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# Disease outbreak response: why epidemiology plays a central role

R. Avigad* (1), J. Ellis-Iversen (2), J. Gibbens (1), R. Hepple (3) & A. Paterson (4)

## Summary

The need to control transboundary animal disease outbreaks is widely recognised, as is the need for evidence-based decisions regarding which control measures to implement. Key data and information are required to inform this evidence base. To ensure effective communication of the evidence, a rapid process of collation, interpretation and translation is required. This paper describes how epidemiology can provide the framework through which relevant specialists can be engaged to this end, and highlights the central role of epidemiologists, with their unique combination of skills, in this process. It provides an example of an evidence team led by epidemiologists, namely the United Kingdom National Emergency Epidemiology Group, which was established to address this need. It then goes on to consider the different strands of epidemiology, the need for a wide multidisciplinary approach, and the importance of training and preparedness activities to facilitate rapid response.

## Keywords

Animal disease control – Epidemiology – Evidence-based decisions – Rapid response – Transboundary.

## Introduction

### The case for controlling outbreaks

Transboundary animal diseases have been defined as highly contagious epidemic diseases that can spread extremely rapidly, irrespective of national borders [1]. The need to control them is recognised internationally. New contagious diseases introduced into naïve livestock populations can have serious public health, animal welfare and societal consequences and, in extreme cases, can affect the national economy of a country. The desire to enhance preparedness and standardise control of transboundary livestock diseases at a global level led to the creation of the World Organisation for Animal Health (WOAH, founded as OIE) in 1924. Today, the Organisation provides guidance for surveillance and control of WOAH-listed diseases [2]. The Food and Agriculture Organisation of the United Nations also recognises the potential disastrous consequences that animal diseases

can have on society, and it established the Emergency Prevention System for transboundary animal and plant pests and diseases to support early warning and early reaction to transboundary infectious animal diseases [3]. The argument for 'early' intervention is that it will limit the consequences of disease outbreaks. For example, it will reduce the risk of the pathogen spreading into populations in which control is more complicated, e.g. wildlife, or in which it has greater impact, e.g. humans.

### The case for understanding outbreaks in order to implement effective control

Once a WOAH-listed transboundary disease is detected in a Member Country previously free of the disease, an outbreak is declared and emergency control plans are triggered. There is a need to quickly identify, contain and eradicate the infection, and in many cases the outbreak is controlled by managing the primary case and possibly a few traced contacts.

<footnote>(1) World Organisation for Animal Health Collaborating Centre for Risk Analysis and Modelling, c/o Department of Epidemiological Sciences, Animal and Plant Health Agency, Woodham Lane, Addlestone, Surrey, KT15 3NB, United Kingdom</footnote>

<footnote>(2) Danish Veterinary and Food Administration, Stationsparken 31-33, 2600 Glostrup, Denmark</footnote>

<footnote>(3) Field Epidemiology Team, Animal and Plant Health Agency, Rivers House, East Quay, Bridgwater, Somerset, TA6 4YS, United Kingdom</footnote>

<footnote>(4) Field Epidemiology Team, Animal and Plant Health Agency, Suite 2, Gatwick House, Peeks Brook Lane, Horley, Surrey, RH6 9ST, United Kingdom</footnote>

<footnote>*Corresponding author: rachelle.avigad@apha.gov.uk</footnote>
However, uncertainty is inherent in outbreak control, and during the outbreak it is difficult to predict its ultimate size due to uncertainty around identification of infected holdings. Without an understanding in each specific outbreak of the primary (initial introduction) versus the index (first detected) case, the mode of introduction on affected premises, the specific methods of spread and the affected population(s), control efforts will be reactive rather than preventive. As understanding of the outbreak grows during the control stages, identification of infected premises is likely to become less reactive, and more targeted surveillance and control measures can be implemented. Reducing uncertainty and enhancing understanding of the epidemiology of the outbreak will reduce the risk of inefficient or ineffective use of resources, by more appropriately focusing and prioritising control efforts in a proportionate, risk-based manner, such as by establishing concentric rings of differential surveillance around the outbreak. This was the approach taken during the foot and mouth disease (FMD) outbreak in the United Kingdom (UK) in 2007 [4, J. Gibbens, personal communication, 2022]. Haphazard or 'blanket' control efforts can prolong an outbreak, increase the impact on public finances and lead to dissatisfaction or worse, e.g. mistrust in the measures from trading partners, livestock industries and the public.

