variables, more
data and the additional production of information. In this context, ECDC and the Member
States will take decisions on a case-by-case basis.

Behavioural and risk-factor surveillance

A surveillance system focussing on risk factors collects data on any attribute, characteristic or
exposure of an individual that increases the likelihood of developing an infection, disease or
injury.
Behavioural Surveillance Systems (BSS) are the most widely developed risk-factor surveillance
systems: if there is a high prevalence of a known risk factor for an infection in a certain area,
then the possibility of future transmission of that infection is high. BSS are designed to
systematically monitor trends in infection-risk behaviours over time, usually in target-risk
groups and only for specific diseases. Monitoring is generally conducted through a series of
repeated cross-sectional surveys at regular intervals. As for enhanced surveillance, ECDC and

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the Member States will decide — on a case-by-case basis — which behavioural risk factors
will be surveyed.

Epidemic intelligence
‘Epidemic intelligence’ can be defined as the sum of all activities related to the early
identification of potential health threats, their verification, and their assessment and
investigation in order to recommend public health measures to control them. It encompasses
both indicator-based surveillance and event-based surveillance as defined above.

Alternative surveillance methods

As information technology continues to develop, several implications for surveillance activities
evolve. There is the need to look beyond traditional methods and study the value of
alternative methods and systems in order to assess whether they can be further developed in
the context of the European Union. Such non-traditional methods include ‘open web’
surveillance, data linkage, automatic reporting through existing administrative data sources,
and automatic syndromic reporting from electronic medical records. The most promising of
these methods will be the subject of future studies and discussion on what is feasible in the
Member States.

Monitoring and evaluation

Monitoring is the routine, daily assessment of ongoing activities and their progress — usually
limited to prevention or health care activity indicators. By contrast, evaluation is the episodic
assessment of overall achievements. Monitoring looks mainly at what is being done, whereas
evaluation examines what has been achieved or what impact has been made. Surveillance
data feed into Member States’ monitoring and evaluation (M&E) systems, but M&E systems
frequently include specific data collection systems (i.e. on-going user surveys) which produce
information that would also be useful for the surveillance, prevention and control of a
particular disease.

VISION FOR 2013

This strategy aims to achieve certain targets by 2013. These targets include:

Event-based surveillance
● all Member States have procedures and tools in place to monitor and assess early
threats detected through event-based surveillance;
● all Member States use the ECDC Threat Tracking Tool to perform joint risk assessment
in the event of a threat potentially affecting more than one Member State; and
● all Member States routinely report communicable disease threats through the Early
Warning and Response System (EWRS), once their assessment has confirmed the
existence of a threat affecting the EU (as defined in the EWRS regulation).

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Indicator-based surveillance
● a statutory list of notifiable diseases limited to those notifiable diseases that are a
priority for Europe (including anti-microbial resistance and health care-acquired
infections); diseases are only included on this list if surveillance at the European level
actually adds value;
● all Member States use one integrated European surveillance system based on The
European Surveillance System (TESSy). This surveillance system covers all statutory
communicable diseases with the appropriate level of detail according to their priority
and follows EU-wide reporting standards and common principles of collaboration and
agreements on data exchange, access and publication;
● uniform case definitions for surveillance accepted and in use by all Member States, with
a reliable system for their revision to keep up with developments in the respective
diseases;
● fully integrated epidemiology and laboratory surveillance databases and surveillance
and reporting systems;
● effective quality-control programmes in operation for both the epidemiological and the
laboratory data, thus significantly improving the comparability of data between all
Member States;
● accurate and detailed systems in use to analyse surveillance data and provide
sophisticated trend analysis methods and models, in conjunction with system algorithms
to identify even subtle trends or low-level clusters or potential outbreaks; and
● common surveillance objectives accepted by all Member States and key stakeholders,
updated regularly to ensure that they remain valid and relevant to the needs of the
entire EU.

For both event-based and indicator-based surveillance

components:
● good communication systems developed that ensure that the right information for
action is reported and disseminated to policy makers, key technical stakeholders and
the general public, thus facilitating the transfer into public health action.

GOALS AND OBJECTIVES OF INFECTIOUS DISEASE

SURVEILLANCE AT THE EUROPEAN LEVEL

Surveillance goals
The overall goal is to contribute to reducing the incidence and prevalence of communicable
disease in Europe by providing relevant public health data, information and reports to
decision makers, professionals and health care workers in an effort to ensure informed
decision making for actions that will result in the timely prevention and control of
communicable diseases in Europe.

