European Diphtheria Surveillance Network (EDSN)
In February 2010, the responsibility for the activities of the European Diphtheria Surveillance Network was transferred to ECDC.
The activities are aimed at integrating surveillance, which covers all diphtheria diseases caused by toxigenic C.diphtheriae, C.ulcerans and C pseudotuberculosis from an epidemiology and laboratory point of view.
Although diphtheria (caused by toxigenic C. diphtheriae) is a rare disease in the European Union region, the World Health Organization (WHO) elimination targets for western and central Europe are met and more than 10 years past the elimination target date. The elimination goal of indigenous diphtheria strains has not been met in the entire region (NB region is based on the WHO European Regional Office's definition). The indigenous transmission continues in Latvia, Ukraine and in Russian Federation, and epidemic diphtheria could return to the European Union. Therefore, high vaccination coverage must be sustained, adult booster coverage increased, and surveillance and laboratory capacity maintained.
What is EDSN
The European Diphtheria Surveillance Network (EDSN) consists of contact points for diphtheria surveillance (epidemiological and microbiological) nominated by the Competent Bodies for surveillance of the Member States. Epidemiological and microbiological surveillance data on diphteria are collected through the European Surveillance System (TESSy).
By providing data analyses and issuing epidemiological reports, ECDC provides decision makers in Member States and national public health experts the basis to improve assessment of diphtheria activity in Europe. In turn, they could give more accurate epidemiological and microbiological information to their governments, health care professionals, and the general public.
Participating in the network are all the 28 EU countries and the three EEA States: Norway, Iceland, and Liechtenstein.
Objectives for Diphtheria Surveillance at the EU level
The general objectives for strengthening the surveillance of communicable diseases in the European Union are:
- Surveillance at the European level shall add value to Member States by directly strengthening and supporting the national surveillance systems and by coordinating the standardisation of EU-wide surveillance activities to ensure better availability of more comparable data between countries.
- It shall strive to reduce the complexity of surveillance systems across Europe and enhance insight into communicable disease epidemiology in Europe.
To be able to achieve these broad goals, the following general objectives have been identified to strengthen surveillance in the EU:
- Define surveillance outputs that will provide added value by informing public health decisions and actions at the EU and/or Member State level;
- Collect and disseminate validated and comparable information on communicable diseases;
- Improve and update methodologies and quality assurance;
- Strengthen the laboratory surveillance in EU Member States;
- Consolidate outbreak detection and monitoring in EU Member States and at the EU level;
- Strengthen national capacities for surveillance and contributing to the evaluation of prevention and control programmes;
- Ensure patient confidentiality and legal foundation for data collection in individual Member States;
- Promote the wider use of surveillance data for a maximum of public health benefit, including research projects at a European level;
ECDC's role to strengthen the European Diphtheria Surveillance Network
The surveillance tasks of ECDC according to Regulation (851/2004/EC) of the European Parliament and of the Council are:
- To collect, collate, validate, analyse and disseminate relevant data at EU level
- To operate the dedicated surveillance networks
- To maintain the database(s) for epidemiological surveillance
- To develop the statistical element of data collection with MS
- To develop sufficient capacity to detect, characterise infectious agents and encourage collaboration between laboratories
- To develop procedures to facilitate consultation, data transmission and access with the MS and the Commission
- To evaluate prevention and control measures at EU level
- To closely cooperate with the organisations operating in the field of data collection
The objectives of the outsourced European laboratory network to strengthen laboratory capacity for diphtheria surveillance
- To coordinate the European laboratory network on diphtheria, which will be part of a broader EU surveillance system for diphtheria with both epidemiological and laboratory components that are built up and coordinated by ECDC
- To assess and improve laboratory performance for standardised and appropriate methods to be used for the laboratory diagnosis of culture-confirmed diphtheria infections for ensuring accurate and comparative diphtheria surveillance across Europe
- To expand knowledge on serological immunity procedures for detecting diphtheria antitoxin antibodies across Europe, and to assess and improve laboratory performance for accurate and standardised serological immunity methods
- To uphold a high level of laboratory preparedness and strengthen the microbiological expertise across Europe for diphtheria through laboratory training workshops
- To coordinate the molecular surveillance on diphtheria (in particular C. diphtheriae), including evaluating new, rapid, automated molecular technologies, and maintain a high quality molecular surveillance across Europe, including assessment and improvement of laboratory performance of molecular typing
Catchment area or the area under surveillance for diphtheria includes countries that are EU Member States and the three EEA States: Norway, Iceland, and Liechtenstein.
How does the network report
Case based data are encouraged to be reported on real time, while zero reporting is done once a year.
During the re-emergence of diphtheria to epidemic levels in the Russian Federation and Newly Independent States (NIS) in the 1990s, the European Laboratory Working Group on Diphtheria (ELWGD) was formed in July 1993 upon a request of WHO Regional Office for Europe (WHO/Europe).
In 2001, the network was expanded through a feasibility study funded by DG SANCO (now known as DG Sante). Based on the results of this study the European Diphtheria Surveillance Network (previously known as DIPNET) was established in November 2006 and was recognised as a Dedicated Surveillance Network (DSN) by the European Commission (EC).
The hub for the coordination of the network was located at Health Protection Agency (HPA), now known as Public Health England, in London. HPA also serves as the WHO Collaborating Centre for Diphtheria. The 38-month grant agreement with DG SANCO started 1 November 2006 and ended 31 January2010.
The main purpose of DIPNET was "to establish a network of expertise for the prevention of diphtheria and other related infections" across the EU Member States and beyond. The network has had both epidemiological and laboratory components. The epidemiological activities focused on the collection and analysis of data on diphtheria cases caused by either Corynebacterium diphtheriae or Corynebacterium ulcerans. The laboratory activities focused on trainings and EQA, aiming at strengthening the laboratory capacity in MS to accurately characterise the isolates of C. diphtheriae and C. ulcerans, and to develop novel tools for molecular characterising of C. diphtheriae.An evaluation and assessment of the network was performed in January 2009. This was done to ensure that objective and reliable information is available for making decisions on which surveillance activities and functions should be continued at the EU level, which ones should be omitted, and which added/modified, and finally where these activities/functions should take place.
Transfer to ECDC
Following the decision taken by ECDC, the coordination of the EU diphtheria surveillance activities was transferred to ECDC at the end of the former grant agreement with DG SANCO.
After the transition of the diphtheria surveillance activities, ECDC aims to maintain and develop further these activities and thus, continue the international development both in epidemiology and laboratory fields. ECDC will continue to ensure exchange of information and expertise among the current and potential future partners of the network. The network partners will continue to report regularly to ECDC and the reporting will be integrated as part of The European Surveillance System (TESSy), developed by ECDC.