## Evidence-informed decisions

Disease control decisions during an outbreak are usually taken by budget-holders and policy-makers, guided by scientists, economists, operational staff and other technical experts. The high inherent uncertainty and initially limited understanding of the outbreak during the emergency complicate decision-making. Control measures based on incomplete information can have wide-ranging negative impacts on the size of the outbreak and use of public funds and may affect the future trust between government and stakeholders. Therefore, it is paramount that decisions are based on evidence so that they are as effective as possible and will stand up to scrutiny and demands for proof and audits [5].

## Interpretation and communication of evidence to decision-makers

Decisions informed by broadly sourced but imperfect evidence are usually better than decisions informed by one-sided or no evidence, particularly if uncertainties are made clear. This generates a need for real-time processing and interpretation of all the information captured during every stage of an outbreak. Such information must be rapidly collated, analysed, interpreted and translated into understandable advice to support decision-making, because disease control decisions are made rapidly and continuously during an outbreak [6]. It is equally important that decision-makers understand the inherent uncertainty around the evidence on

which they make decisions. As noted by Pfeiffer, uncertainty can then be handled by risk managers through introduction of more complex risk management strategies or by applying the 'precautionary principle' [7].

# Identifying and defining evidence requirements

## Information captured as the basis for decision-making

Throughout an outbreak, from detection of the index case to control and recovery, many different types of information are collected by various individuals or professions. All information collected can be considered pieces of a puzzle and each piece tells part of the story; however, each piece is also associated with uncertainty or even fallacies if used in isolation to understand the outbreak. Anyone party to a piece of information generates opinions and advice based on that particular piece of information. It is important that the different strands of information required are identified and that each piece of information is generated by experts within that field of science to minimise the uncertainty around it, e.g. samples should be analysed by competent laboratories to ensure valid results. Similarly, farm production and tracing data on infected premises should be collected by someone familiar with animal husbandry and farm practices, e.g. a veterinarian or a trained animal health investigator. These data need to be captured in an accessible and useable format in which linkages can be made. Even if these pieces of information are high quality, they do not explain the outbreak and therefore further analysis, collation and interpretation of all strands of information are needed to transform them into epidemiological evidence that can be communicated effectively.

## Types of information

The types of information commonly generated during an outbreak include:

- population data and maps showing animal density and location;

- clinical history;

- test results;

- pathogen characteristics;

- disease epidemiology and relevant risk factor information (in an avian influenza outbreak, for example, this may include information on the presence of wild birds);

- information about premises, including production data, production chains, husbandry practices and farm layout;

- disease timeline, and tracing and contact information detailing movements on/off the farm;

- predictive modelling.
## Actions needed to understand outbreaks and inform control measures

From a disease control perspective, once the index case is identified and contained, a critical next step is to identify and contain further transmission of infection. A timeline from earliest likely date of introduction (based on disease characteristics) to latest date for potential spread must be estimated in order to identify high-risk contacts for potential spread and the likely source of infection. Surveillance must be designed to ensure the detection and containment of locally transmitted infection. To help understand wider related impacts, modelling can be commissioned to predict the likely size of the outbreak and determine the relative impact of potential control options.

## Interpretation and communication of the information

The information needed must be elicited from a variety of sources and may not be in a standardised format. However, it needs to be rapidly collated and interpreted, acknowledging the existing assumptions and uncertainty. The types of uncertainty often relate to the quality and timeliness of the data, test availability and characteristics, understanding of the pathogen (including factors such as infectious dose and environmental persistence), and on-farm recording, including the recording of personnel and vehicle movements. This collated evidence then needs to be communicated to decision-makers in a timely and easily assimilated way, including through the production of risk assessments. Additional information may need to be sought to reduce outstanding uncertainty. This may be obtained by, for example, carrying out further laboratory testing or conducting interviews with the animal keepers about on-farm events or practices.

## The need for a central evidence team and the example of the National Emergency Epidemiology Group

### The requirement for a central evidence team

A central team is needed to identify and engage with data providers, bring the different strands of information together and standardise definitions and format to aid collation and interpretation of the evidence. This team needs to include representation from the evidence providers but also those involved in the communication of the evidence to policy-makers and operational colleagues. These relationships need to be built and nurtured between outbreaks. Whilst deep expertise is important, the individual findings need to be synthesised and contextualised, with conclusions presented to decision-makers on the current understanding of the animal disease outbreak, highlighting key areas of uncertainty. As the understanding of the outbreak develops, regular updates need to be provided to inform activities related

to surveillance and control. International guidelines and legislative requirements will need to be adhered to; however, within this framework, adjustments may need to be made to account for resourcing, infrastructure and logistical limitations, as well as the trade-off between the cost and impact of different interventions and their potential to control disease. An understanding of these factors is also needed to inform discussions on the wider impact of the outbreak on the primary production chain, animal welfare, international trade, public health and the wider economy and environment.

