EuroTravNet &

Geosentinel in EuropeGeosentinel in Europe

Prof. Philippe PAROLA, MD, PhDEuroTravNet Project Coordinator

GeoSentinel Director EuropeMarseille, France

HISTORY: 2008 - CREATION OF EUROTRAVNET

TENDER

European Sites and Members of GEOSENTINELThe Global Surveillance Network of the ISTM and CDC

Principles of GeoSentinel

• Provider-based surveillance1. Diagnosis2. Place of Exposure2. Place of Exposure3. Chronology of Exposure

• Only basic demographics• Not a complete clinical record

The ECDC Collaborative Network for Travel and Tropical Medicine

www.eurotravnet.eu

EuroTravNet in ECDC Website

EUROTRAVNET: CURRENT PERIOD

2010-2011Contract with ECDC

57 EuroTravNetMembers

16 Core Sites + 41 Network Members41 Network Members

in 22 countries

Last new members:Milan - Czech

Republic - Denmark– Russia - Romania

EUROTRAVNET / GEOSENTINEL : 2010 - 2011

EuroTravNet Annual Meetings

After Stockholm (2009) and Hamburg (2010) 3rd EuroTravNet Annual Meeting: Bucharest, at the Clinical Hospital of Infectious and Tropical Diseases "Dr. V. Babes“, April 2011

EUROTRAVNET: 2010 – 2011

EXPERTISE+ GEOSENTINEL SURVEILLANCE SYSTEM

In Europe = EuroTravNet Cores Site

SUPPORT TO ECDC’S EPIDEMIC INTELLIGENCE AND RESPONSE ACTIVITIES

+33 6 85 XX XX XX

2 Philippes

SITES – MEMBERSPARTNERS

Eurotravnet@yahoo.fr

surveillance@eurotravnet.eu

Ad hoc advice/guidance for risk assessment and risk communication

Participation in the preparation of ECDC’s Annual “Threat” Report

Participation in ECDC's epidemic intelligence meeti ng

Provider-based Sentinel SurveillanceThe 3 Functions of GeoSentinel

1. Surveillance – Response– Alarming sentinel events

2. Surveillance – ongoing trends3. Analysis of morbidity and estimating risk3. Analysis of morbidity and estimating risk

– Diagnosing the ill-returnee; the clinician perspective

– Advising the Prospective Traveler; the traveler perspective

– Defining associations between patient characteristics and disease

Provider-based Sentinel SurveillanceThe 3 Functions of GeoSentinel

1. Surveillance – Response– Alarming sentinel events

2. Surveillance – ongoing trends3. Analysis of morbidity and estimating risk3. Analysis of morbidity and estimating risk

– Diagnosing the ill-returnee; the clinician perspective

– Advising the Prospective Traveler; the traveler perspective

– Defining associations between patient characteristics and disease

Published in EuroSurveillance 7 days later

1. Surveillance – Response - Alarming sentinel events

outbreak response support team from ECDC in Greece to assess the current situation related to malaria

GeoSentinel Response Capabilities• Rapid Query-Response loop

• 55 GeoSentinel Sites• 215 GeoSentinel Network Members• ISTM members

(TravelMed; 2600 members in 75 countries)• Partners

(WHO, ProMed, IDSA, TropMed, CDC, etc)

• Outgoing Alerts/Advisories– Broadcast radius is situation dependent

• Collaboration with public health partners

Alarming Events Strategy

• Fixed list of flagged diagnoses

– Any such record entered into the central database triggers an immediate alarm

– Immediate notification of a Project Director – Immediate notification of a Project Director for decision on response

• Temporary flagged diagnoses added based on situations arising

Rare Alarming Events• Anthrax, pulmonary/cutaneous• Botulism• Chagas disease, acute• Cholera (toxigenic V. cholera)• Death• Dengue (severe/complicated)• Diphtheria

• Meningococcal meningitis• Mycobacterium tuberculosis

(MDR or XDR)• Polio• Rabies• Rickettsia prowazeki• SARS

• Diphtheria• Ebola virus• Encephalitis, acute• Hemorrhagic fever, acute• Influenza, Avian• Lassa Fever• Malaria - Atovaquone/

