Overview of surveillance of water related diseases in the UNECE region

1
Overview of surveillance of water related
diseases in the UNECE region

• Monica Francesca Blasi
• Unit of Quality of Aquatic Environments and
  Bathing Water
• National Institute of Health
• Rome, Italy

--------------------------------------------------
--------------------------------------------------
--------------- Workshop on Water and Health,
Bucharest 14th -16th of May 2008 5th Meeting of
the Capacity for Water Cooperation, UNECE
Capacity Building events
2
Plan of the activities Task Force on surveillance
and early warning systems, contingency plans and
response capacity (2007-2009)

• Questionnaire to assess the current capacity of
  water-related disease surveillance, and
  elaboration and publication of replies
• Guidance materials (technical and policy
  guidelines)
• Scientific workshop
• Assistance and in-country support

3
QUESTIONNAIRE

• The Task Force developed a questionnaire in
  order to assess
• The state-of-the-art on the surveillance systems
  of water-related diseases in the UNECE region
• Critical areas and situations
• The burden of WRDs in the region
• Assistance programmes and training activities

4
QUESTIONNAIRE 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

5
The questionnaire, as well as information on
registration, access and compiling, have been
sent to the Protocols national focal points by
the end of February
The questionnaire is available in the online
version at the link http//cms2.iss.it/ Info
monicafrancesca.blasi_at_iss.it
6
the questionnaire is also hosted in electronic
format on a protected site of the Italian
National Institute of Health (http//cms2.iss.it/
)
7
QUESTIONNAIRE REPLIES

• At the moment only 8 countries sent back the
  questionnaires answers
• Andorra 1
• Czech Republic 2
• Estonia 3
• Finland 4
• Hungary 5
• Norway 6
• Slovakia 7
• Turkey 8

7
8
1. General information

• 1.1 Is there a mandatory surveillance and
  reporting system for any diseases in the
  country? YES8
• 1.2...and the surveillance systems cover the
  following WRDs...
• PRIORITY DISEASES EMERGING DISEASES

9
1.3. Are there additional surveillance programmes
for specific water-related diseases that are
locally important such as

• Blue baby syndrome 2
• Arsenicosis 1
• Viral infections particularly norovirus 5
• Parasitic diseases 6

10
2. Surveillance structure, coordination and
reporting

• 2.1. Is there a mandatory surveillance and
  reporting system for water-related disease (WRD)
  in your country?
• YES8

11
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
laboratories6 countries replied to this
question
Hospitals or Laboratories responsible persons,
reference laboratories in the country or in
others countries, clinicians
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
Surveillance System
12

• 2.3. Is there a surveillance coordination body at
  the national level? Yes 8
• 2.4. Is there a standardized surveillance form
  provided by the central level collecting
  communicable disease surveillance data? Yes 8
• 2.5. Is the possible vehicle of infection (water,
  foods, etc) considered on the notification form?
  Yes4
• 2.7. Are potential environmental sources
  responsible for water contamination investigated
  or reported in the notification form? Yes 5

13

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

Emerging less then priority diseases
14
3. Case confirmation

• 3.1. Is case confirmation mandatory by laboratory
  analysis for the following water-related
  diseases?

15

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

The most of countries are able to confirme the
etiological agents
16

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

Etiological agent Yes No
V. cholerae 7 1
Enterohaemorrhagic E. coli 7 1
Shigella spp. 7 1
Salmonella typhi 7 1
Salmonella paratyphi 7 1
Viral hepatitis A 6 2
Campylobacter (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 2
Giardia lamblia/ G. duodenalis 5 2
Legionella pneumophila 6 2
Others (Please specify) 3 2
Emerging less then priority diseases
17
4. Public information

• 4.1Is there a public awareness programme on the
  importance of water-related diseases and the
  relationship between water hygiene and health.
  YES4
• 4.2 Is there an integrated information system,
  accessible to the public, about long-term trends,
  current concerns and successfully handled past
  problems in water and health? YES2
• 4.3 Is there an information system on rights and
  entitlements to water? YES4
• 4.4 If yes, list the web site, databases or other
  forms of communication
• -Web-pages4
• -School education system activities for the
  public such as World water day, annually
  reports1
• -No responses 3

18
5. Data characteristics

• 5.1. Please provide information on the level of
  detail available at the central level on data
  concerning water-related diseases.
• DESCRIPTIVE INFORMATION
• STATISTICAL INFORMATION

