Overview of surveillance of water related diseases in the UNECE region

Overview of surveillance of Overview of surveillance of water related diseases in water related diseases in

the UNECE regionthe UNECE region

Monica Francesca BlasiMonica Francesca BlasiUnit of Quality of Aquatic Environments and Bathing WaterUnit of Quality of Aquatic Environments and Bathing Water

National Institute of HealthNational Institute of HealthRome, ItalyRome, Italy

-------------------------------------------------------------------------------------------------------------------Workshop on Water and Health, Bucharest 14th -16th of May 2008

5th Meeting of the Capacity for Water Cooperation, UNECE Capacity Building events

Plan of the activities Plan of the activities Task ForceTask Force on surveillance on surveillance and early warning systems, contingency plans and and early warning systems, contingency plans and

response capacity (2007-2009)response capacity (2007-2009)

QuestionnaireQuestionnaire to assess the current capacity of water- to assess the current capacity of water-related disease surveillance, and elaboration and related disease surveillance, and elaboration and

publication of repliespublication of replies

Guidance materials (technical and policy guidelines)Guidance materials (technical and policy guidelines)

Scientific workshopScientific workshop

Assistance and in-country support Assistance and in-country support

QUESTIONNAIREQUESTIONNAIREThe Task Force developed a questionnaire in The Task Force developed a questionnaire in order to assess:order to assess:

The state-of-the-artThe state-of-the-art on the surveillance systems on the surveillance systems of water-related diseases in the UNECE region of water-related diseases in the UNECE region

Critical areasCritical areas and situations and situations The burden of WRDs The burden of WRDs in the regionin the region AssistanceAssistance programmes and programmes and training training activitiesactivities

QUESTIONNAIRE STRUCTUREQUESTIONNAIRE STRUCTURE General section: priority, emerging and locally

important diseases Organization of the surveillance systems structure,

coordination and reporting Case confirmation and laboratory capabilities to detect

pathogenic microorganisms Public information Data characteristics Outbreaks detection Epidemic preparedness Capacity of response Training Databases and mapping/GIS resources

The questionnaire, as well as information on registration, access and compiling, have been sent to the Protocol’s national focal points

by the end of February

The questionnaire is available in the online version at the link: http://cms2.iss.it/

Info: [email protected]

http://cms2.iss.it/

…the questionnaire is also hosted in electronic format on a protected site of the Italian National Institute of Health (http://cms2.iss.it/)

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8

QUESTIONNAIRE REPLIESQUESTIONNAIRE REPLIES At the moment only 8 countries sent back the

questionnaire’s answers

Andorra 1Czech Republic 2

Estonia 3Finland 4

Hungary 5Norway 6

Slovakia 7Turkey 8

7

1. General information1. General information 1.1 Is there a mandatory surveillance and reporting system for 1.1 Is there a mandatory surveillance and reporting system for any any

diseasesdiseases in the country?: YES=8 in the country?: YES=8

1.2...and the surveillance systems cover the following WRDs...1.2...and the surveillance systems cover the following WRDs... PRIORITY DISEASESPRIORITY DISEASES EMERGING DISEASES EMERGING DISEASES

Diseases Yes No

Cholera 8 0

EHEC 7 1

Shigellosis 8 0

Typhoid fever

8 0

Viral hepatitis A

8 0

Diseases Yes No

Campylobacteriosis

8 0

Cryptosporidiosis

6 2

Giardiasis 8 0

Legionellosis 8 0

1.3. Are there additional surveillance programmes for 1.3. Are there additional surveillance programmes for specific water-related diseases that are locally important specific water-related diseases that are locally important such as…such as…

Blue baby syndrome: 2

Arsenicosis: 1

Viral infections particularly norovirus: 5 Parasitic diseases: 6

2.1. Is there a mandatory surveillance and 2.1. Is there a mandatory surveillance and reporting system for water-related disease reporting system for water-related disease ((WRDWRD) in your country?) in your country?

