EPI-NEWS NATIONAL SURVEILLANCE OF COMMUNICABLE DISEASES Editor: Susanne Samuelsson Statens Serum Institut - 5 Artillerivej - 2300 S - Tel: +45 3268 3268 - Fax: +45 3268 3874 www.ssi.dk - [email protected] - ISSN: 1396-4798

SURVEILLANCE OF INFECTIOUS DISEASES AT THE BEGINNING OF 2002 No. 1-2, 2002 Dept. of Epidemiology addition, the Danish childhood vac- and a database technician have been The Dept. of Epidemiology was esta- cination programme is under on- employed. Denmark also participates blished at Statens Serum Institut in going surveillance, validation and in the EU surveillance of TB, HIV its present form in 1979. At that time, updating. and AIDS, influenza, meningococcal 3 physicians and 4½ secretaries were disease and travel-associated legio- employed. Today the department The year 2001 nella. The second half of 2001 was employs 2 senior medical officers, 2 In 2001, the Dept. of Epidemiology distinguished, on a global scale, by staff specialist grade doctors, 2 regi- received just under 4,000 notificati- the terrorist attack of 11 September. strars, 2 nurses, 1 IT assistant, 2 data- ons of infectious diseases. The equi- In almost all countries, attention was base secretaries and 2 conventional valent statistic was approx. 3,200 in focused on the national biological secretaries, whose tasks include co- 1990. Today, most notifications are emergency plan and on international ordinating the writing and printing received for the following : cooperation. In Denmark, a proposal of EPI-NYT (the Danish version), food-borne illness, tuberculosis, me- for guidelines for a biological emer- EPI-NEWS and the presentation on ningococcal disease, HIV, and whoo- gency plan has been drawn up, and SSI’s website. The first issue of EPI- ping cough in children under 2 years a Biological Emergency Contingency NYT was published in January 1980, of age. In 1990, the picture was the Centre has been established at SSI. as a topical newsletter concerning same, except that the number of Along with the diagnostic depart- the occurrence of infectious diseases, AIDS cases at that time was also ments and the Dept. of Epidemiology , vaccinations and out- high. In 2001, there were small out- at SSI, as well as external partners, breaks, domestic as well as foreign. breaks of hepatitis A, tuberculosis, the Centre will ensure up-to-date Over the years, EPI-NYT has chan- food-borne illness and meningococ- knowledge of biological terrorism ged its appearance slightly, while cal disease. Compliance with child- and co-ordinate efforts in the event the objective remains the same. Both hood vaccination programmes is cru- of suspected attack. A network has EPI-NYT and EPI-NEWS are accessi- cial to their success. MMR vaccinati- been created under the auspices of ble under Public Health on SSI’s on has been the subject of an increa- the EU, to function as a quick decisi- website: www.ssi.dk. sed effort for several years, and com- on-making channel and to host fora pliance reached a satisfactory level for communication and discussion. Surveillance in Denmark in 2000. The number for 2001 is not The risk of biological terror has also In Denmark, a national registration yet available. focused attention on the importance of the occurrence of infectious disea- of good ongoing national surveillan- ses can be traced all the way back to International surveillance and ce, offering flexibility and facilities the 17th century. Surveillance of the cooperation for rapid response. occurrence of infectious diseases is a Denmark participates in the interna- key function in their prevention, en- tional surveillance cooperation under Future challenges suring an insight into both changes the auspices of both WHO and the Along with developments in micro- in the incidence of the infections mo- EU. WHO has for many years shared biology, especially in virology, speci- nitored and the effect of preventive the responsibility for the global mo- fic microbiological diagnostic data measures that have been implemen- nitoring of infectious diseases, and should form a central part of the case ted. This interaction requires an up- has supported vaccination program- definitions for many of the infectious to-date, adequate and ongoing regi- mes and other monitoring procedu- diseases that are monitored. Thus, stration, for which reason collabora- res, primarily in the developing the coming years should ensure a tion with reporting physicians is ab- countries. It is also WHO that is re- better integration of clinical and solutely crucial for the quality of the sponsible for the current "Internatio- laboratory-based surveillance. Other surveillance and thus theusefulness nal Health Regulations", which in- important tasks include monitoring of the result. The altered composition clude a recommendation for yellow of the development of resistance, of the population has involved chan- fever vaccination on certain journeys strategies for smallpox vaccination ges in the incidence of certain infec- and allow for restrictions on transport and the preparation of emergency tions and has naturally placed new of goods between countries. These provisions for influenza pandemic. demands on the preventive work. guidelines are under revision. IT developments have brought new The compulsory clinical notification The EU membership in the last challenges. The Institute's website is system appointed by The National approx. five years has brought with it undergoing overall improvement, Board of Health deals with a whole a dramatic increase in the extent of and the Dept. of Epidemiology will range of infections, using the pati- collaborative tasks. A decision of the be able to offer access to selected ent's name and personal registration EU parliament in 1998 meant that all surveillance data via the website in number as well as anonymous notifi- member countries are now obliged to the course of 2002. cation systems for proven HIV infec- enter into what are known as co- SSI will celebrate its 100th anniversa- tion, gonorrhoea and syphilis. The operation networks for the surveil- ry in September 2002. This will be results of the serological screening lance of a total of 35 infectious disea- commemorated by events including of donor blood are also monitored. ses. For each , a surveillance a major international sympo- There also exist compulsory labora- centre is to be established, to which sium focusing on future vaccines, in- tory-based notification systems, e.g. the other member countries continu- cluding vaccines against HIV, mala- for enteropathogenic bacteria and ously report. Thus, the Dept. of Epi- ria and tuberculosis. A provisional malaria. Influenza is monitored by demiology is the centre for EU sur- programme is available on SSI’s means of a voluntary sentinel- veillance of vaccine-preventable in- website. based system, established by the fections, known as EUVAC-NET. To (E. Smith, Dept. of Epidemiology) Dept. of Epidemiology in 1994. In attend to this task, an epidemiologist 9 January 2002

Sentinel surveillance of influenza activity Weekly percentage of consultations, 2000/2001/2002

% 12

10

8

6

4

2

0 27 30 33 36 39 42 45 48 51 2 5 8 11 14 17 20 23 26 29 32 35 38 41 44 47 50 1 4 7 10 13 16 19 22 25 Week

2000 2001 2002

Sentinel Alert threshold Basal curve

Sentinel: Influenza consultations as % of total consultations Basal curve: Expected frequency of influenza consultations under non-epidemic conditions Alert threshold: Possible incipient epidemic

Sentinel specimens received 2001/2002

Week no. 40-44 45 46 47 48 49 50 51 52 1 Specimens received 29610437201

Influenza virus has not yet been isolated in Denmark.

(Dept. of Epidemiology, Dept. of Virology)