## The case for epidemiology leading the central evidence team

The epidemiology discipline provides a framework for bringing together, weighting, comparing and challenging conflicting evidence, as well as understanding, interpreting and communicating uncertainty. An epidemiological approach can also make best use of the varying levels of quantification in information, from qualitative risk assessments to more in-depth quantitative analysis and modelling.

Epidemiologists are well placed to identify these disparate sources of information and bring them together. Whilst understanding the various disciplines and information sources, they seldom generate the primary evidence, e.g. test results or production data. This may help prevent confirmation bias, which, as noted by Sutherland et al., can arise 'when scientists find evidence for a favoured theory and then become insufficiently critical of their own results, or cease searching for contrary evidence' [8].

## Example: the National Emergency Epidemiology Group

In the UK, a group called the National Emergency Epidemiology Group (NEEG) was established to address this requirement for a central evidence team. It was set up partly in response to the experience of the FMD outbreak in 2001 and to address a European Union requirement for Member States to maintain an expert group to conduct epidemiological investigations (outlined in Article 78 of Council Directive 2003/85/EC on EU measures for the control of foot-and-mouth disease). The NEEG's purpose is to deliver high-quality epidemiological advice and expertise in the event of an outbreak, so that the causes, level and extent of disease are described, high-impact risks are flagged and future disease patterns are predicted. This supports and enables the development of policy, the management of resources and the implementation of successful control measures. A key function of the NEEG framework is the process for rapid and efficient channelling and translation of field information all the way from the affected epidemiological group of animals on the individual holding to the senior decision-makers. Along the way it brings in technical expertise and analysis as part of the translation process.
The NEEG comprises four main teams:

- a field epidemiology team, which comprises vet-
erinarians with field epidemiology experience and
training;

- an analytical epidemiology team, which comprises two sub-specialties:

a) the policy-facing analytical team, which includes epidemiologists with experience in the translation of the epidemiological evidence for senior policy-makers, and

b) the science-facing analytical team, which in-
cludes quantitative epidemiologists, a modelling
co-ordinator and data scientists;

- a business management team, which is key to ensur-
ing management of documents and meetings, main-
tenance of staff resourcing and welfare, audit and
assurance.

Importantly, the NEEG also includes representatives from the international disease monitoring team, risk analysts, statisticians, disease and laboratory test specialists, species experts and wildlife/ecological experts. Members of the NEEG sit both within the central outbreak coordination centre working in close collaboration with policy-makers, laboratory experts and operational teams as well as the Chief Veterinary Officers (CVOs) of the UK administrations, but also within the field offices where the local activity is coordinated [9].

The NEEG is responsible for leading and coordinating the national epidemiological investigation of animal disease outbreaks. It designs surveillance plans, identifies risk factors and higher-risk tracings and reviews modelling outputs to inform control measures. It identifies the most likely source of infection, outbreak timelines and knowledge gaps. It communicates its analysis of the outbreak by sending frequent, short epidemiology briefs to CVOs and policy/operation senior managers and providing input for reports sent to WOAH. It also produces longer, published epidemiology reports for wider stakeholders and provides regular verbal updates at strategic and operational meetings. It maintains preparedness between outbreaks through transboundary disease outbreak exercises, review of lessons identified, delivery of training and by involvement in endemic animal disease outbreaks.

A reduced mobilisation of the NEEG, known as the ‘NEEG Lite’, allows subsequent rapid scaling-up of response to highly suspicious reports of cases of notifiable diseases, such as FMD. It also facilitates the response to complex outbreaks of more slowly transmitting notifiable animal diseases and/or reportable zoonotic diseases, such as bovine tuberculosis or *Salmonella* infection. In these outbreaks, an efficient structure is required from the outset to ensure effective management of the response, but potentially the response requires fewer resources. The guiding principle is to apply the same organisational processes for all disease

outbreaks. This limited mobilisation can be escalated to the
full NEEG structure if required.

An important strength of the NEEG is its working plan, which documents how to fit in with the wider schedule of meetings and written communications in an outbreak (the ‘battle rhythm’), ensuring the availability of the right people for attendance at the wide range of meetings. It defines the frequency and purpose of meetings and outputs and provides pre-drafted agendas, templates and aide-mémoires to guide members in their contribution to other parts of the outbreak response. This enables rapid deployment and a common understanding of purpose.

