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EPIET Slideshow Malta fever

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					Update on the EPIET programme
Marion Muehlen and Katharina Alpers
EPIET and PAE scientific coordinators
EPIET
•   European Programme for Intervention Epidemiology Training
•   Started 1996, funded by EU Commission and Member States
•   From Nov 07 funded by ECDC/EU Member States
•   Coordinators:
      Viviane Bremer, based at ECDC in Stockholm, Sweden (100%,
       leading coordinator)
      Alicia Barrasa, based at Carlos III in Madrid, Spain (100%)
      Marion Muehlen, based at HPA-CfI in London, UK (60%)
      Brigitte Helynck, based at INVS in Paris (50%)
      Marie-Anne Botrel, based at INVS in Paris (50%)
      Doris Radun, based at RKI in Berln (80%)
      Katharina Alpers (100% PAE-Coordinator)
• Administration:
    Anna Bohlin, Claudia Metz-Ruffer, ECDC staff


                                                                     1
EPIET programme objectives

To:
• Strengthen CD surveillance & control in EU
• Develop a European network of intervention
  epidemiologists
    Training fellows and externals together
    Training of trainers
    Sustaining and strengthening a network of training sites
• Develop a response capacity inside & beyond EU:
    surveillance
    outbreak investigations
    applied research

                                                                2
Training objectives


  • Plan, implement, evaluate a surveillance system
  • Perform outbreak investigations
  • Develop a research project on a relevant public
    health issue
  • Acquire oral and written scientific
    communication skills
  • Acquire teaching skills


                                                      3
Training format

• Theoretical training
  An introductory course (3 weeks), open to
   external participants
  At least 6 one-week training modules rotating in
   EU Member States
• Learning by doing practical training
  23 months
  At a European public health institute
  On site supervision by senior epidemiologists and
   from EPIET coordinators

                                                       4
Modules

• Compulsory
   Introductory course
   Computer tools in outbreak investigations
   Vaccinology
   Project review
   Multivariate analysis
• Optional
   Scientific writing
   Time series analysis
   Lab and epi
   Rapid assessment of complex emergency
    situations
                                                5
Introductory course, content

• Lectures from field
  epidemiologists
• Interactive case studies
  based on real
  investigations
• Development of a study
  protocol based on real
  PH issue
• Surveillance exercise
• Communication exercises


      Since 2004 in Menorca, Spain
                                     6
Course Modules in 2002-2007
               • Biostatistics (Porto, Rome)
               • Communication (London, Berlin)
               • Rapid assessment techniques in
                 emergency situations (Veyrier, Berlin)
               • Time series analysis and Geographic
                 Information System (Athens, Madrid,
                 Veyrier, Bilthoven)
               • Vaccines (Glasgow, Helsinki, Stockholm,
                 London, Bilthoven)
               • Data management (Bilthoven)
               • Computer & outbreak investigations
                 (Heraklion, Paris, Athens, Prague,
                 Budapest, Malta, Vienna, Sesimbra)
               • Bioterrorism (Berlin)
               • Logistic Regression (Bordeaux, Madrid)
               • Scientific Writing (Berlin)
               • Multivariable Analysis (Stockholm)
                                                           7
Outbreak investigations (examples)

• Campylobacter and norovirus linked to communal water in
  Sweden, 2002
• Q-Fever associated with sheep market in Germany, 2002
• Avian influenza in poultry cullers in NL, 2003
• Legionella associated with cooling towers in France, 2003
• Hepatitis A in homosexual men in Denmark, 2004
• Tuberculosis linked to supermarket in NL, 2005
• S. Hadar associated with roasted chicken in Spain, 2005
• Giardia linked to communal water in Norway, 2005
• S. DT 104 associated with pork meat in NL, 2005/6

                                                              8
Choice of modules

• Skills assessment form at start of training
• Depending on
   Previous skills
   Local training opportunities
   Future needs