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High validity and good comparability of communicable disease data between Member States
are indispensable for the success of this goal.
Other main goals for surveillance are
● to monitor trends in communicable diseases over time, in order to better understand
the present situation and to compare trends across Member States;
● to detect and monitor any international infectious disease outbreaks with respect to
source, time, person, population and place, in order to provide a rationale for public
health action. Event-based activities should detect threats on the basis of events
reported or identified and assessed, while indicator-based activities should include the
monitoring of indicators to assess the effectiveness, performance and impact of
communicable disease prevention, response and control programmes;
● to detect and monitor health care-associated infections and pathogens that display
clinically and epidemiologically relevant antimicrobial resistance in Europe, in order to
respond to increases above warning thresholds and to implement appropriate action;
and
● to evaluate and monitor infectious disease surveillance programmes that support
prevention and control activities, in order to contribute to recommendations aimed at
improving and strengthening these programmes in the Member States and at the
regional level.
It is recognised that both ECDC and the Member States have responsibilities for building up a
strong surveillance system at the European level, and it will be necessary to proceed in
partnership. Member States will have to strengthen, maintain or set up the structures which
are required to provide relevant data. This may require investments from Member States, to
which ECDC may contribute. At the same time, ECDC will continue to develop the
infrastructure and framework, including quality assurance systems and training support
needed at the regional level. An idea that will be further explored is the possibility of
introducing minimum standards considered to be essential for ensuring that surveillance in
the Member States results in good data quality. All these initiatives will be developed in
conjunction with the Competent Bodies (CB) for surveillance to ensure that only feasible
initiatives are promoted.
ECDC’s priority focus is on the greatest threats to human health from infections. Besides any
emerging new threats (e.g. avian influenza, chikungunya), the immediate priorities in the first
year were established as: HIV/AIDS, antimicrobial resistance (AMR), influenza, and zoonoses,
with tuberculosis being added in 2006. ECDC’s work on these diseases will not just cover
surveillance; it will tackle them in a comprehensive way, including research and prevention
aspects.
Over the coming years, there will be a need to regularly review the prioritisation of diseases
for surveillance and risk assessment, using agreed-upon, objective criteria. It should be noted
that priorities for surveillance may not always coincide with priorities for research or public
health action: in many instances the development or maintenance of a reliable surveillance
system must receive high priority just to provide continuing assurance that an already
addressed public health problem remains under control. Another important concern is that
surveillance for potential risk factors and determinants is not systematically established

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throughout the region. Finally, ECDC will develop strategic guidelines on how to best deal
with monitoring new diseases and specific pathogen threats that may emerge, e.g.
surveillance of a new pathogen resistant to antibiotics.

Surveillance objectives
The long-term view for common future objectives for communicable disease surveillance in
the EU aims to establish a harmonised set of objectives for surveillance and then re-visit
these with Member States from time to time in order to ensure their suitability and relevance
to the situation in the European Union.
The overall goal of providing relevant data for key public health decision makers,
professionals and health care workers in Member States will be achieved by strengthening
national capacities, harmonising and modernising surveillance methods for communicable
diseases across Europe, and by providing a strong coordinated approach at the EU level. The
validity and comparability of data on communicable diseases between Member States is a key
issue for the future EU-wide surveillance system.
As referred to above under ‘Definition and scope’, the surveillance of communicable disease
does not exclusively refer to national (usually compulsory) surveillance systems, but also
involves other forms of surveillance, e.g. syndromic surveillance, sentinel surveillance,
behavioural surveillance, etc. As part of the long-term surveillance strategy of ECDC, the use
of these methods will be further developed, in particular with respect to the methodology of
data collection, data interpretation, most beneficial use of data, the communication of results,
quality assurance and continuous quality improvement.
Surveillance at the European level will continue to add value to the Member States’ efforts in
the field of healthcare by directly strengthening and supporting the national surveillance
systems and by coordinating the standardisation of EU-wide surveillance to ensure the easier
availability of comparable data between countries. It will reduce the complexity of surveillance
across Europe and enhance insights into communicable disease epidemiology in Europe.
To be able to achieve this, the following broad objectives need to be met:
● collect and provide comparable information on communicable diseases by standardising
and improving the technical frameworks for surveillance;
● strengthen and update methodologies and quality assurance to improve data collection,
the effectiveness of surveillance systems and the analytical tools for surveillance;
● strengthen laboratory surveillance activities by promoting the standardisation of
diagnostic methods and through improved coordination of laboratory networks on
specific pathogens;
● strengthen outbreak detection and monitoring by developing more effective algorithms
and protocols for reporting and through improved coordination of information
exchange;
● strengthen surveillance of antimicrobial resistance and health care-related infections by
promoting the standardisation of these specific surveillance systems;

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● strengthen national capacities for surveillance by providing general country support;

and
● strengthen surveillance, prevention and control programmes by monitoring and
evaluating their effectiveness.

ADDED VALUE OF EUROPEAN SURVEILLANCE

The added value of a coordinated approach to surveillance at the European level is more than
just the convenience of collecting data at one location. It will be visible at several levels:
● A coordinated approach to surveillance (leading to more standardised operating
procedures at the more specialised dedicated surveillance networks, their databases
and their output):
– will improve the comparability of data, which is especially relevant when
comparing trends, using the data for regional or sub-regional modelling or
forecasting (to better inform strategy development);
– will reduce the complexity in surveillance work across Europe and enhance
insights into the current situation of communicable diseases in Europe;
– would also allow to tackle infectious disease surveillance in a synergistic way and
avoid duplication of work.