**Table I** shows proposed deliverables that were part of the working plan when the NEEG was established and demonstrates the central role played by epidemiologists in the evidence team. Many of these deliverables have been retained as typical outputs from the NEEG. A further important NEEG deliverable is the production of qualitative and quantitative risk assessments to answer key risk questions, such as the likelihood of disease spreading beyond the original infected premises. In 2012, for example, the NEEG assessed the risk of equine infectious anaemia spreading in southwest England (which was assessed as negligible) [10]. An adaptation of the qualitative risk assessment, known as ‘the veterinary risk assessment’, is also used to help frame advice in terms understood by non-technical policy decision-makers. It describes the potential risk pathways, risk factors, mitigating factors, impacts and remaining residual risk and documents any uncertainties.

Discussion

Could other professions/disciplines lead the
central evidence team?

Leadership of the central evidence team is needed to co-
ordinate and guide the epidemiological investigation of
transboundary animal disease outbreaks, bringing together
the evidence from a range of sources/experts and commu-
nicating it to key stakeholders. Whilst in the UK example
epidemiologists assume this leadership role, there are also
arguments for professionals from other disciplines doing so.
Veterinarians, for example, could be good candidates for the
role, as they have training in animal production systems, pa-
thology and disease transmission. However, they may be less
familiar with population medicine, sensitivity of surveillance,
interpretation of test and other data, the use of modelling
and more complex analytical techniques. Disease specialists
may also be candidates for leading this central team, as they
have a deep understanding of the pathogen, its host, trans-
mission and interaction with its environment. However, as
noted by Sutherland et al., ‘multiple, independent sources of
evidence and replication are much more convincing’ [8], and
disease specialists may not be best placed to bring all these
**Table I**

**Proposed deliverables included in the working plan of the National Emergency Epidemiology Group when it was first established**

Adapted from Review of NEEG Report [internal AHVLA report]

© Crown copyright [2013]. Licensed under the Open Government Licence v.3.0

<table><thead><tr><td>Deliverable</td><td>Product and procedure</td><td>Expected deadline</td></tr></thead><tbody><tr><td>Chief Veterinary Officer's brief</td><td>Brief report on epidemiological aspects of the outbreak, e.g. suspected source, potential spread and risk factors</td><td>By 9:45 on second morning following confirmation then daily or as agreed thereafter</td></tr><tr><td>Outbreak sampling strategy</td><td>Sampling strategy for infected premises, protection zones, surveillance zones, monitoring zones, other premises if required</td><td>As rapidly as possible and prior to culling or other activities that would prevent sampling</td></tr><tr><td>Input to drafting of emergency instructions to Operations</td><td>Defined details of sample strategy, collection frequency, testing laboratories, etc., drawn up in liaison with disease consultants</td><td>In time to be carried out before culling or other activities that would prevent its implementation</td></tr><tr><td>First epidemiology report</td><td>Draft circulated to senior managers</td><td>Eighth day after confirmation or to fit international reporting demands negotiated in outbreak</td></tr><tr><td>International reports</td><td>Provide input into reports to international bodies, including WOAH, on the disease outbreak, often derived from the epidemiology reports</td><td>Linked to the first epidemiology report; timing defined at start of outbreak</td></tr><tr><td>Commissioning of urgent, ad hoc reports on premises assessed as very high risk</td><td>Instructions to field epidemiologists to undertake onsite veterinary assessment, sent via local operations leader</td><td>As soon as possible to prevent further disease transmission</td></tr><tr><td>Commissioning and production of additional epidemiology reports when required</td><td>Further epidemiology reports as agreed, including a final one that addresses all outstanding questions posed in previous reports, including a report of the final outcome of surveillance</td><td>Interim reports as agreed; final report within one month of declared freedom from disease</td></tr><tr><td>Attendance and informed/expert contribution at meetings</td><td>Amber alert teleconferences, 'bird tables' and National Expert Group meetings <sup>(a)</sup></td><td>As per the schedule of meetings ('the battle rhythm')</td></tr><tr><td>Reports to inform financial and resource outbreak management</td><td>A record of working hours recorded by members of staff to ensure hours are regulated and paid correctly</td><td></td></tr></tbody></table>

sources together. There is also the question as to whether separation from the production of the primary evidence is needed to ensure unbiased collation and analysis of evidence that is not unduly weighted. The role of economists in helping to inform the use of limited resources provides an argument for their leadership of this evidence team, but choosing the most suitable control measures requires an understanding of the different transmission pathways of infection/disease, and their relative probability, which may make epidemiologists the more appropriate choice for leadership.