YES=8YES=8

2. Surveillance: structure, 2. Surveillance: structure, coordination and reportingcoordination and reporting

2.2. If yes, please provide a short textual description of the operation of the mandatory surveillance system composition, function and links to various sectors including the laboratories:

6 countries replied to this question

Hospitals or Laboratories: responsible persons, reference laboratories in the country or in others countries,

clinicians

Surveillance System

Local authorities: Municipal Health Protection Authorities, Departments of Epidemiology of Regional Public Health Authorities, Health protection

Institutes regional Offices, local or regional medical Officers Service

Central authorities: Health protection Inspectorates, National public Health Authorities, Ministry of Health or Social Affairs, National

Epidemiological Information System, National public health and medical officers service

2.3. Is there a surveillance 2.3. Is there a surveillance coordination bodycoordination body at the at the national level?national level? Yes= 8 Yes= 8

2.4. Is there a 2.4. Is there a standardized surveillance formstandardized surveillance form provided by the central level collecting communicable provided by the central level collecting communicable disease surveillance data? disease surveillance data? Yes= 8Yes= 8

2.5. Is the possible 2.5. Is the possible vehicle of infectionvehicle of infection (water, foods, (water, foods, etc) considered on the notification form? etc) considered on the notification form? Yes=4Yes=4

2.7. Are potential 2.7. Are potential environmental sourcesenvironmental sources responsible responsible for water contamination investigated or reported in the for water contamination investigated or reported in the notification form?notification form? Yes= 5Yes= 5

2.6. Is there a specific 2.6. Is there a specific reporting formreporting form for the for the following water-related diseases, which allows following water-related diseases, which allows later confirmation of the exposure route?later confirmation of the exposure route?

Yes No Yes No

Cholera 6 2 Campylobacteriosis 5 3

Enterohaemorrhagic E. coli 6 2 Cryptosporidiosis 3 5

Shigellosis/bacillary dysentery 6 2 Giardiasis 5 3

Typhoid fever 6 2 Legionellosis 7 1

Viral hepatitis A 6 2

Priority diseases Emerging diseases

Emerging less then priority diseases

3. Case confirmation3. Case confirmation 3.1. Is 3.1. Is case confirmation mandatorycase confirmation mandatory by by

laboratory analysis for the following water-laboratory analysis for the following water-related diseases?related diseases?

Yes No

Cholera 7 1

Enterohaemorrhagic E. coli 7 1

Shigellosis/bacillary dysentery 7 1

Typhoid fever 7 1


Priority diseases

Yes No

Campylobacteriosis 7 1

Cryptosporidiosis 7 1

Giardiasis 7 1

Legionellosis 7 1

Emerging diseases

3.2.a. Is there a national laboratory 3.2.a. Is there a national laboratory capability capability to confirm the etiological agentsto confirm the etiological agents of the of the following water-related diseases?following water-related diseases?

Yes No

Campylobacteriosis 7 1

Cryptosporidiosis 7 1

Giardiasis 7 1

Legionellosis 7 1

Emerging diseases

Yes No

Cholera 7 1

Enterohaemorrhagic E. coli 7 1

Shigellosis/bacillary dysentery 7 1

Typhoid fever 7 1


Priority diseases

The most of countries are able to confirme the etiological agents

3.2.b. If yes, list 3.2.b. If yes, list etiological agentsetiological agents detected by routine laboratory analysis:detected by routine laboratory analysis:

Etiological agent Yes No V. cholerae 7 1Enterohaemorrhagic E. coli 7 1Shigella spp. 7 1Salmonella typhi 7 1Salmonella paratyphi 7 1Viral hepatitis A 6 2Campylobacter (C. coli, C. jejeuni, C. laridis, C. upsaliensis)

5 2

Campylobacter (C. fetus, C, hyointestinalis, C. concisus, C. mucosalis and C. sputorum)

4 3

Cryptosporidiosis parvum 5 2Giardia lamblia/ G. duodenalis 5 2

Legionella pneumophila 6 2Others (Please specify) 3 2

Emerging less then priority

diseases

4. Public information4. Public information 4.1Is there a 4.1Is there a public awareness programmepublic awareness programme on the importance of on the importance of

water-related diseases and the relationship between water hygiene and water-related diseases and the relationship between water hygiene and health. health. YES=4YES=4

