COMMISSION OF THE EUROPEAN COMMUNITIES Brussels, 29.3.2005 SEC(2005) 394 COMMISSION STAFF WORKING DOCUMENT Annex to the: REPORT ON THE OPERATION OF THE EARLY WARNING AND RESPONSE SYSTEM OF THE COMMUNITY NETWORK FOR THE EPIDEMIOLOGICAL SURVEILLANCE AND CONTROL OF COMMUNICABLE DISEASES (DECISION 2000/57/EC) DURING 2002 AND 2003 {COM(2005) 104 final} EN EN TABLE OF CONTENTS 1. Lists of events and responses communicated to EWRS during 2002 and 2003 .......... 3 2. Features of the EWRS operation in 2002 and 2003..................................................... 3 3. Additional information on selected events................................................................... 3 3.1. Outbreak of pericarditis-myocarditis in Greece (event 16, 2002)................................ 4 3.2. Outbreaks of viral gastroenteritis linked to permanence in Andorra (event 17, 2002) 4 3.3. Outbreak of Salmonellosis (S. cerro) in Belgium (with cases also in France) (event 27, 2002) ...................................................................................................................... 4 3.4. SARS in Europe (event 11, 2003)................................................................................ 4 3.5. Gastroenteritis in a cruise ship (event 32, 2003).......................................................... 3 4. Tables ........................................................................................................................... 5 5. Figures........................................................................................................................ 47 EN 2 EN 1. LISTS OF EVENTS AND RESPONSES COMMUNICATED TO EWRS DURING 2002 AND 2003 Notifications of events communicated to EWRS in 2002 and 2003 are listed chronologically in Tables 1 and 3, respectively. The tables include all the messages delivered by means of the information exchange application present in the web site of the Health Surveillance System on Communicable Diseases (HSSCD), grouped by event, with selected features of the event notification. Responses communicated by Member States with reference to these events are listed in Table 2, which refers to the events communicated in 2002, and in Table 4, which refers to the events communicated in 2003. 2. FEATURES OF THE EWRS OPERATION IN 2002 AND 2003 Figures 1 and 3 describe the distribution of the notification in the different alert levels used by EWRS. These levels refer to the definitions set out in Annex II of Decision 2000/57/EC, namely: • Activation level 1: information exchange • Activation level 2: potential threat • Activation level 3: definite threat The operation of the system is described using two basic measures of each notification. The first indication (in the horizontal axis) is the time elapsed from the onset of the disease in the index case until notification to EWRS. The second indication (in the vertical axis) is the cumulative number of cases that had been detected before notification to EWRS. Fig. 2 plots in this way the events communicated to EWRS in 2002. The number besides each point corresponds to the number of the event that was given in Table 1. About 60% (18 outbreaks) of the 32 outbreaks occurring in the EU Member States were notified within 35 days from the outbreak onset and with an outbreak size of less than 93 cases. Fig. 4 plots data related to events communicated in 2003 and occurring in EU Member States. The number besides each point corresponds to the number of the event that was given in Table 3. From this plot it appears that about 60% (14 events) of the 25 events occurring in the EU were notified to the EWRS within 14 days from the onset of symptoms in the index case and in association of outbreak sizes of less than 15 confirmed cases. 3. ADDITIONAL INFORMATION ON SELECTED EVENTS The following chapters provide more detailed information for the events which required a more complex response, involving contacts or coordination between health authorities of different Member States. 3.1. Outbreak of pericarditis-myocarditis in Greece (event 16, 2002) A time line of the event is summarized in Table 5. EN 3 EN Publication: An article on the event has been published in Eurosurveillance Weekly 2002; 6 (18): 3/5/2002 (http://www.eurosurveillance.org/ew/2002/020503.asp) 3.2. Outbreaks of viral gastroenteritis linked to permanence in Andorra (event 17, 2002) The time line of the outbreak is summarized in Table 6. Publication: An article on the event has been published in Eurosurveillance Weekly 2002, 6 (10): 7/3/2002 (http://www.eurosurveillance.org/ew/2002/020307.asp) 3.3. Outbreak of Salmonellosis (S. cerro) in Belgium (with cases also in France) (event 27, 2002) A time-line of the events is summarized in Table 7. 