**The need for a multidisciplinary team**

More widely, the central role of epidemiology is supported by Zepeda et al., who note that a closer link between national animal health authorities and the scientific community should be established through epidemiologists when considering the implementation of the World Trade Organization's Agreement on the Application of Sanitary and Phytosanitary Measures [11]. King also highlights the 'importance of epidemiology in helping to define the parameters of an acceptable level of risk' [12]. The value of epidemiologists working alongside policy-makers and as part of a wider multidisciplinary team has also been highlighted in a number of papers [12,

13, 14, 15, 16]. Hueston notes that 'animal health problems cannot be resolved by consideration of biological and physical factors alone' and that '...applied epidemiology demands knowledge of the policy-making process and a wide range of social skills, including listening strategies, written and verbal communications, conflict resolution, negotiation abilities and an appreciation of cultural differences and diversity. The veterinary epidemiologist must be able to work as a member of an interdisciplinary team...' [6].

This discussion focuses on transboundary animal disease outbreaks; however, it is suggested that the central role of epidemiology is also important in human health. The role of epidemiology, and particularly field epidemiology, in human disease outbreak response was reinforced by the World Health Organization's Joint External Evaluation tool, part of the International Health Regulations (2005) Monitoring and Evaluation Framework. This tool sets a target of one trained field epidemiologist (or equivalent) per 200,000 population and the establishment of a Field Epidemiology Training Programme [17, 18, 19]. In the UK, the importance of epidemiology in responding to outbreaks has been reinforced by the inclusion of epidemiologists in the Public Health Rapid Support Team (UK-PHRST), which was established in 2016

<footnote>(a) as defined in the Contingency Plan for Exotic Notifiable Diseases of Animals in England [9]</footnote>

<footnote>WOAH: World Organisation for Animal Health</footnote>
following the 2013–2016 West African Ebola epidemic [20]. As well as noting the role of epidemiology in the UK-PHRST outbreak response, Raftery et al. highlight both the need for a multidisciplinary team that takes input from social, economic and political science disciplines and the need for local investigators leading on operational research [21]. The key role of epidemiology as part of a wider multidisciplinary team in human disease outbreak response has also been identified in several other publications [22, 23, 24].

## Types of epidemiologists

In the NEEG example, epidemiologists are separated into two key groups: the field epidemiologists and the analytical epidemiologists. The field epidemiologists lead the on-farm epidemiological investigations and provide input at a local level, e.g. by contributing to the design of control measures. The analytical epidemiologists, on the other hand, provide input at a wider national level, e.g. by designing surveillance strategies, conducting risk-factor studies, reviewing modeling outputs and evaluating control measures. However, there is marked overlap, as the national level surveillance and the control measures in the field are both informed by local findings and, equally, a national strategy needs to be deliverable in the field. Therefore, the skills and experience needed for each of these roles can differ, but the exchange of knowledge and understanding between them is important. Both types of epidemiologist have interaction with policy-makers for strategic decision-making and operational implementation of policies. A key part of this interaction is the translation of the epidemiological evidence for non-technical colleagues and stakeholders. For small, contained outbreaks the focus is more on the field epidemiology and operational considerations, whereas for larger outbreaks there is increasing importance placed on analytical epidemiology and modelling, where forecasting and analysis to inform surveillance design and the selection and evaluation of control options is required.

Whilst it is argued that epidemiology is central to outbreak response, this is not to say that all functions should be located in one place, and modern technology enables a geographically dispersed team to work effectively together. This facilitates the development of regional expertise, an important aspect of the field epidemiologist role, which informs understanding of the local aspects of transmission of infection and source/ spread. It also allows for analytical epidemiologists to withdraw from the hustle of the outbreak management, to carry out advanced analyses or key, in-depth research-type investigations during an outbreak. Within the NEEG, the analytical epidemiology team is commonly divided into policy-facing and science-facing subspecialties, and it is important to have access to both during a disease outbreak. In a crisis situation

there is a constant need for fast-moving policy advice and rapid interpretation of information, but there is often also a need for profound, well-researched decision support.