● The continuous efforts to standardise the data and improve the comparability of data
will be a major added value. This general harmonisation of EU-wide surveillance tools
and methods for communicable diseases (case definitions, TESSy, Threat Tracking Tool,
etc.), together with an on-going review of the relevance of the collected data, leads to a
refinement of the system and will provide better quality public health evidence, based
on more relevant and reliable data. This evidence can then be used by decision makers,
professionals and health care workers in Member States and European organisations.
● Important communicable diseases could more readily be included both in a surveillance
and research agenda matching European priorities. Similarly, it would be easier to
identify those diseases for which there is no added value of surveillance at the
European level.
● Standardised, coordinated surveillance will facilitate the strengthening of the national
surveillance systems in general and also in the context of the implementation of the
International Health Regulations (revised in 2005).
● Having the surveillance coordination in one central place will most likely be
economically more efficient and sustainable compared with the past arrangements.
● This should enhance the detection and monitoring of international outbreaks of
infectious diseases — in particular those involving rare diseases/pathogen strains which
are more easily detected at the EU level — and, in the longer term, strengthen the links
to the public health response sector.
● Better surveillance enables the improved description of affected populations and makes
for more accurate estimates of the burden of disease, so that policy makers can be
better informed on the most effective prevention and control measures.

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● Member States, technical institutions and key stakeholders will have easier access to —
and use of — the data, and hence improve the quality of their reports and, at the same
time, foster better European collaboration.
● A coordinated approach will enable closer cooperation with the people in field
epidemiology training and provide more practical hands-on issues for the trainees.

ORGANISATIONAL REQUIREMENTS OF SURVEILLANCE

IN THE EU

Integrated European indicator-based surveillance system

ECDC is developing a system for infectious disease indicator-based surveillance at the
European level, The European Surveillance System (TESSy). TESSy will be a valuable tool to
improve the collection, validation, storage and dissemination of surveillance data of the EU
Member States and EEA countries. TESSy will start with the collection of a reduced set of
‘core’ variables relevant to the routine surveillance of cases of all infectious diseases. For
some diseases, these variables will be extended so as to embrace a more ‘enhanced’ set of
variables that so far have been collected by the DSNs. This — together with any aggregated
data the DSNs may have collected — will gradually become integrated into TESSy, as ECDC
takes over the coordination of the DSN. Close collaboration (see below) with the Member
States and their Competent Bodies will ensure that their needs and expectations are always
taken into account.
Once TESSy is generally accepted as the EU standard, ECDC’s long-term goal of further
reducing the complexity and workload for all participants will be greatly helped. This will be
achieved by:
● standardising the data collection on infectious diseases surveillance;
● providing a ‘one stop shop’ for reporting and retrieving data for the Member States;
● standardising surveillance-data-based reports;
● providing a consistent and easily available overview of the current situation in the EU.
The current double reporting of some diseases — with various (EU or European wide)
organisations involved in the surveillance of disease, like WHO/Europe or EMCDDA — will also
be addressed. The aim will be to reduce and possibly eliminate double reporting by
memoranda of understandings, taking advantage of technological advances in IT systems and
their potential for greater interoperability.

Integrated European event-based surveillance system

ECDC has also developed an integrated information system for event-based surveillance at
the European level, the Threat Tracking Tool (TTT or 3T).
TTT records all threats related to communicable diseases or to diseases of unknown origin
which present a potential threat to Member States. The tool allows access to all data

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Surveillance of communicable diseases in the European Union
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regarding these threats, including their verification and assessment status. It produces a daily
update bulletin as well as a comprehensive weekly threat bulletin (the Communicable Disease
Threat Report — CDTR), circulated to Member States representatives nominated by the
Competent Bodies for threat detection. In 2008, the TTT will be further developed into a full-
blown Epidemiological Information System (EPIS) which will include discussion forums
targeting alerts. Ongoing review and further refinement over the medium term will ensure
that this system will remain an effective adjunct to the other surveillance systems at both the
Member States and regional levels.

Case definitions for surveillance at the EU level

The original common case definitions for surveillance were revised in 2006 and will be
finalised in 2007. However, an agreement on the case definitions is only a first step. ECDC
will promote and support Member States during the implementation of these definitions as
they are a fundamental cornerstone for standardising the collection of data. Over the coming
years, their implementation will be followed up and evaluated, while the case definitions will
be revised and updated as required. A review and update process for the list of case
definitions will be developed and approved for surveillance by the Member States’ Competent
Bodies, thus ensuring that the statutory list remains relevant and continues to be focused on
those priority diseases whose European-level surveillance promises to be most beneficial.

Principles of collaboration: data exchange, access and

publication
Up until 2010, some of the DSNs will continue operating in their current format. During this
transition phase, an interim procedure on the principles of collaboration on data exchange
needs to be established between ECDC and the Member States — as well as between ECDC
and the various DSNs. This interim procedure will define the role of data providers and data
users both in the Member States and at ECDC and other parties, e.g. WHO. It will, among
other details, map out the procedures for publishing the results of data analyses. Later on, a
more detailed, final, long-term procedure will be established with the involved stakeholders,
based on the experiences that, by then, will have been made with the interim procedure.
Many of the DSNs developed out of small networks of microbiologists or epidemiologists with
personal connections and with a strong shared interest in a particular disease or disease
group. The DSN network hubs are often manned by experts with a varying degree of
expertise in surveillance — even if the DSNs are connected to surveillance institutes. The
overall need for a specific network — or the division of resources between them — has never
been critically assessed at the European level. The term ‘resources’ not only implies the
amount of funding from the Community, but also includes the amount of work put into each
of the DSNs by the Member States’ surveillance institutes. Usually, the routine work between
these network members was organised via email and through annual meetings with all
members. Most of the DSNs also established smaller groups such as ‘steering groups’ or
‘scientific advisory committees’, etc. These groups were made up by network members as
well as external experts who met between annual meetings in order to follow up on the
progress of activities and prepare proposals to be presented to the whole group. Any plans

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for the transition of the coordination of these networks need to take these structures into
account.
With the integration of the coordination of the work of these DSNs into ECDC, some practical
changes will be necessary. In accordance with Regulation (EC) No 851/2004, Member States
have nominated Competent Bodies to work in various areas within the ECDC’s remit, including
surveillance. This means that ECDC will rely on the Competent Bodies for surveillance to
confirm (or replace) the current DSN members and to nominate epidemiological and
laboratory contact points for each of those diseases where no network is in place (with one
person possibly covering more than one disease). (See Figure 2.)

