Report from the Commission to the Council and the European Parliament Operation of the Early Warning and Response System (EWRS) of the Community Network for the epidemiological surveillance and control of communicable diseases during 2006 and 2007 (Decision 2000/57/EC) (Text with EEA relevance)
Date: 2009-05-15
Institutions: European Commission
Subjects: disease prevention, epidemiology, health control, infectious disease, information network, public health, report

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COMMISSION OF THE EUROPEAN COMMUNITIES 

Brussels, 15.5.2009 
COM(2009) 228 final 

REPORT FROM THE COMMISSION TO THE COUNCIL AND THE EUROPEAN 
PARLIAMENT 

Operation of the Early Warning and Response System (EWRS) of the Community 
Network for the epidemiological surveillance and control of communicable diseases 
during 2006 and 2007 (Decision 2000/57/EC) 

(Text with EEA relevance)

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TABLE OF CONTENTS 

1. 

2. 

3. 

3.1. 

3.2. 

3.3. 

3.4. 

3.5. 

4. 

5. 

5.1. 

5.2. 

5.3. 

5.4. 

6. 

7. 

8. 

9. 

Introduction .................................................................................................................. 3 

Events notified in 2006 ................................................................................................ 3 

Response and follow-up to the main events notified in 2006 ...................................... 3 

Chikungunya in La Réunion ........................................................................................ 3 

Measles......................................................................................................................... 4 

Lassa fever ................................................................................................................... 4 

Clostridium difficile 027 .............................................................................................. 4 

Avian influenza in humans........................................................................................... 4 

Events notified in 2007 ................................................................................................ 5 

Response and follow-up to the main events notified in 2007 ...................................... 5 

Tuberculosis ................................................................................................................. 5 

Chikungunya in Italy.................................................................................................... 6 

Measles in Belgium...................................................................................................... 6 

Legionellosis ................................................................................................................ 6 

Assessment of events reported versus notification criteria .......................................... 7 

The new International Health Regulations (IHR) ........................................................ 8 

Transfer of the EWRS to the ECDC ............................................................................ 9 

Conclusions .................................................................................................................. 9 

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1. 

INTRODUCTION 

This report is intended to inform the Council and Parliament about the events due to 
communicable  diseases  of  Community  relevance  notified  during  2006  and  2007 
through  the  Early  Warning  and  Response  System  (EWRS)  under  Decision 
2119/98/EC1 of the Council and Parliament and Commission Decision 2000/57/EC.  

2. 

EVENTS NOTIFIED IN 2006 

During  2006  a  total  of  138  messages  were  posted  (2.6  messages/week),  with  223 
comments. Of the 138 messages, 37 were information messages, 47 activation level 1 
messages,  22  activation  level  2,  and  two  activation  level  3  messages.  Of  the  30 
messages  posted  in  response  to  specific  events,  16  were  about  the  adoption  of 
measures,  nine  coordination  of  measures,  and  five  intended  or  planned  measures. 
The  breakdown  of  messages  by  country  or  area  of  occurrence  was:  Germany  (10 
events notified), France (8), Italy, Spain, Sweden and Denmark (7 each), the United 
Kingdom and Austria (6), Belgium  and  Slovenia  (5),  Latvia  and  Israel  (4),  Poland, 
Lithuania  and  Turkey  (3),  Portugal,  Estonia,  Greece,  the  Netherlands,  Norway  and 
Sierra  Leone  (2),  and  Hungary,  the  Czech  Republic,  Slovakia,  Romania,  the  Faroe 
Islands  (Denmark),  La  Réunion  (France  DOM-TOM),  Saint  Helena  (United 
Kingdom),  Croatia,  the  Russian  Federation,  Mauritania,  Egypt,  Tunisia,  Iraq,  India 
and  Thailand  (one  each).  Seven  events  involved  more  than  one  country  of  the  EU, 
and two involved more than one country outside the EU. Four events have not been 
identified  by  geographical  origin.  48  messages,  relating  to  16  events  were  posted 
through the selective exchange channel. 

43  events  were  related  to  influenza;  18  to  acute  diarrhoea;  eight  to  diarrhoea  and 
salmonellosis;  seven  to  measles;  six  to  legionellosis;  five  to  tuberculosis;  two  to 
cholera,  death  of  unexplained  origin,  fever,  food  poisoning,  haemorrhagic  fever, 
hepatitis,  haemolytic  uremic  syndrome,  mumps  or  vCJD;  and  one  each  to 
campylobacteriosis,  leptospirosis,  listeriosis,  septicaemia,  shigellosis,  soft  tissue 
infection,  sexually  transmitted  infection,  and  typhoid  fever.  Eight  messages  were 
classified as ‘not applicable’ and five as ‘unlisted’.  