Mefloquine/Quinine resistant

• SARS• Smallpox• Trypanosomiasis, African• Tularemia• Yellow Fever• Yersinia pestis, plague

& pneumonic

Provider-based Sentinel SurveillanceThe 3 Functions of GeoSentinel

1. Surveillance – Response– Alarming sentinel events

2. Surveillance – ongoing trends3. Analysis of morbidity and estimating risk3. Analysis of morbidity and estimating risk

– Diagnosing the ill-returnee; the clinician perspective

– Advising the Prospective Traveler; the traveler perspective

– Defining associations between patient characteristics and disease

Returning travellers serve as sentinels for local outbreaks in endemic areas !

Provider-based Sentinel SurveillanceThe 3 Functions of GeoSentinel

1. Surveillance – Response– Alarming sentinel events

2. Surveillance – ongoing trends3. Analysis of morbidity and estimating risk3. Analysis of morbidity and estimating risk

– Diagnosing the ill-returnee; the clinician perspective

– Advising the Prospective Traveler; the traveler perspective

– Defining associations between patient characteristics and disease

EuroTravNet & Geosentinel plateform

Diagnoses: Comprehensive & FlexibleComprehensive

• 520 available diagnosis codes in table

• New codes added as

Flexible

1000x Etiologies

• New codes added as needed

• 199,134 final diagnoses for 155,086 patients

10x Syndromes

100x Diseases

US 17%

Canada Israel

Nepal 20%

Contribution by Treating Siten = 155,086 patients as of Sept 2011

Canada 11%

Aus/NZ 3% Asia

11%

Europe 32%

Israel 3%

1.7% from Latin America, Africa, Caribbean

17228 patients

1997-2007

10 ill returned travellers4 Gastro-intestinal diseases2 Febrile systemic ilnesses2 Dermatologic1 Respiratory diseases

Proportionate Morbidity: no. of patients with given diagnosis (or group of diagnoses) / all ill travelers to a destination

Risk groups : targets for prevention

• Acute diarrhea : all categories of European travellers to South CentralAsia, North Africa and Middle East, but particularly classi c tourist-travellers

• P. falciparum malaria : immigrant-travellers from Italy and France whovisit friends and relatives in sub-Saharan Africa and the In dian OceanIslands.

• Dengue : travellers to South East Asia• Dengue : travellers to South East Asia

• Thyphoid fever : travellers to South Central Asia

• Rickettsiosis : travellers to sub-Saharan Africa

• Dermatological conditions : tourist travellers to the Caribbean and Central and South America (parasitic diseases) and to North Africa, Middle East and South East Asia (Potentially rabid animal bites)

• STD : missionary expatriate and immigrant VFR traveller s to Eastern Europe, South East Asia and Caribbean.

Eu vs Non Eu

Flagged as

6957 Ill returned travellersFlagged as « highly accessed »> 4000 times !!!

3 deaths recorded• E.coli pyelonephritis and sepsis following a 2-month sojou rn in Spain• Dengue Shock Syndrome following a 3 week pre-arrang ed tourist trip to Phuket • P. falciparum malaria related death in an aid worker who had visited Liberia for three weeks

Febrile systemic illnesses (20%) with identified pathogen:

Gastro-intestinal : 33% of illnesses followed by febrile systemic illnesses : 20% dermatological conditions : 12%and respiratory illnesses : 8%

Malaria (5.4%) accounted for most cases followed by dengue (1.9%)

others including chikungunya, rickettsial diseases, leptospirosis, brucellosis, EBVinfections, tick-borne encephalitis (TBE) and viral hepatitis.

Dermatological conditions (12% of total) :dominated by bacterial infections, arthropod bites, cutaneous larva migrans animal bites requiring rabies post-exposure prophyl axis and also leishmaniasis, myasis, tungiasis and one c ase of leprosy.

Respiratory illness (8% of total) :• 112 tuberculosis including 6 MDR tuberculosis, • 112 tuberculosis including 6 MDR tuberculosis, • 104 cases of influenza like illness• 5 cases of Legionnaires disease.