Members of „Task Forces“

TESSy working group Disease-specific TFs

Nominated by MS (2/2007) Competent bodies for

Should be confirmed by CB surveillance

Confirm (or replace) Nominate

Contact points
Current DSN members for all (other)
diseases

dis.-spec. epi dis.-spec. lab

Figure 2. Foreseen nomination process for disease-specific contact points in future EU

surveillance activities (MS: Member States; CB: Competent Bodies; TF: Task Force).

The collaboration (for both indicator- and event-based surveillance) with all experts will be
structured as follows: The diseases/pathogens will be divided into six main groups (see Figure
3). Where necessary, more focussed (disease-specific) subgroups can be established within
any of these six broad groups. Each of these main disease groups will be coordinated
separately from the two specific Task Forces already in operation (one working on developing
the principles of collaboration, the other advising on IT issues, mainly TESSy and TTT). (See
Figure 3).
Annual meetings will be held for each of these six main groups. During these meetings,
issues pertinent to the surveillance of the whole disease group will be discussed. It is likely
that additional, more disease-specific ‘parallel session’ symposia will be held at the same time,

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Surveillance of communicable diseases in the European Union
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if necessary. For each of the six main disease groups, a coordinating group will be established
and these coordinating groups will take over many of the functions carried out by the old DSN
steering groups.
The main tasks of these coordinating groups will be to:
● discuss and advise ECDC on the topics to be included in the ECDC annual workplans for
specific disease groups;
● discuss and advise ECDC on the items to be included in the annual disease group
meeting agenda;
● discuss and advise ECDC on which more-disease-specific subgroup task forces should
be established (if any) and what should be included in the terms of reference for these
more-disease-specific subgroups; and
● liaise closely and work in conjunction with any ECDC disease-specific consultation
groups within the horizontal disease-specific programmes that will be set up to advise
on strategic or technical issues.
There are plans to establish several disease-specific consultation groups to advise ECDC on a
number of disease-specific issues. Wherever possible, the work of these disease-specific
consultation groups will be coordinated with that of the main disease task force coordination
groups, to avoid duplication and unnecessary travelling. In addition to annual meetings of the
six main disease groups, ad hoc sub-groups on specific issues will be formed. Additional
more-disease-specific workshops can be held as required.

Surveillance working group

Task Force
Task Force
Principles of
collaboration IT issues
(TESSY, TTT)

Task Forces
Disease-Specific
(Epi and Lab)
Food- and Water-borne Anti-Microbial Resistance and Health Care
and Zoonosis Associated Infections

Vaccine Preventable
HIV, STI and BBV

Respiratory Environmental, Emerging

and Vector Borne

Figure 3. Proposal for future disease-specific work in surveillance. The disease-specific

task forces will be coordinated within the overall disease-specific work of ECDC currently
taking place in horizontal disease-specific programmes.

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 Surveillance of communicable diseases in the European Union
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Horizontal disease-specific programmes also serve as common structures for prevention,

scientific advice, guidance, and preparedness and response issues.

Links to other international databases

Links will be established with relevant databases outside of ECDC to complement the data
available at ECDC (e.g. Eurostat, EMCDDA, WHO). Agreements on disease-specific data and
surveillance have already been reached with a number of international host organisations and
will continue to be consolidated over the coming years. One element to be kept in mind when
discussing these agreements is the burden on the surveillance system staff in the Member
States, and every effort will be made to reduce the reporting and validation work required at
the Member States level.

Review of diseases under EU-wide surveillance

The added value of surveillance of specific diseases at the European level is clearer for some
diseases than others. Also, certain threats require just as much effort during phases of low
activity as during their peak to ensure that they never grow into a problem. The recent past
has shown that new and emerging threats are continuously arising, and it is clear that over
the medium term there may well be communicable diseases that will need to be added to
those already under surveillance. It is therefore necessary to introduce an objective system or
process (ECDC, DG-SANCO and Member States) that allows constant reviewing and adjusting
of the list of those priority diseases (old and new) that require EU-wide surveillance. This
system should also include the criteria (burden, consensus about which disease, feasibility
studies, official procedure, etc.) that lead to the inclusion or exclusion of diseases from the
list.