3. 

RESPONSE AND FOLLOW-UP TO THE MAIN EVENTS NOTIFIED IN 2006 

3.1. 

Chikungunya in La Réunion 

In  February  2006,  France  notified  a  major  outbreak  of  Chikungunya  virus  in  the 
overseas department of La Réunion. It quickly spread to other islands in the Indian 
Ocean  and  reached  India.  The  risk  of  Chikungunya  virus  appearing  in  the  EU  was 
assessed  by  the  ECDC  to  give  Member  States  options  for  a  higher  state  of 
preparedness. Risk assessment information for travellers in and from affected areas 
was  prepared  and  circulated  to  the  Member  States.  The  risk  from  blood  donors 
returning  from  affected  areas  was  also  addressed,  and  public  health  authorities 
responsible for blood safety issues were alerted to give them the chance to apply a 
deferral policy for blood donors.  

1 

OJ L 268, 3.10.1998, p. 1. 

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3.2.  Measles 

In March 2006, Germany notified a number of regional outbreaks of measles in the 
south and west of the country. Outbreaks involving 58 cases in the greater Stuttgart 
area and 149 cases in the Land of North Rhine-Westphalia were reported. Additional 
investigation  revealed  1 018  cases  notified  to  the  health  authorities  between  1 
January and 3 May 2006 in North Rhine-Westphalia, older children and adolescents 
being predominantly affected. These events triggered specific public health measures 
in  response  to  the  event  (information  to  all  local  health  authorities,  increased 
vaccination  coverage,  information  campaign  for  schools,  nurseries,  parents  and 
general practitioners).  

3.3. 

Lassa fever 

On 21 July 2006, Germany notified the case of a Lassa fever patient who travelled 
from Freetown (Sierra Leone) via Abidjan (Ivory Coast) and Brussels to Frankfurt. 
The patient was sick during the flights and was carrying a dysfunctional urinary tract 
catheter, which leaked urine to the airplane seat, blankets  and the patient’s clothes. 
While  the  risk  to  other  passengers  was  judged  by  the  ECDC  to  be  low,  contact 
tracing  procedures  for  persons  considered  to  be  at  higher  risk  were  agreed,  and  a 
coordination mechanism including the European Commission, the ECDC, the Robert 
Koch Institute, the Belgian public health authorities, Sabena Airlines and the WHO 
was put in place. A kit of tools and documents was rapidly made available. 92 people 
were sought, of whom 43 were from EU Member States (Belgium, Germany, Italy, 
Poland, the UK, France and Spain). Each of these countries received a list of persons 
to be traced via the selective exchange of information tool available in the EWRS. A 
press  release  was  agreed  to  give  Member  States  a  consistent  message  should  they 
have felt the need to inform the public. Although no secondary case was identified, 
the event clearly demonstrated the value of the coordination mechanism and revealed 
additional needs for dealing with similar events in the future. 

3.4. 

Clostridium difficile 027 

On  28  April  2006,  France  notified  the  first  cluster  of  toxinotype  III,  PCR-ribotype 
027 Clostridium difficile associated disease in a hospital in the north of the country. 
The  information  pointed  out  the  similarity  of  the  cluster  with  the  epidemic  strains 
already  isolated  from  severe  Clostridium  difficile  associated  disease  outbreaks  in 
other  countries.  Detected  in  Canada  and  the  US  since  2003,  PCR-ribotype  027 
Clostridium  difficile  was  involved  in  hospital  outbreaks  in  the  United  Kingdom  in 
2004  and  in  Belgium  and  the  Netherlands  in  2005.  Control  measures  were 
implemented in France on 21 March 2006 by the infection control unit and no further 
case  has  occurred  since  11  April  2006.  Experience  and  lessons  learned  at  national 
level by France were passed on to the other Member States, and appropriate response 
options were discussed. Since 2006, Clostridium difficile 027 has also been isolated 
in Poland, Luxembourg and Denmark. 

3.5. 

Avian influenza in humans 

In Turkey transmission of the H5N1 influenza virus to humans triggered significant 
message traffic. The epidemiological situation was updated on a regular basis in case 
of possible spread to other geographical areas. Although there were more messages 
about avian influenza events than for any other events (43 messages, or 31.1%), most 
of the information was about cases in birds in the EU and about measures taken at 
national level to inform travellers about affected areas.  

