Disease programmes

Antimicrobial resistance and healthcare-associated infections

Antimicrobial resistance (AMR) and healthcare-associated infections (HAI) are high on the European and global agenda as various AMR threats keep increasing in number and intensity. Unfortunately, awareness of the need for prudent use of antibiotics and of infection prevention and control measures, both among the general public and healthcare professionals, is poor in many Member States. In addition, most ARHAI staff members were involved in COVID-19 support work in 2020. The team mostly contributed with expertise in infection prevention and control (IPC) as well as surveillance of COVID-19 in healthcare.

However, ECDC regularly updated its guidance on IPC and preparedness for COVID-19 in healthcare settings and adapted its protocols for surveillance of HAI, to include COVID-19.

ECDC also published its updates of surveillance data on AMR and antimicrobial consumption: they confirmed that AMR remained a challenge for the EU/EEA. While antimicrobial consumption overall continued to slowly decrease in the EU/EEA, there were still large variations between countries, both in the community and the hospital sector, and antimicrobial consumption still increased in some countries. Resistance to carbapenems remained a concern.

In conjunction with WHO’s World Antimicrobial Awareness Week (18–24 November 2020), ECDC organised the 13th European Antibiotic Awareness Day to raise awareness about the threat to public health from antibiotic resistance, emphasising the importance of prudent antibiotic use and improved IPC practices to significantly reduce AMR, during the COVID-19 pandemic.

Over recent years, EU/EEA countries have reported an increasing number of AMR and/or HAI events and outbreaks to ECDC via the EPIS platform. The work of the European Antimicrobial Resistance Genes Surveillance Network for the whole genome sequencing (WGS)-based surveillance of multidrug-resistant bacteria of public health importance continued in 2020.

The Centre continued to contribute also to the Transatlantic Taskforce on Antimicrobial Resistance, a collaborative effort of the EU, the United States, Canada and Norway in the field of AMR. It also contributed to the EU joint action on AMR and healthcare-associated infections.

Emerging and vector-borne diseases

During the transmission season, ECDC publishes maps of West Nile virus infections, to provide timely information to national health authorities on the need of blood transfusion testing in affected areas. ECDC also collects data to help public health experts understand the factors that could trigger sudden outbreaks.

In this field, the Centre continued developing modelling tools:

• To appraise and compare vector control strategies against West Nile fever in Europe (at user’s testing stage)
• To support the decision-making process for surveillance and vector control of dengue, chikungunya and Zika virus infections in Europe (finalised).

In terms of vector-borne diseases, among other activities, ECDC continued publishing updated distribution maps of European disease vectors on its website in 2020. Data for the maps were collected through the VectorNet project, jointly funded by ECDC and EFSA.

In cooperation with European Food Safety Agency, WHO European Regional Office, and the World Organisation for Animal Health, a project to review the epidemiological situation of leishmaniasis in the European Union and its neighbourhood was initiated. During the meantime, the Centre continued addressing and coordinating inquiries launched by participating countries or ECDC through the EPIS-FWD platform.

Food- and waterborne diseases, zoonoses and Legionnaire’s diseases

In 2020, ECDC and EFSA worked on two reports: 1) the EU One Health 2019 zoonoses report, and 2) the annual report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2018/2019. ECDC, EFSA and EMA also jointly worked on the third JIACRA report, where ECDC contributed with AMR data on Salmonella and Campylobacter.

Cooperation with EFSA continued through weekly teleconferences to monitor the evolution of multi-country food-borne events and produce joint public health risk assessments related to food. In 2020, ECDC published two joint rapid outbreak assessments with EFSA: a third update on multi-country Salmonella Enteritidis outbreak linked to eggs and one on S. Typhimurium & S. Anatum infections linked to Brazil nuts.

In 2020, the routine enhanced surveillance continued for listeriosis through WGS. Preparatory work on implementing a joint ‘One Health’ approach between ECDC and EFSA for the collection and analysis of WGS data from human and food isolates continued.

HIV, sexually transmitted infections, and viral hepatitis

In 2020 most ECDC staff working on HIV, sexually transmitted infections and viral hepatitis were re-allocated to work on the ECDC response to COVID-19. Due to this, the original work plan was revised, and activities cancelled or postponed.

The Centre worked however on further improving the quality of surveillance data for hepatitis B and C. The pilot of a new sentinel system (in hospitals and clinics) was finalised, and the results were discussed in an expert meeting.

As part of the efforts to monitor progress to achieving the Sustainable Development Goals targets, ECDC together with WHO and EMCDDA, established the first monitoring system for national hepatitis programmes to assess the progress made in the EU/EEA to meet the SDG targets on hepatitis. In addition, in close collaboration with UNAIDS, the Centre produced a set of European principles for HIV pre-exposure prophylaxis (PrEP) and an operational guidance. On the other hand, jointly with EMCDDA, ECDC started the evidence collection phase for the update of the guidance on prevention of infectious diseases for people who inject drugs.

Influenza

Throughout most of 2020, the epidemiological and microbiological resources normally devoted to influenza activities were all shifted to deal with the ECDC COVID-19 response. Still, ECDC and the WHO Regional Office for Europe managed to continue their joint influenza surveillance and the publication of the weekly influenza bulletin during the influenza season.

ECDC also continued its funding of the external I-MOVE network, which provided estimates of seasonal influenza vaccine effectiveness and produced valuable data for the composition of the next seasonal influenza vaccine. The work of the EuroMOMO network on all-cause excess mortality data reported from participating European countries was also maintained.

Increased efforts were made through social media to reinforce the awareness for seasonal influenza and the importance of vaccination to avoid a twindemic in 2020.

Tuberculosis

ECDC and the WHO Regional Office for Europe produce a joint annual surveillance report on TB, covering all 53 countries of the WHO European Region, which measures the progress against the objectives of the WHO Europe Tuberculosis Action Plan for the WHO European Region 2016–2020.

Even if most ECDC staff working on TB were re-allocated to work on the ECDC response to COVID-19, the Centre started a project to provide support to all Member States, following a successful three-year project that focused on the five high priority countries for TB in Europe. The project consists of joint workshops, training activities, exchange visits between countries, and consultancy support to individual countries.

In 2020, the first two activities took place: in February, a workshop on the screening of migrants for tuberculosis took place in Athens, then the workshop was repeated in October in a virtual form.

Vaccine-Preventable Disease

The European Vaccination Information Portal (EVIP) was launched in April 2020, during European Immunisation Week, to provide evidence on vaccination. ECDC worked closely with the European Commission to provide scientific input to ensure immunisation and with Member States to prepare the rollout of vaccination programmes against COVID-19 disease. Indeed, EVIP also provided an overview of the mechanisms in place in the European Union to ensure that available vaccines conform to the highest standards of safety and effectiveness.

EVIP was developed by ECDC, in partnership with the European Commission, specifically its Directorate-General for Health and Food Safety and the European Medicines Agency (EMA).