Integration of data from laboratories and ways of collaborating

with them
Good laboratory services in the countries are essential for strengthening EU-level surveillance.
Much work has been done — through the public health and research laboratory networks, in
the former DSNs and the DG-Research-funded projects — to improve and standardise
laboratory methodology and systems. ECDC will build on this work and support the
strengthening of the laboratory capacity in the Member States, EEA-EFTA countries and the
candidate countries, in collaboration with the Commission, the ECDC Competent Bodies, and
the recently nominated Member States National Microbiology Focal Points.
The next section deals more specifically with how the laboratories will support the
surveillance of communicable disease. These strategies will also be integrated into the overall
ECDC strategy for collaboration with laboratories.
The following general principles guide the development of cooperation with the laboratories
from a surveillance perspective:

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Surveillance of communicable diseases in the European Union
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● Every country should have either close access to or its own reference-level laboratory to
confirm the diagnosis, isolation and further characterisation4 of pathogens5 as a basis
for reporting confirmed and probable cases during normal times and emergencies. As
stipulated in the revised 2005 International Health Regulations, each country should
have the capacity to provide support to regional and community levels for laboratory
analysis of samples, either domestically or through collaborating centres6.
● National reference laboratories or laboratories carrying out reference functions at the
national level (both referred to as NRLs in this text) would be the main link for ECDC to
the primary diagnostic laboratories in the countries. Several excellent European
surveillance and research laboratory networks already exist, and these networks could
form the basis for establishing a collaboration with ECDC.
● Links between the NRLs and the nationally responsible epidemiological
departments/institutes need to be established where they do not already exist. The
structure of some DSNs, having both epidemiological and laboratory contact points,
would be a useful starting point for those diseases that are covered by the DSNs. In
general, the laboratory and epidemiological (and clinical) data should be linked at least
at the national (better local) level before they are reported to ECDC.
● For zoonoses/food-borne diseases, a strong link between data from public health,
animal health, and food safety laboratories and epidemiological data should be the
ultimate goal. Different options on how to achieve this need to be explored and utilised
— in close collaboration with the appropriate stakeholders, e.g. the Commission, EFSA,
and WHO.
● Wherever relevant, the integration of molecular sub-typing data with epidemiological
(and clinical) data will be promoted by ECDC.
● Quality assurance of laboratory methods is essential to ensure valid and accurate data.
Accurate laboratory results are essential for the true comparability of laboratory data.
Standardisation of analysis methods should be promoted whenever feasible. Similarly,
the procedures when taking samples should be standardised. For external quality
assurance, the availability of schemes for advanced laboratory techniques such as
molecular typing needs to be ensured. More detailed strategies to support quality
assurance in the laboratories would be developed in collaboration with the NRLs and
will be explained in the ECDC strategy on collaboration with laboratories.
● Training in laboratory techniques and methods should be ensured. Some of the DSNs
have successfully organised laboratory training, and this experience could be used to
develop further training activities, in accordance with EU needs. In addition, closer
cooperation between epidemiologists, microbiologists and other relevant stakeholders

4
Further characterisation means e.g. antimicrobial susceptibility testing (including antivirals) or sub-
typing (both phenotyping and genotyping).
5
Here we refer to the pathogens set out in 2000/96/EC: Commission Decision of 22 December 1999
on the communicable diseases to be progressively covered by the Community network under Decision
No 2119/98/EC of the European Parliament and of the Council.
6
Revised International Health Regulations, annex 1.6. Available from:
http://www.who.int/csr/ihr/IHRWHA58_3-en.pdf

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will be fostered as well as additional training based on the evolving needs of these
stakeholders.
● ECDC would commission several studies, within the framework of feasibility studies, in
particular to:
– evaluate microbe-typing methods used for routine surveillance. This refers to
methods that have already been developed, but where it hasn’t been determined
whether their use during routine surveillance is of benefit to Europe-wide
surveillance. Normally, these feasibility studies will be limited to a few countries
and restricted to a limited period before proposing recommendations for the EU
level;
– compare and evaluate diagnostic tests for specific infectious diseases. This refers
to situations where there are several new tests on the market. These studies
would try to evaluate the strengths and weaknesses of the tests and provide
recommendations on their use in surveillance.

Suggested laboratory communication pathway

National Reference Local/Regional
Laboratory Function Public Health
(disease-specific) Authority

Member State National Surveillance

NRL
Coordinator

TESSy
ECDC database

= laboratory data
= advice, consultation (e.g. Interpretation of laboratory
results

Figure 4: Planned information and data flow between NRL coordinator, NRL, Member
States surveillance institutes and ECDC.

National reference level laboratories (NRLs)

In 2008 and 2009, a project will analyse in detail the clinical and public health microbiology
laboratory services in the Member States, with a strong focus on the reference function. This
project will result in a detailed overview of laboratory systems, gaps, limitations, obstacles as
well as models of good practice. This should help clarify where ECDC can intervene most