Sexually transmitted infections (STI) : 0.6% including HIV infection and syphilis.

165 cases of potentially vaccine preventable diseases

Purpose of travel and destination specific risk factors was identified for several diagnoses such as

• Chagas disease in immigrant travellers from South America • P. falciparum malaria in immigrants from • P. falciparum malaria in immigrants from sub-Saharan Africa (SSA).

Travel within Europe is also associated with health risks with distinctive profiles for Eastern and Western Europe.

Marked increase in the number of travellers exposed in North America and

6392 patients at EuroTravNet core sites

western Europe.

Respiratory illnesses, in particular pandemic A(H1N1) influenza, influenza-like syndromes, and tuberculosis, were also observed more frequently. A significant increase in reported dengue cases in 2009 as compared with 2008 was observed (n = 172, 2.7% vs. n = 131, 1.90%). The numbers of malaria and chikungunya cases were also increasing, although not significantly.

Two deaths: visceral leishmaniasis and sepsis in a Sudanese migrant, and Acinetobacter sp. pneumonia in a patient who had visited Spain.

2011

H1 N1H1 N1

2010: on going analysis 7408 ill returned travellers

2010: on going analysis

Flores-Figueroa J, et al. Patterns of illness in travelers visiting Mexico and Central America : the GeoSentinel experience. Clin Infect Dis. 2011 Aug 10 [Epub ahead of print].

Boggild AK, et al. Vaccine preventable diseases in returned international travelers: results from the GeoSentinel Surveillance Network. Vaccine. 2010 Oct 28;28(46):7389-95.

Mendelson M, et al. Short report: Health risks in travelers to South Africa : the GeoSentinel experience and implications for the 2010 FIFA World Cup.Am J Trop Med Hyg. 2010 Jun;82(6):991-5.

Hagmann S, et al. Illness in children after international travel: analysis from the

GeoSentinel Publications 2009-2011

Hagmann S, et al. Illness in children after international travel: analysis from the GeoSentinel Surveillance Network. Pediatrics. 2010 May;125(5):e1072-e1080.

Schlagenhauf P, et al. Sex and gender differences in travel-associated disease. Clin Infect Dis. 2010 Mar;50(6):826-32.

Chen LH, et al. Illness in long-term travelers visiting GeoSentinel clinics. Emerg Infect Dis. 2009 Nov;15(11):1773-82.

Gautret P, et al. Multicenter EuroTravNet/GeoSentinel study of travel-related infectious diseases, Europe. Emerg Infect Dis. 2009 Nov;15(11):1783-90.

Jensenius M, et al. Multicenter GeoSentinel analysis of rickettsial diseases in international travelers, 1996-2008. Emerg Infect Dis. 2009 Nov;15(11):1791-8.

Swaminathan A, et al. A global study of pathogens and host risk factors associated with infectious gastrointestinal disease in returned travellers. J Infect. 2009 Jul;59(1):19-27.

EuroTravNet / Geosentinel plateform: NEW TOOLS

EuroTravNet HealthMap – live at ECDC and all sites in real time

EuroTravNet / Geosentinel plateform: EuroTravNet HealthMap update

an automatic daily alert an automatic daily alert about what’s been reported

at European sites.

SPECIFIC SURVEYS

Extra Task includeResearch Proposals

EuroTravNet future ?Futur Collaboration between

ECDC and Geosentinel?

Focus onExpertise +Epidemic

Travel Medicine

Epidemic Intelligence and Supports activities

=

Geosentinel plateform & surveillance system

Futur Collaborations of Geosentinel

Public Health Agency of Canada will provide financial support to the consortium of Canadian sites for data entry through geosentinel. geosentinel.

The terms are exactly the same as the model with ECDC for EuroTravNet.

Who can join? How to join ?

What is the benefit?

www.eurotravnet.eu

THANK YOUTHANK YOU

www.eurotravnet.eu

www.geosentinel.org

Special thanks:EuroTravNet / Geosentinel reporting sites and membersGeosentinel staff and DirectorsPartners at ISTM, US CDC, ECDC