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4. 

EVENTS NOTIFIED IN 2007 

During 2007 a total of 85 messages were posted (1.6 messages/week), with a total of 
300  comments.  Of  the  85  messages,  26  were  information  messages,  32  activation 
level 1 messages, three activation level 2 messages, and one was an activation level 3 
message.  23  messages  concerned  measures  taken  in  response  to  specific  situations 
(12 messages on adopted measures, eight on coordination of measures, and three on 
intended  measures).  The  geographical  origin  of  the  incidents  was:  Italy  (9);  the 
United  Kingdom  (8);  India  (6);  Spain,  Germany,  Ireland  and  Hungary  (4  each); 
France,  Sweden,  Portugal,  Poland,  Estonia,  Vietnam,  the  Czech  Republic,  Canada, 
Malta  and  Bulgaria  (2);  Denmark,  Belgium,  Lithuania,  Turkey,  Latvia,  Norway, 
Egypt, Finland, Thailand, Romania, the Dominican Republic, Nigeria, Luxembourg, 
China  and  Uganda  (one  each).  Four  events  involved  more  than  one  country  of  the 
EU, and one event more than one non-EU European country. One event has not been 
identified  by  geographical  origin.  159  messages,  related  to  14  events  were  posted 
through the selective exchange channel. 

Ten events were related to tuberculosis and influenza; seven to legionellosis; five to 
diarrhoea  and  salmonellosis;  four  to  cholera  and  measles;  three  to  acute  diarrhoea; 
two  to  fever,  food  poisoning,  haemorrhagic  fever  and  multi-drug  resistant 
tuberculosis;  and  one  each  to  cryptosporidiosis,  laryngitis,  melioidosis,  meningitis, 
mumps, pneumonia,  rabies, septicaemia,  shigellosis,  syphilis, trichinosis and vCJD. 
Sixteen messages were quoted as ‘not applicable’ and one was ‘unlisted’.  

5. 

RESPONSE AND FOLLOW-UP TO THE MAIN EVENTS NOTIFIED IN 2007 

5.1. 

Tuberculosis 

Ten events related to tuberculosis were notified in 2007. Four were related to flights 
of more than 8 hours (France, Italy (2) and Germany). One event involved a person 
working in a nursery hosting children from several EU countries (Luxembourg). One 
incident concerned a patient who was attending a summer course at an international 
college  (Italy).  Two  events  related  to  cases  of  multi-drug  resistant  tuberculosis 
(MDR-TB) travelling by bus (Sweden and France). Two incidents involved short air 
journeys:  one  with  MDR-TB  (Malta),  and  one  with  extensively  drug-resistant 
tuberculosis (XDR-TB) (Iceland). 

Among the reported events was a case of XDR-TB in an American citizen travelling 
in  Europe,  notified  on  25  May  by  the  Italian  health  authorities.  The  patient  had 
travelled  on  a  long-haul  flight  from  Atlanta  (United  States)  to  Paris  (France).  He 
returned  to  Canada  on  a  Czech  Airlines  flight  from  Prague  to  Montreal  and  re-
entered the United States by car. The patient had been diagnosed with TB in March, 
and was informed, while travelling in Europe, that his tuberculosis was extensively 
drug-resistant.  The  ECDC  issued  a  threat  assessment,  concluding  that  the 
infectiousness of the patient was very low and that there was no evidence of XDR-
TB being more transmissible than drug-sensitive TB. However, given the seriousness 
of  XDR-TB,  the  ECDC  recommended,  as  a  precautionary  measure,  applying  the 
WHO guidelines on ‘Tuberculosis and Air Travel’ for the two transatlantic flights (> 
8 hour flights). The Commission chaired a number of coordination meetings with the 
Member States concerned, the ECDC, the WHO, the United States, Canada and the 
Commission’s  Delegations  in  the  United  States  and  Canada,  and  coordinated 
measures  on  contact  tracing  were  implemented.  Considering  the  very  high  media 
attention, a press statement was agreed. The event highlighted the need to strengthen 

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the existing mechanism for contact tracing and to take a common line with the media 
in case of need.  