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Surveillance of communicable diseases in the European Union
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efficiently to strengthen these services at both the EU and Member States level, to help raise
standards and to better define core competencies and improve links to epidemiological work.
The results of this project will also contribute to the work of the Commission which is
preparing a general framework on laboratory cooperation in Europe.
Aside from this activity, there is a clear surveillance role for NRLs. NRLs need to collaborate
closely on pathogen- or pathogen-group-specific issues in a sustainable but flexible structure
that enables the integration of public health microbiology in selected disease-specific or area-
specific fields and activities. NRLs need to be able to improve their collaboration with their
epidemiology counterparts, provide training and technical support in the laboratory methods
for the regional and local public health laboratories, promote harmonisation of practices
related to laboratory investigation of clinical samples, and support the availability of External
Quality Assessment (EQA) schemes and quality-assurance methods for clinical diagnostic
methods.
One NRL (disease-specific or disease-group specific) will be selected through an open call to
take on a coordinating function at the European level to ensure that all specified activities are
performed. This NRL will also act as ECDC’s main contact point for microbiological expertise
on surveillance aspects (Figure 4). This process is also highlighted in ECDC’s overall
laboratory strategy which will be coordinated with the European Commission’s plans for a
general framework on laboratory cooperation in Europe.
As a rule, data on laboratory-confirmed or probable cases will be processed by one nationally
responsible epidemiological department or institute and then be uploaded to ECDC. The data
flow details for alerts of international clusters and/or outbreaks — identified through pooled
laboratory data — will be agreed upon by the Member States. Some of the DSNs have built-in
alert functions, and as ECDC gradually takes over the coordination of these network activities,
many of these functions will be merged with and integrated into ECDC activities and
developed further — in close collaboration with Member States and in line with the
International Health Regulations (IHR).

Data analysis methods

The infrastructure for the data on those infections that the Centre is required to cover will
continue to be developed, as well as the means to detect new diseases or syndromes arising
in the EU. Particular attention will be paid to surveillance developments that can provide a
clear added value to the national systems. For the system to achieve the objectives listed
above, regular analysis of the disease data will be required.
This implies, for example, that algorithms have to be developed that automatically detect
unusual clusters within the surveillance data. The information derived from these algorithms
will contribute to the other epidemic intelligence mechanisms being established in the Centre
and will result in a more comprehensive early identification and investigation system on
health threats (operated by national authorities with or without assistance from ECDC).
Moreover, since analytic methods at the EU level are mostly descriptive, more advanced
analytical approaches, including modelling and forecasting of infectious disease developments
in the EU region, will be implemented and further developed.

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COMMUNICATING THE RESULTS – INFORMATION FOR ACTION

Results will be communicated in two principle ways: as direct feed-back to the data providers
and as ‘information for action’ that will be disseminated to all relevant stakeholders.
The main stakeholders are the Member States’ public health authorities and policy makers
(national and local levels), various EU bodies such as DG SANCO, EMCDDA or EFSA, other
international agencies such as WHO (both Headquarters and the Regional Office for Europe)
and various leading non-governmental organisations and civil society groups. Also, the
audience may range from technical epidemiologists and public health policy makers to
laboratory specialists and non-technical policy advisors. Also, some basic results and tables
will be made available to the general public through ECDC’s web portal.
It is recognised that such a disparate collection of partners cannot be reached with a one-
size-fits-all method of feedback of surveillance information. ECDC will be studying how best
to improve and expand on the existing array of communication channels (Annual
Epidemiological Report, Eurosurveillance, weekly CDTR, website/portal, direct mailing lists,
new/other outlets) in order to make sure that the relevant information reaches the right
people in the most timely fashion.
ECDC will:
● produce and improve an Annual Epidemiological Report and a weekly bulletin within the
CDTR and/or Eurosurveillance and contribute to the annual European Zoonoses report;
● make available key surveillance data and analyses to public-health professionals and
scientists via the ECDC web portal and in a format that meets their needs;
● display key facts, figures and analyses for the general public on its web portal;
● improve the various outputs based on user feedback, advances in dissemination
technology and best practices;
● issue specific ECDC reports, bulletins and messages as part of global actions (e.g. on
TB or AIDS Days) and according to ECDC’s own analysis;
● hold annual meetings (during scientific conferences or separately organised by ECDC);
and
● publish scientific literature.

SUPPORT FOR MEMBER STATES TO MEET THE DEMAND (NEEDS

ASSESSMENT AND WAYS TO STRENGTHEN NATIONAL SYSTEMS)

Quality management and assurance process

A more effective national surveillance system is able to produce better quality data. ECDC,
together with the Competent Bodies (CBs) will develop and utilise a tool for assessing the
needs of national surveillance systems and then identify the best way of supporting the
Member States, so gaps can be defined and filled. As an ongoing activity, ECDC and the CBs

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Surveillance of communicable diseases in the European Union
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will consider developing a set of minimum-standards criteria for operating effective national
surveillance systems that meet EU demands. In addition to using these criteria for planning,
they could also be used for advocacy with policy makers to ensure that these key public
health activities are suitably resourced. ECDC will accept invitations by Member States to visit
the country and contribute to self-assessments of national surveillance systems. In this
context, ECDC will provide specific technical advice and support, as requested by the Member
States. Surveillance systems are very well established in most Member States, so ECDC will
take advantage of their good practices to help promote policies that will improve data quality
in other countries. A mapping exercise of the quality-assurance systems used by the
surveillance systems in the Member States should provide information on how to develop a
tool that evaluates the data quality in the Member States’ surveillance systems. A suitable
methodology will then be developed by ECDC and the CBs on how best to utilise such a
quality-assessment tool in the continuous upgrading of data quality. From time to time,
studies will be carried out to determine the main issues/problems with data comparability,
surveillance-system efficiency and under-ascertainment/under-reporting in the Member States.
Actions will be recommended and implemented to reduce any shortcomings.
ECDC and the CBs will also work on developing and implementing quality management and
assurance protocols. They will continue to develop standard analytic strategies and pilot
advanced methods of analysis (including developing new analytic approaches where
necessary) in order to continue to improve the relevance and impact of the surveillance
information for all Member States.
Wherever possible, all activities and systems developed should have little or no impact on the
basic workload of the Member States. This can be achieved by introducing, for example, by
automated plausibility checks during data upload to TESSy.