4.2 Is there an 4.2 Is there an integrated information systemintegrated information system, accessible to the public, , accessible to the public, about long-term trends, current concerns and successfully handled past about long-term trends, current concerns and successfully handled past problems in water and health? problems in water and health? YES=2YES=2

4.3 Is there an information system on 4.3 Is there an information system on rights and entitlementsrights and entitlements to water? to water? YES=4YES=4

4.4 If yes, list the web site, 4.4 If yes, list the web site, databases or other forms of databases or other forms of communicationcommunication

-Web-pages=4-Web-pages=4-School education system activities for the public such as World water -School education system activities for the public such as World water day, annually reports=1day, annually reports=1-No responses= 3-No responses= 3

5. Data characteristics5. Data characteristics 5.1. Please provide information on the 5.1. Please provide information on the level of detail available at the central level on datalevel of detail available at the central level on data concerning water- concerning water-

related diseases. related diseases.

DESCRIPTIVE INFORMATIONDESCRIPTIVE INFORMATION STATISTICAL INFORMATIONSTATISTICAL INFORMATION

priority diseases priority diseases DESCRIPTIVE INFORMATIONDESCRIPTIVE INFORMATION

Case based information Choleral EHEC Shigellosis

Typhoid feverl

Viral hepatitis

Age 8 8 7 7 7Sex 8 8 8 8 8Occupation 7 7 7 8 7Location related information Choleral EHEC

Shigellosis

Typhoid feverl

Viral hepatitisl

District 8 8 8 8 8Region 8 8 8 8 8Municipality 8 7 7 8 7Travel related 7 7 7 7 7

Descriptive information Choleral EHEC Shigellosis

Typhoid feverl

Viral hepatitis

Outbreak 7 6 7 7 7Sentinel 3 3 3 3 2Time 6 5 6 6 5

Case based informationCampylobacteriosis

Cryptosporidiosis Giardiasis

Legionellosis Others

Age 7 6 6 7 2Sex 8 7 7 8 2Occupation 7 6 7 8 2Location related information

Campylobacteriosis



District 7 6 7 8 4Region 7 6 8 8 3Municipality 6 5 7 8 2Trave related 6 5 6 7 2

Descriptive informationCampylobacteriosis



Outbreak 7 5 7 7 4Sentinel 2 2 2 2 1Time 5 5 5 6 2

emerging diseases emerging diseases DESCRIPTIVE INFORMATIONDESCRIPTIVE INFORMATION

STATISTICAL DATA TREATMENTSTATISTICAL DATA TREATMENT

Basic statistics:

YES=7 for all the priority and emerging WRDs

Trend analysis:

YES=7 for all the priority and emerging WRDs

5.1.c. Action threshold – has an action threshold been defined for the following diseases and, if so, what is the threshold value?

PRIORITYPRIORITY EMERGINGEMERGING

Country Cholera

Enterohaemorrhagic E. coli

Shigellosis/

bacillary dysenter

yTyphoid

fever

Viral hepatitis

A

1 1 1Unknow

n 1 1

2 1 2 5 1 5

3 1 1 1 1Unknow

n

4 1 1

more than

expected 1

more than

expected5 No No No No No

6 1 1 ? 1 ?7 no no no no no

8 1 >2 >2 >2 >2

CountryCampylobacterio

sisCryptosporidio

sis GiardiasisLegionello

sis Other

1 Unknown Unknown Unknown 1 Unknown

2 2 5

Yes, the threshold

is:: 5 1 No

3 Unknown Unknown Unknown 1 No

4more than expected 1

more than expected 1 Unknown

5 No No No No No

6 Yes, 1 1 1 No7 no no no no no

8 >2 >2 >2 >2 No

6. Outbreak detection6. Outbreak detection 6.1. Are you able to identify the 6.1. Are you able to identify the exposure exposure

routes of water – related diseasesroutes of water – related diseases by by source of source of drinking waterdrinking water??