Assessment  of  the  other  events  drew  attention  to  such  issues  as:  (i)  data  protection 
questions;  (ii)  the  potential  for  creating  EU  ‘no  fly’  lists;  (iii)  the  responsibility  of 
airlines and travel companies to collect, provide and store travellers' personal data for 
such  public  health  measures  as  contact  tracing;  (iv)  the  transmission  of  passenger 
information  to  national  health  authorities  in  line  with  WHO  guidelines;  and  (v) 
contact tracing only for MDR/XDR-TB cases.  

5.2. 

Chikungunya in Italy 

The  Italian  public  health  authority  identified  an  outbreak  caused  by  Chikungunya 
virus in the Ravenna area and reported the event on 30 August 2007. By the time of 
notification  the  number  of  cases  was  131  and  the  epidemic  curve  trend  was 
decreasing. This is the first ever report of indigenous transmission  of  Chikungunya 
virus  in  Italy  and  Europe.  The  outbreak  was  linked  to  a  traveller  returning  from 
India.  Local  transmission  was  possible  because  of  the  presence  of  the  Aedes 
albopictus  mosquito  in  the  area.  The  rapid  response  of  the  Italian  health  authority 
quickly brought the outbreak to an end. Information was shared swiftly through the 
EWRS, and the Commission — with the ECDC — helped Member States to boost 
their  preparedness,  enhance  their  early  warning  and  surveillance  arrangements, 
extend  their  Chikungunya  diagnostic  capacity,  implement  targeted  blood-safety 
measures, and intensify their checks on imported goods such as lucky bamboos and 
used tyres (likely vehicles for vector importation).  

5.3.  Measles in Belgium 

Belgium  notified  on  30  October  2007  an  outbreak  of  22  measles  cases  among  an 
orthodox Jewish community in Antwerp. The index case was a 17 year-old American 
student,  studying  in  London  and  visiting  relatives  in  Antwerp.  Previous  measles 
outbreaks  in  ultra-orthodox  Jewish  communities  had  been  reported  in  the  United 
Kingdom  and  in  Israel  (imported  from  the  United  Kingdom).  The  low  coverage  of 
measles  vaccination  in  the  ultra-orthodox  Jewish  community  was  apparently  at  the 
root of the outbreak. The information was circulated rapidly by Belgium and widely 
shared. Close collaboration with the European Jewish Council was an important asset 
in reaching the vulnerable group in those communities in the European Union, who 
usually have low awareness of the risk linked to low vaccination coverage.  

5.4. 

Legionellosis  

In January, the EWRS contact points in Sweden, Finland and Norway notified four 
cases of Legionnaires’ disease diagnosed in guests who stayed at the same hotel in 
Phuket  (Thailand).  All  cases  were  reported  to  the  European  Working  Group  for 
Legionella Infections (EWGLI). A press statement was released regarding measures 
adopted by Finland. The Nordic institutes worked closely with EWGLI and the tour 
operators, who informed the authority responsible at local level in order to identify 
and  treat  the  source  of  infection  so  as  to  prevent  further  cases.  A  contact  tracing 
procedure  was  rapidly  put  in  place:  284  European  tourists  from  11  EU  Member 
States  were  identified  and  contacted,  where  possible.  The  persons  contacted  were 
informed about the possible exposure and advised to seek medical care should they 
develop  symptoms  suggestive  of  legionellosis.  Similar  steps  were  taken  after  a 
cluster of Legionnaires’ disease in a Bulgarian hotel in July 2007. 

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6. 

ASSESSMENT OF EVENTS REPORTED VERSUS NOTIFICATION CRITERIA  

ECDC  was  asked  by  the  Commission  to  carry  out  an  assessment  of  whether  the 
events reported under Decision 2119/98/EC matched the criteria specified in Annex I 
to  Decision  2000/57/EC.  The  purpose  was  to  provide  the  Commission  and  the 
Member  States  with  scientific  evidence  to  strengthen  reporting  arrangements  under 
the current EU legislation on communicable diseases and to provide a basis for using 
the IT tools more efficiently. The full report on the assessment was presented by the 
ECDC  and  discussed  with  Member  States  and  is  available  on  request.  The  main 
figures are summarised below. 

A  total  of  195  events  (activation  levels  1,  2,  and  3)  notified  through  the  EWRS 
between  May  2004  and  December  2007  were  reviewed  independently  by  three 
ECDC experts. Each incident was assessed to see whether it matched the four criteria 
in Annex I2 to Decision 2000/57/EC. 

Of the 195 messages circulated, 163 (83.6%) matched at least one of the four criteria 
in Annex I. Thirty-two (16.4%) did not match any of the criteria. Most of the events 
(104  –  53.3%)  matched  only  one  criterion.  The  breakdown  of  posted  messages  by 
number of matched criteria is given in the following table.  