                                                9
EU Cross-border Investigations
1999-2007

• Salmonella paratyphi B among EU tourists returning
  from Turkey, 1999
• Clostridium infection and deaths among intravenous
  drug users, England, Scotland, Ireland, 2000
• EU-wide outbreak of
  Salmonella typhimurium 204b, 2000
• Meningitis W135 in pilgrims returning from the Haj, 2000,
  2001
• Hepatitis A in Ibiza and German tourists, 2001
• An outbreak of gastroenteritis in holiday-makers
  travelling to Andorra, January-February 2002
• Hepatitis A among returning travellers from Egypt, 2004
                                                              10
    Research Projects (examples)

•   Risk factors (RF) for Hantavirus in France and Belgium
•   RF for meningococcal meningitis in day care centers, Ireland
•   RF for Q fever in Germany
•   RF for sporadic cases of Listeriosis in France
•   RF for MRSA in nursing homes, Germany
•   RF for Hep C in hemodialysis Unit, France
•   Seroprevalence of WNV among German and
    Austrian bird-ringers
•   RF for sporadic campylobacteriosis, Ireland
•   RF for CA-MRSA, Switzerland
•   RF for syphilis, Sweden
•   Influenza vaccine effectiveness, Denmark
                                                                   11
Surveillance Projects (Examples)

 • Establishment of new surveillance
    Norovirus in Sweden
    Congenital toxoplasmosis in France
    CA-MRSA in Switzerland
    Heat and cold-related mortality in Spain
    Winter mortality in the UK
    Sales of flu medicine in Northern Ireland

 • Evaluation of surveillance systems
    EHEC in France
    STI in Finnland
    Syphilis and Influenza in Germany
    Tuberculosis in Spain
                                                 12
EPIET international missions (1)

Outbreak investigations
   Infant deaths following immunisation (Egypt)
   Tularaemia (Kosovo)
   Suspected anthrax (Ethiopia)
   Ebola (Uganda, Gabon, Sudan)
   Hepatitis E (Sudan)
   Marburg fever (Angola)
   Measles (Nigeria, Niger, DRC, Serbia, Kosovo)
   SARS (Hong Kong)
   Meningitis (Sri Lanka)
   Avian influenza (Vietnam, Turkey, Azerbaijan)
   Mumps (Moldovia)
   Meningitis (Burkina Faso)
                                                    13
EPIET international missions (2)

 Surveillance projects and surveys
    Cholera Surveillance (Mozambique)
    Unsafe Injection Practices survey (Burkina Faso)
    Assessment of neonatal tetanus status (Zimbabwe)
    Vaccine coverage (Côte d’Ivoire, Republic of Guinea,
     East-Timor, Pakistan)
    SARS (Hong Kong)
    Retrospective Mortality Survey (Darfur, Sudan)
    Nutritional survey (Niger, East-Timor)
    Early warning system (Pakistan after Earthquake)
    Avian influenza (Georgia, Azerbaijan)



                                                            14
Scientific Conference

 • ESCAIDE annually in fall
     co-organized ECDC, EPIET, EAN, TEPHINET-Euro
        • Slots for EPIET fellows
     500 persons from European and international
      field epidemiology
        • EPIET fellows, alumni, FETPs Europe, supervisors
          and colleagues from training sites
     EPIET Fellows prepared by “project review” module
        • Review of methods and presentations during a
          whole week, this year in September
 • Satellite workshops: training the trainers
   organized by EPIET, Tephinet, EAN, PAE and FETP-
   Canada

                                                             15
  Time frame


modules
outbreak
investigation
surveillance-
project
research
project
teaching

ESCAIDE
                SeptOkt Nov Dez Jan Feb Mrz Apr Mai Jun Jul Aug Sep Okt Nov Dez Jan Feb Mrz Apr Mai Jun Jul Aug Sep Okt Nov



                               Year 1                                          Year 2


                                                                                                                              16
 Practical Training
 “learning by doing”

• 27 Nations
  + Norway
  + Switzerland
  + WHO
  + EpiCentre / MSF
  + ECDC
• 27 Training sites
  (23 for cohort 11-13)