PRIORITYDiseases

Yes No Unknown Yes No Unknown Yes No Unknown Yes No Unknown Yes No Unknown

Cholera 7 1 * 6 2 * 6 2 * 6 2 * 4 2 2

EHEC 6 2 * 6 2 * 6 2 * 6 2 * 4 2 2

Shigellosis 6 2 * 6 2 * 6 2 * 6 2 * 4 2 2

Typhoid fever

6 2 * 6 2 * 6 2 * 6 2 * 4 2 2

Viral hepatitis A

5 3 * 5 3 * 5 3 * 5 3 * 4 2 2

Unregulated watersCentralised system Small-scale systems Community supplies Private supplies

6. Outbreak detection6. Outbreak detection 6.1. Are you able to identify the exposure 6.1. Are you able to identify the exposure

routes of water – related diseases by routes of water – related diseases by source of source of drinking waterdrinking water??

EMERGINGDiseases

Yes No Unknown Yes No Unknown Yes No Unknown Yes No Unknown Yes No Unknown

Campylobacteriosis

6 2 * 6 2 * 6 2 * 6 2 * 4 2 2

Cryptosporidiosis

6 2 * 5 2 1 5 2 1 5 2 1 3 2 3

Giardiasis 6 2 * 6 2 * 6 2 * 6 2 * 4 2 2

Legionellosis

6 2 * 6 2 * 6 2 * 6 2 * 4 2 2

Others 3 3 2 3 3 2 3 3 2 3 3 2 1 3 4

Centralised system Small-scale systems Community supplies Private supplies Unregulated waters

6.2. Are you able to identify the exposure route of 6.2. Are you able to identify the exposure route of water-related diseases by water-related diseases by food sourcefood source? ?

Diseases

Yes No Unknown Yes No Unknown Yes No Unknown

Cholera 3 2 3 3 2 3 2 2 4EHEC 3 2 3 3 2 3 2 2 4Shigellosis 3 2 3 3 2 3 2 2 4Typhoid fever

3 2 3 3 2 3 2 2 4Viral hepatitis A

3 2 3 3 2 3 2 2 4Campylobacteriosis

3 2 3 3 2 3 2 2 4Cryptosporidiosis

3 2 3 3 2 3 2 2 4Giardiasis 3 2 3 3 2 3 2 2 4Legionellosis 2 3 3 2 3 3 1 3 4Others 0 3 5 0 3 5 0 3 5

Food resulting from aquaculture (shellfish, clams, mussels, É)

Irrigated agriculture products

Agriculture products irrigated with reclaimed wastewater

6.3. Are you able to identify the exposure route 6.3. Are you able to identify the exposure route of water-related diseases by type of of water-related diseases by type of recreational waterrecreational water? ?

Diseases

Yes No Unknown Yes No Unknown Yes No Unknown

Cholera 3 3 2 4 3 1 4 3 1EHEC 3 3 2 4 3 1 4 3 1Shigellosis 3 3 2 4 3 1 4 3 1Typhoid fever

3 3 2 4 3 1 4 3 1Viral hepatitis A

2 4 2 4 3 1 4 3 1Campylobacteriosis

3 3 2 3 3 2 4 3 1Cryptosporidiosis

3 3 2 3 3 2 4 3 1Giardiasis 3 3 2 3 3 2 4 3 1Legionellosis 3 3 2 3 3 2 4 3 1Others 1 4 3 1 4 3 1 4 3

Natural coastal waters Natural inland waters Enclosed recreational environments (spa, pools)

7. Epidemic preparedness7. Epidemic preparednessDiseases

Yes No Unknown Yes No Unknown Yes No Unknown Yes No Unknown Yes No UnknownCholera 3 5 0 5 3 0 2 6 0 6 2 0 4 2 2EHEC 3 5 0 5 3 0 2 5 1 6 2 0 4 2 2Shigellosis 3 5 0 5 3 0 3 5 0 5 2 1 4 2 2Typhoid fever

3 5 0 5 3 0 5 3 0 5 2 1 4 2 2Viral hepatitis A

3 5 0 5 3 0 7 1 0 6 1 0 4 2 2Campylobacteriosis

3 5 0 5 3 0 3 5 0 5 2 1 4 2 2Cryptosporidiosis

3 5 0 5 3 0 3 5 0 5 2 1 4 2 2Giardiasis 3 5 0 5 3 0 3 5 0 5 2 1 4 2 2Legionellosis 4 4 0 5 3 0 3 5 0 5 2 1 4 2 2Others 2 4 1 2 4 2 2 4 2 2 3 3 1 3 4

Is there a national epidemic preparedness and response plan?