## Maintaining expertise between outbreaks

To be able to rapidly respond to outbreaks of transboundary animal disease, sufficient training and preparedness activities need to continue between outbreaks [25]. For the NEEG, these include workshops and exercises involving different diseases, species and production systems that members of the team help to design alongside laboratory, disease and industry experts. These help to practise and test delivery of NEEG requirements. Equally important is their role in ensuring continued awareness of changes in personnel and routes of communication with other teams and disciplines with which the NEEG works. Ongoing training of the existing team and new members is essential to maintain expertise and remain abreast of new developments in the evidence base, e.g. understanding of pathogen survival and newer techniques such as whole genome sequencing. A further important activity is to review what went well or could be improved in the last outbreak and design measures to address these for the future.

## Conclusions

This paper has presented the case for the central role of epidemiology in leading the provision of evidence to inform transboundary animal disease outbreak response. It underlines the relevance of the mix of different skills that are unique to epidemiology training and the importance of the impartiality that derives from not being a generator of the primary data. It illustrates how epidemiology binds together a wider multidisciplinary team and enables collation, translation and communication of the evidence to inform the rapid decision-making often required during outbreaks. It is noted that, whilst the rationale for the central role of epidemiology has been described, this does not mean that all epidemiological functions need be in one location, with substantial benefit observed from some regional activities. Finally, the importance of preparedness and training activities is stressed to ensure rapid response. Such activities should not only include training in epidemiological skills, information sources and the drafting of reports and other outputs, but also ensure that team members understand the linkages between themselves and the other teams and disciplines that are key to effective outbreak response.
# Réponse à l'apparition de maladies : pourquoi l'épidémiologie a un rôle central à jouer

R. Avigad, J. Ellis-Iversen, J. Gibbens, R. Hepple & A. Paterson

## Résumé

La nécessité de contrôler les foyers de maladies animales transfrontalières est largement reconnue, tout comme celle de fonder la prise de décisions sur des données probantes pour la mise en œuvre des mesures de contrôle. Afin de documenter cette base d'éléments probants, il est nécessaire d'obtenir un certain nombre de données et d'informations clés. Un processus rapide de collecte, d'interprétation et de traduction des données doit être mis en place afin de communiquer ces éléments probants de manière efficace. Les auteurs décrivent le cadre que l'épidémiologie peut apporter aux chercheurs pour s'engager sur cette voie ; ils soulignent le rôle central des épidémiologistes dans ce processus, grâce au faisceau unique de compétences dont ils disposent. Ils donnent l'exemple d'une équipe animée par des épidémiologistes travaillant sur les données probantes qui a été mise en place spécifiquement pour répondre à ce besoin : le Groupe national d'épidémiologie d'urgence du Royaume-Uni (National Emergency Epidemiology Group). Les auteurs concluent en menant une réflexion sur les différentes branches de l'épidémiologie, le besoin d'une approche pluridisciplinaire large et l'importance des activités de formation et de préparation pour une réponse rapide.

## Mots-clés

Contrôle des maladies animales – Décision étayée par des données probantes – Épidémiologie – Réponse rapide – Transfrontalier.

# Por qué la epidemiología cumple una función central para responder a brotes de enfermedades

R. Avigad, J. Ellis-Iversen, J. Gibbens, R. Hepple & A. Paterson

## Resumen

Hay coincidencia general en que hoy resulta imperativo combatir los brotes transfronterizos de enfermedades animales, al igual que es necesario contar con un sólido fundamento de datos factuales para tomar decisiones sobre las medidas de lucha que conviene implantar. Para generar esta base empírica hay que disponer de un conjunto esencial de datos e información y para comunicarla eficazmente se requiere un rápido proceso de recogida, interpretación y traducción. Los autores explican cómo puede la epidemiología constituir el marco de referencia desde el que trabajen para tal fin los distintos especialistas y destacan la función central que cumplen en este proceso los epidemiólogos, gracias a la singular combinación de competencias que presentan. A modo de ejemplo, describen un equipo dedicado al estudio de datos factuales que fue establecido, bajo la dirección de epidemiólogos, justamente para responder a esta necesidad: el Grupo nacional de respuesta epidemiológica a situaciones de emergencia del Reino Unido (National Emergency Epidemiology Group). Por último, tras detenerse en las distintas vertientes de la epidemiología, inciden en la necesidad de abordar la cuestión desde un planteamiento ampliamente pluridisciplinar y en la importancia que revisten las actividades de formación y preparación para facilitar una respuesta rápida.

## Palabras clave

Decisiones fundamentadas en datos factuales – Epidemiología – Lucha zoosanitaria – Respuesta rápida – Transfronterizo.
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