19
DESCRIPTIVE INFORMATION

• priority diseases

Case based information Choleral EHEC Shigellosis Typhoid feverl Viral hepatitis
Age 8 8 7 7 7
Sex 8 8 8 8 8
Occupation 7 7 7 8 7
Location related information Choleral EHEC Shigellosis Typhoid feverl Viral hepatitisl
District 8 8 8 8 8
Region 8 8 8 8 8
Municipality 8 7 7 8 7
Travel related 7 7 7 7 7
Descriptive information Choleral EHEC Shigellosis Typhoid feverl Viral hepatitis
Outbreak 7 6 7 7 7
Sentinel 3 3 3 3 2
Time 6 5 6 6 5
20
DESCRIPTIVE INFORMATION

• emerging diseases

Case based information Campylobacteriosis Cryptosporidiosis Giardiasis Legionellosis Others
Age 7 6 6 7 2
Sex 8 7 7 8 2
Occupation 7 6 7 8 2
Location related information Campylobacteriosis Cryptosporidiosis Giardiasis Legionellosis Others
District 7 6 7 8 4
Region 7 6 8 8 3
Municipality 6 5 7 8 2
Trave related 6 5 6 7 2
Descriptive information Campylobacteriosis Cryptosporidiosis Giardiasis Legionellosis Others
Outbreak 7 5 7 7 4
Sentinel 2 2 2 2 1
Time 5 5 5 6 2
21

• STATISTICAL DATA TREATMENT

Basic statistics YES7 for all the priority
and emerging WRDs Trend analysis YES7 for
all the priority and emerging WRDs
22

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

Country Cholera Enterohaemorrhagic E. coli Shigellosis/bacillary dysentery Typhoid fever Viral hepatitis A
1 1 1 Unknown 1 1
2 1 2 5 1 5
3 1 1 1 1 Unknown
4 1 1 more than expected 1 more than expected
5 No No No No No
6 1 1 ? 1 ?
7 no no no no no
8 1 gt2 gt2 gt2 gt2
Country Campylobacteriosis Cryptosporidiosis Giardiasis Legionellosis Other
1 Unknown Unknown Unknown 1 Unknown
2 2 5 Yes, the threshold is 5 1 No
3 Unknown Unknown Unknown 1 No
4 more than expected 1 more than expected 1 Unknown
5 No No No No No
6 Yes, 1 1 1 No
7 no no no no no
8 gt2 gt2 gt2 gt2 No
23
6. Outbreak detection

• 6.1. Are you able to identify the exposure routes
  of water related diseases by source of drinking
  water?

PRIORITY
24
6. Outbreak detection

• 6.1. Are you able to identify the exposure routes
  of water related diseases by source of drinking
  water?

EMERGING
25

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

26

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

27
7. Epidemic preparedness
28
7. Epidemic preparedness
29

• 7.2. Is information related to the emergency
  adequately provided to the people?
• Yes 4
• No3
• No response1

30
8. Capacity of response

• 8.1. Has the central level or local authority the
  ability to start intervention measures within 48
  hours of notification?
• Yes7
• Unknown1

31
9. Training

• 1. Has your Country foreseen periodic training
  courses on surveillance systems?
• YES 6
• 2. Are WRD addressed by the training courses?
• YES 5
• 3. Is international support needed for the design
  and/or implementation of such training courses?
• No3
• Elaborated methods and financial support would be
  necessary1
• Would be helpful1
• Yes1
• WRD training is needed1
• No response1

32
10. Databases and Mapping/GIS Resources

• 10.1. Is the central computerized database
  available for the cases and outbreaks of WRD?
• YES5
• 10.2. Is Geographical Information System (GIS)
  used within your sector?
• YES 1
• Partially 4
• 10.3. Has your country foreseen periodic training
  courses on GIS?
• YES 1

33
CONCLUSIONS
On the basis of these limited replies is possible
to reach some preliminary conclusions The
current WRDs Surveillance Systems are generally
able in detecting and reporting priority,
emerging and locally important diseases These
countries use different organization in reporting
WRDs There is a lack of information expecially
for rural areas (unregulated water-systems)
There is also a lack of information on the
possible diseases due to bathing water,
shell-fish and crops consumption Lack of adequate
information to the public Weakness in the
capacity of response (vaccines, medical supplies
and water tratment available at all times) Scarse
use of database and mapping Request of training
34
RECOMMENDATIONS

• 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.