Emergency supply of drugs available at all times during the last year?

Emergency supply of vaccines available at all times during the last year?

7. Epidemic preparedness7. Epidemic preparednessDiseases


3 5 0 5 3 0 5 3 0 5 2 1 4 2 2

3 5 0 5 3 0 7 1 0 6 1 0 4 2 2

3 5 0 5 3 0 3 5 0 5 2 1 4 2 2


Emergency supply of water treatment supplies available at all times during the last year?

Emergency supply of vaccines available at all times during the last year?

Emergency supply of medical supplies available at all times during the last year?

Diseases


3 5 0 5 3 0 5 3 0 5 2 1 4 2 2Viral hepatitis A

3 5 0 5 3 0 7 1 0 6 1 0 4 2 2Campylobacteriosis

3 5 0 5 3 0 3 5 0 5 2 1 4 2 2Cryptosporidiosis


7.2. Is information related to the emergency 7.2. Is information related to the emergency adequately provided to the people?adequately provided to the people?

Yes= 4Yes= 4No=3 No=3

No response=1No response=1

8. Capacity of response8. Capacity of response 8.1. Has the central level or local authority 8.1. Has the central level or local authority

the ability to start intervention measures the ability to start intervention measures within 48 hours of notification?within 48 hours of notification?

Yes=7 Yes=7 Unknown=1Unknown=1

9. Training9. Training 1. Has your Country foreseen 1. Has your Country foreseen periodic training coursesperiodic training courses on surveillance on surveillance

systems?systems?

YES= 6 YES= 6 2. Are WRD addressed by the training courses?2. Are WRD addressed by the training courses?

YES= 5YES= 5 3. Is 3. Is international supportinternational support needed for the design and/or needed for the design and/or

implementation of such training courses?implementation of such training courses?No=3No=3

Elaborated methods and financial support would be necessary=1Elaborated methods and financial support would be necessary=1Would be helpful=1Would be helpful=1Yes=1 Yes=1 WRD training is needed=1WRD training is needed=1No response=1No response=1

10. Databases and 10. Databases and Mapping/GIS ResourcesMapping/GIS Resources

10.1. Is the central computerized database available for the cases and outbreaks of WRD?

YES=5 YES=5 10.2. Is Geographical Information System (GIS) used within

your sector?

YES= 1 YES= 1 Partially= 4Partially= 4

10.3. Has your country foreseen periodic training courses on GIS?

YES= 1YES= 1

On the basis of these limited replies is possible to reach some On the basis of these limited replies is possible to reach some preliminary conclusions:preliminary conclusions:

The current WRDs Surveillance Systems are generally able in detecting The current WRDs Surveillance Systems are generally able in detecting and reporting priority, emerging and locally important diseasesand reporting priority, emerging and locally important diseases

These countries use different organization in reporting WRDsThese countries use different organization in reporting WRDs

There is a lack of information expecially for rural areas (unregulated There is a lack of information expecially for rural areas (unregulated water-systems) water-systems)

There is also a lack of information on the possible diseases due to There is also a lack of information on the possible diseases due to bathing water, shell-fish and crops consumptionbathing water, shell-fish and crops consumption

Lack of adequate information to the public Lack of adequate information to the public

Weakness in the capacity of response (vaccines, medical supplies and Weakness in the capacity of response (vaccines, medical supplies and water tratment available at all times)water tratment available at all times)

Scarse use of database and mappingScarse use of database and mapping

Request of trainingRequest of training

CONCLUSIONSCONCLUSIONS

It is crucial to receive replies from the focal points and to facilitate such replies; it is also fundamental to translate the questionnaire into Russian, in order to overcame the language barrier.

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Overview of surveillance of water related diseases in the UNECE region