3.4. SARS in Europe (event 11, 2003) Table 8 summarizes the timeline of the event and of the EWRS actions. Table 9 lists all the documents produced as a result of the EWRS consultation and coordination actions. Table 10 gives the final assessment of the event as far as the European cases are considered. 3.5. Gastroenteritis in a cruise ship (event 32, 2003) The time line of the outbreak is summarized in Table 11. 4. TABLES EN 4 EN Table 1 - EWRS messages received in 2002 grouped by event NUMBER OF FINAL/TOTAL TOTAL DATE OF DATE OF COUNTRY EVENT EWRS CODE EVENT CASES UNTIL NUMBER OF NUMBER OUTBREAK COMMENTS ONSET OF ILLNESS NOTIFICATION CASES OF COMPLETION DEATHS 1 20020117LU0001- Tularemia 1-nov-01 Kosovo 282 170c+141s Information 2 20020118LU0001- Meningococcal 1-janv-02 France 17 17t (15c) 3 Information infection 3 20020204LU0001- Trichinosis 30-déc-01 Serbia and 247 247t Information Montenegro 4 20020206BE0001- Influenza 6-févr-02 UK Information-A 5 20020206LU0001- Tularemia 1-nov-01 Serbia and Information Montenegro This event was first reported 20020208DE0001- to EWRS on 11/12/2001; NL: Information following the early warning, 6 persons were found infected Salmonella 1-oct-01 Germany 6 with the same Salmonella type, of which 5 reported 20020317DE0001- consumption of German Information chocolate. 7 20020211BE0001- Meningococcal 8-févr-02 France 1 1c Information infection 8 20020219LU0001- Plague India 18 18t 4 Information Other bacterial 20020225BE0001- diseases - wound 28-janv-02 UK 4 1c+3s 9 Information-B botulism 10 20020304LU0001- Unlisted -Hepatitis A 25 1 AU: The recall was already Information vaccine recall known from the EMEA EN 5 EN NUMBER OF FINAL/TOTAL TOTAL DATE OF DATE OF COUNTRY EVENT EWRS CODE EVENT CASES UNTIL NUMBER OF NUMBER OUTBREAK COMMENTS ONSET OF ILLNESS NOTIFICATION CASES OF COMPLETION DEATHS Unlisted - Allograft- 20020318LU0001- associated bacterial USA 11 Information infections 12 20020319FR0001- Legionellosis 15-janv-02 France 6 5c+1p 3-janv-00 EW: Level1 (IE) 20020409FR0001- Other infestation - 15-mai-01 France 6th French case 13 Information vCJD Other bacterial 20020410NO0001- many cases still to be diseases - P. 1-nov-02 Norway 78 14 Information identified aeruginosa infection 15 20020412SE0001- Salmonella 6-avr-02 Sweden >100 >100 (13c) Information 20020423BE0001- Information 20020424BE0001- Information 20020426BE0001- Information 3/5/2002 (date of Unlisted - peri- 16 20020426LU0001- 1-avr-02 Greece 32 53 3 disease onset of see extended report Information myocarditits last case) 20020429BE0001- Information 20020510BE0001- Information 20020528BE0001- Information 20020425IE0001- Intestinal infections 31-mars-02 Ireland 92 see extended report 17 Information due to other organisms - viral EN 6 EN NUMBER OF FINAL/TOTAL TOTAL DATE OF DATE OF COUNTRY EVENT EWRS CODE EVENT CASES UNTIL NUMBER OF NUMBER OUTBREAK COMMENTS ONSET OF ILLNESS NOTIFICATION CASES OF COMPLETION DEATHS 20020430ES0001- 23-janv-02 Spain 201 166c 0 16-avr-02 Etiological agent not EW: Level1 (IE)-A confirmed Intestinal infections 20020503FR0001- due to other 15-janv-02 France 0 17 Information organisms - viral gastroenteritis 18 20020506LU0001- Whooping cough Information 19 20020510DE0001- Diphtheria 8-mai-02 Germany 1 Information 20020522LU0001- Information-A Unlisted (test 20 message) 20020523LU0001- Information-A Bacterial infection in conditions classified 20020528LU0001- elsewhere and of UK 41 21 Information unspecified site - fatal antibiotic resistant bacteriemia 22 20020611LU0001- Legionellosis France Information-A 23 20020626IT0001- Measles 1-févr-02 Italy 3931 summer 2002 EW: Level1 (IE) 20020701FR0001- EW: Level1 (IE) Other food poisoning 24 (bacterial) - 29-mai-02 France 8 8c 1 20020703FR0001- Listeriosis EW: Level1 (IE) 25 20020705ES0001- Salmonella enteritidis 23-juin-02 Spain 1243 1243 0 27-juin-02 EW: Level1 (IE) infection EN 7 EN NUMBER OF FINAL/TOTAL TOTAL DATE OF DATE OF COUNTRY EVENT EWRS CODE EVENT CASES UNTIL NUMBER OF NUMBER OUTBREAK COMMENTS ONSET OF ILLNESS NOTIFICATION CASES OF COMPLETION DEATHS 26 20020724IT0001- Meningococcal 21-juil-02 Italy 1 1c 1 EW: Level2 (PT)-A infection 26 20020726IT0001- Meningococcal EW: Level2 (PT) infection Thanks to early warning, 20020726BE0001- Belgium and 22 BE France could react quickly Salmonella 1-avr-02 30 0 1-août-02 27 Information France 5 FR when cases appeared in France. See extended report. Case imported from India 20020731ES0001- Cholera 3-juil-02 Spain 1 1 0 3-juil-02 (toxigenic Vibrio cholerae O1 28 EW: Level1 (IE) Ogawa infection) foodborne parasite This message was sent by e- EWARS-CD infection by Fasciola 15-mars-02 France 18 18c mail because of a temporary Information hepatica server failure 29 Other intestinal 20020802FR0001- helminthiases - France EW: Level1 (IE) infection by Fasciola