Annual review of objectives and priorities

Objectives and priorities will be subject to change over the next seven years. The more
detailed ‘specific’ objectives will be reviewed regularly, based on the findings of the Annual
Epidemiological Report, advances published in the scientific literature, and discussions from
other major forums. During this process, data-flow and collection systems will also be
evaluated and modified accordingly. These reviews will help develop better procedures for
assessing under-reporting and under-ascertainment for all diseases. They will also provide a
look into new priorities such as the more accurate estimation of true incidence or burden of
disease.

External evaluation of ECDC, surveillance activity

Apart from the annual review of objectives and priorities, ECDC as a whole — including its
event-based and indicator-based surveillance activities — will undergo an external evaluation.
Article 31 of ECDC’s Founding Regulation (EC) No 851/2004 provides for an independent
external evaluation of the Centre. The main purpose of this evaluation is to independently
and objectively evaluate ECDC’s achievements, measured against its objectives and work
programme. The evaluation aims to identify possible shortcomings and necessary
improvements regarding structure, management and working practices. The external

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 Surveillance of communicable diseases in the European Union
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evaluation will also look at any possible improvements relating to relevant EU legislation,
ECDC’s relations with the Member States and their public health institutes, and the possible
need for an extension of ECDC’s mandate, while taking into account the financial implications
of such an extension. The timing of future external evaluations is laid down in ECDC’s
Founding Regulation; evaluations are scheduled every five years. The results of such
evaluations will most likely impact the objectives and possibly also the strategy of surveillance.
All this needs to be reflected in ECDC’s surveillance strategy, therefore a comprehensive
review of the strategy is provisionally scheduled after each external evaluation.
In addition, internal and external peer reviews at varying levels will be designed.

ROADMAP FOR IMPLEMENTATION OF THE LONG-TERM

STRATEGY
ECDC will implement its surveillance strategy in two phases: phase one is a transition period
that will last until 2010, with its main focus on the gradual integration of the coordination of
the current DSNs with ECDC; during phase two (2010–2013), ECDC will have taken over full
responsibility of surveillance and can subsequently focus on developing and consolidating the
highest quality systems possible for Europe. A broad overview of the main steps in this
roadmap is presented in Annex 1.

Transition and transfer of the current Dedicated Surveillance

Networks — 2010
According to its mandate, ECDC will set up an integrated European surveillance system with
one central database. Part of this process is the integrated operation of the ‘old’ Dedicated
Surveillance Networks and their activities. ECDC will also assume responsibility for the
surveillance of all diseases outlined in Decision No 2000/96/EC. To achieve this, individual
transition plans have to developed, outlining how these networks will continue their activities
after their current contract expires. There are two possible approaches: integrate their
activities into ECDC or outsource specific activities through an open call. Network-specific
decisions will be based on several considerations:
● Are the diseases covered by the network among the priorities of the future enhanced
EU surveillance system?
● Which epidemiological and laboratory surveillance activities need to be implemented
through further activities in accordance with the future surveillance objectives?
● Which strategy will be employed to integrate the specific epidemiological data with the
laboratory surveillance data?
● What do the results of a standardised evaluation and assessment of the network
suggest?
● What is the staff capacity at ECDC and the required workload to allow conducting the
activities at least at the same level as before?

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Surveillance of communicable diseases in the European Union
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● Will the suggested measures be cost-effective?

The aim is to continue providing at least the same level of activity as is currently displayed by
the network hub and then discuss and implement improvements over the medium term.
Once the decision has been taken to integrate the work of a network hub into ECDC, a
transition plan is prepared. Such a transition plan provides a framework for the transition,
continuation and integration of the network’s activities into ECDC, and the way how this is
accomplished. The plan will contain the following activities, which will be adapted to
accommodate the specifics of the network:
● evaluation and assessment of the network;
● IT transfer: transition of the database and the website;
● focus on work responsibilities;
● preparation of calls;
● collaboration with Member States;
● implementation of future surveillance.
These activities are supposed to ensure that the establishment of the hub activities at ECDC
is maintained at a level equal or above the current one. For the future development of the
network activities, ECDC will closely collaborate with the network members — usually starting
with an initial workshop — to discuss the network’s future. Usually, the former coordination
hub is also consulted and plays an important part in this activity.

Consolidation of surveillance activities — 2010–2013

Phase two continues to the end of 2013. During this phase, ECDC, in conjunction with the
CBs, will focus on the consolidation of the surveillance systems in the Member States, striving
to ensure that all main gaps are filled and that ongoing quality-assurance programmes are in
routine operation. A system to discuss and revise the lists of priority notifiable diseases will
be in operation, and ECDC will be focussing on how to further strengthen the integration of
epidemiological and laboratory surveillance. Other activities relevant to the consolidation of
the European surveillance system will also be carried out during this phase, particularly in
reference to the comparability of data, where progress must be made.