                          17
Who does What?

• ECDC
    Pays grants and expenses for modules and international
     missions
• Training sites
    Host fellow, offer supervision, activities and projects
• Supervisors
    First responsible for training the fellow
    Teaching
• Coordinators
    Overall responsible for training
    Review all work of fellows
    Advise supervisors on questions
    Organise training modules / courses
    Supervise international missions

                                                               18
Supervision of fellows

• Supervision on site by at least 1 senior
  epidemiologist (4 hours/week)
• Draft protocols/reports/manuscripts sent to all
  coordinators
• Viadesk as virtual office
• Final work uploaded to folder on viadesk




                                                    19
Time frame per cohort

Cohort 12: 13 fellows                 Each cohort begins with an
                                      introductory course, and ends
Sept-Oct 06     Sept-Oct 08           with a scientific seminar, where
                                      each fellow presents his/her
                                      work.

              Cohort 13: 13 fellows
               Sept-Oct 07    Sept-Oct 09



                              Cohort 14: 19 fellows
                               Sept-Oct 08       Sept-Oct 10



                                                                         20
Selection process

• 1st stage
    Check eligibility (ECDC human resources)
    ECDC Selection Panel goes through all applications and
     selects eligible candidates
    MS rank 2 best candidates - for this year’s selection process
     this had NO effect on eligibility for ECDC selection panel!
• 2nd stage
    Candidates choose 3 preferred training sites
    Face to face interview with ECDC selection panel
• 3rd stage
    Training site market
    Interviews with training sites
• 4th stage
    Final selection meeting between panel and host site
     representatives and placement of candidates
                                                                     21
   Output of EPIET 1995-2007


• Cohort 1-12:
    124 fellows trained in EPIET
    39 in EU FETP’s (Germany, Norway, Sweden)
• 149 (93%) graduated (diploma)
• Network of trainers (until 2007)
    12 different modules
    252 individual trainers
    55 organisations



                                                 22
            Number of graduated EPIET Fellows
             1995-2008 by Country of Origin/Training
                                              (nr=146)
                                                                   Hosted        Sent

                                                                                Austria
                                                                                Belgium
                                                                                Czech republic
                                                                                Denmark
                                                                                Finland
                                                                                France
                                                                                Germany EPIET
                                                                                Germany FETP
                                                                                Greece
                                                                                Hungary
                                                                                Ireland
                                                                                Italy
                                                                                Latvia
                                                                                Lithuania
                                                                                Luxembourg
                                                                                Malta
                                                                                Norway EPIET
                                                                                Norway FETP
                                                                                Portugal
                                                                                Slovenia
                                                                                Spain
                                                                                Sweden
                                                                                Switzerland
                                                                                The Netherlands
                                                                                United Kingdom
                                                                                WHO
33 30 27 24 21 18 15 12   9   6   3   0   3   6   9   12 15 18 21 24 27 30 33

                          Number of EPIET fellows                                                 23
    EPIET graduates working in MS (1998-2007)


Place of work          Number
EU Member States           89
ECDC                        6
Norway                      4
Switzerland                 1
Ouside Europe               9

Global level
(WHO, NGO's, UN etc)       20
Unknown                     1
Total                     130


                                                24
Next challenges for EPIET

• Training seats
   Equity of access
   Number of salaries
• Trainers
   Expand training sites to all EU member states
   Increase number of trainers
• National field epidemiology training programmes
   Increase synergy with national FETP’s
   Create new FETPs
• Training material
                                                    25
European added value

• Promotion of field epidemiology in EU
• Contribution to the European Network for
  surveillance and control of CD
• Training of trainers in EPIET host institutes
• Promotion of national training programmes
• Increased mobility of epidemiologists
• Cross border investigations in EU
• International missions



                                                  26
More information


More information is available on the web at:

     http://www.epiet.org

Or writing an e-mail to:


Epiet.office@ecdc.europa.eu




                                               27
   Thank you




European
Programme for
Intervention
Epidemiology
Training




                28

				
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