Partnerships and collaboration

In the years ahead, the sharing of knowledge and experience as well as scientific cooperation
requires that ECDC will build close and interactive partnerships with selected institutions and
organisations that have strong programs and expertise in the prevention of communicable
diseases and control at the global and regional level. Priority partnerships will include WHO
(in particular its Regional Office for Europe), other EU agencies (e.g. EFSA, EMCDDA, EEA,
EMEA) and a variety of research networks in the EU.
„

25
 ROADMAP FOR ECDC's LONG-TERM SURVEILLANCE STRATEGY

Target 2: By 2013, ECDC is the central focal point for communicable disease
surveillance in the EU and the authoritative point of reference for strengthening 2008 2009 2010 2011 2012 2013
surveillance systems in MS.

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

main work
possible work
provisional study

Strategy 2.1: To establish EU wide reporting standards and an integrated data

collection network for surveillance including all MS and covering all CDs with the
detail necessary according to their priority

i Further develop The European Surveillance System (TESSy).

General disease core variable inputs – basic data for all 49 diseases
Incorporation of enhanced variable datasets – former DSN databases
Implement and expand on GIS
Introduce signal detection algorithms and modules
Support to National TESSy compatible IT Surveillance systems
Molecular epidemiology module: to integrate laboratory data, including molecular subtyping data
Develop additional features: webtools, syndromic surveillance systems, risk factor monitoring data, etc
General TESSy operational maintenance and upgrading
Develop links to other databases and data sources
Developing accessibility to the databases by the general public

ii Prioritisation of diseases for surveillance

Develop and agree disease/disease group specific objectives
Develop and agree on criteria for prioritisation of diseases
Apply criteria and revise list of diseases
Network Committee approves list and publishes

iii Revision of case definitions

Discuss and agree on new definitions (if considered necessary)
Network Committee approves new definitions (if considered necessary)
Promote and evaluate the implementation of the standard case definitions in EU

iv Ensure the sustainability of the essential surveillance components of the DSNs

Evaluation of all DSNs completed and suitable transition plans prepared
Coordination of relevant DSN activities transferred to ECDC, including out-sourced activities

v Principles of collaboration on data exchange, access and publication

Interim Procedure on Collaboration, agreed and signed with MS
Final Procedure on Collaboration agreed and signed with MS
Review and revise the Procedure on Collaboration with MS (if considered necessary)
Align data collection and reporting methods with key stakeholders (WHO, EMCDDA, etc.)

vi Working with disease specific contact points/tTask Force members

CB nomination or re-confirmation of Disease Specific CPs
Establishing Disease Coordinating Groups (former steering committees)
Meetings of RES Disease Coordination Groups
Meetings of ARM/HCAI Disease Coordination Groups
Meetings of EZO Disease Coordination Groups
Meetings of FWD Disease Coordination Groups
Meetings of VPD Disease Coordination Groups
Meetings of HIV/STI Disease Coordination Groups
Meeting of RES Disease Task Force, review surv objectives and further develop disease specific surv.
Meeting of ARM/HCAI Disease Task Force, review surv objectives + further develop disease specific surv.
Meeting of EZO Disease Task Force, review surv objectives and further develop disease specific surv.
Meeting of FWD Disease Task Force, review surv objectives and further develop disease specific surv.
Meeting of VPD Disease Task Force, review surv objectives and further develop disease specific surv.
Meeting of HIV/STI Disease Task Force, review surv objectives and further develop disease specific surv.

vii Integration of laboratory surveillance data

Mapping of laboratory surveillance potential
Develop principles of collaboration of laboratory surveillance
Select NRL to coordinate laboratory surveillance activities and on-going coordination work
Promote harmonization of testing practices and reporting systems and pilot advanced methods of analysis
Develop further the integration of epidemiological surveillance and laboratory surveillance

Strategy 2.2: To analyze trends of public health importance for EU and MS

regarding CDs in order to provide a rationale for public health action on the EU
level and in MS.

i Develop the analysis of the data

Regular analysis of data according to the timing which is appropriate for the respective disease
Develop advanced methods of analysis and integrate new analytical approaches to identify areas and issues for action
Develop and use modeling as a regular part of ECDC’s periodic surveillance analyses and reports

Strategy 2.3: To report on trends of public health importance for EU and the MS
regarding CDs in an appropriate manner for all stakeholders and foster transfer
into public health action

i Communicating the results

Develop Web portal outputs for various audiences and ensure regular updates
Improve and expand on existing communication channels
Hold or participate in various Annual Meetings to present results (including those listed in 2.1.vi. above)
Contribute to an improved Annual Epidemiological Report

ii Foster the principle of information for action

Promote the use by policy makers of the main conclusions from the surveillance reports
Monitor the key stakeholder and MS reports and publications that refer to or use ECDC surveillance data

Strategy 2.4: To have a system for quality assurance and control of the surveillance
data in place and work towards comparability of data between all MS

i Support MS to strengthen national systems and improve the data quality

Develop ‘minimum standards’ criteria for MS surveillance systems
Develop self -assessment tool for surveillance systems
Provide support to MS regarding infrastructure for surveillance
Develop a tool to evaluate the quality of data in MS surveillance systems.
Develop data quality management and assurance protocols for both laboratory and epidemiological data
Study how to improve the comparability of data
Implement recommendations to improve comparability of data
Implement procedures for assessing underreporting and under-ascertainment
Develop methodologies to estimate true incidence and burden of disease

ii External evaluation of surveillance

Review and revise strategy with evaluation report recommendations