Message type 

activation 

activation 

activation 

EWRS 
level 1 

EWRS 
level 2 

EWRS 
level 3 

Total 

No  of  messages  matching  Annex  I 
criteria 

0 

22

10

32

1 

85 

17 

2 

104

2 

30

21

4 

55

3 

4 

4 

Total 

141 

48 

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195 

Of  the  195  messages  posted,  criterion  1  was  matched  in  11  messages  (5.6%), 
criterion 2 in 87 messages (44.6%), criterion 3 in 36 messages (18.5%) and criterion 
4 in 92 messages (47.1%).  

The  top  four  reporting  reasons  were:  66  messages  (33.8%)  were  posted  because  of 
factors  indicating  potential  for  international  propagation;  35  messages  (17,.9%)  to 
enquire  whether  epidemiologically  linked  cases  of  the  same  disease  had  been 

2 

An event is to be reported to the EWRS if one or more of the following criteria are met:  
1. Outbreaks of communicable diseases extending to more than one Member State of the Community. 
2. Spatial or temporal clustering of cases of disease of a similar type, if pathogenic agents are a possible 
cause and there is a risk of propagation between Member States within the Community.  
3. Spatial or temporal clustering of cases of a similar type outside the Community, if pathogenic agents 
are a possible cause and there is a risk of propagation to the Community. 
4. The appearance or resurgence of a communicable disease or an infectious agent which may require 
timely coordinated Community action to contain it. 

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detected or reported recently in another country; 26 (13.3%) to find out whether the 
source of an outbreak was suspected to be a food product or any other goods that had 
been imported from or exported to other countries; and 23 (11.8%) because the event 
attracted  or  was  likely  to  attract  a  high  degree  of  international  media  or  political 
attention. 

Compliance with the notification criteria in Decision 2000/57/EC appears to be good, 
although  there  is  significant  room  for  improvement.  The  assessment  revealed  some 
difficulties in evaluating whether the reported events matched the EWRS criteria on 
the exclusive basis of  the information provided in the core message. The two main 
criteria associated with the reporting process are the spatial or temporal clustering of 
cases  of  disease  with  a  risk  of  propagation  between  Member  States  within  the 
Community  (criterion  2)  and  the  occurrence  of  a  disease  that  might  require 
coordinated and timely Community action to contain it (criterion 4). It is interesting 
to note that one of the main reasons for reporting is the political or media attention 
that  the  event  can  generate.  Additional  work  to  analyse  the  trend  over  time  of  the 
reported incident (and not simply the messages) will be needed to get more detail on 
progress  in  implementing  the  notification  process  and  to  give  the  Commission  and 
the  Member  States  options  for  improving  it.  Further  assessment  of  the  events  not 
reported through the EWRS will be of pivotal importance for gaining a full picture 
and for assessing compliance with Council and Parliament Decision 2119/98/EC and 
Commission Decision 2000/57/EC. 

7. 

THE NEW INTERNATIONAL HEALTH REGULATIONS (IHR) 

The new International Health Regulations (IHR) were adopted by the World Health 
Assembly  on  22  May  2005  and  entered  into  force  on  15  June  2007.  To  adapt  the 
current  EU  legislation  on  communicable  diseases  to  the  new  IHR,  the  Annexes  to 
Decisions  2119/98/EC,  2000/96/EC  and  2000/57/EC  have  been  amended.  In 
particular  the  obligation  to  report,  through  the  EWRS,  all  events  due  to 
communicable  diseases  notified  to  the  WHO  under  the  IHR  was  introduced 
(Decision  of  28  April  2008  amending  Decision  2000/57/EC).  In  the  interests  of 
consistency  between  the  notifications  to  the  Community  Network  and  from  the 
Member States to the WHO under the new IHR, an IT function has been developed 
in the EWRS to inform the WHO about events notified under Decision 2119/98/EC.  

To  meet  the  need  expressed  by  Member  States  to  create  a  discussion  forum  for 
coordinating  the  practical  aspects  of  IHR  implementation,  the  Commission 
established, beside the EWRS contact points, a group of National IHR Focal Points 
in  the  European  Union,  who  met  for  the  first  time  in  Stockholm  on  31  May  2007. 
Most  of  the  Member  States  (23  out  of  27),  Norway  and  Iceland  have  appointed  as 
National IHR Focal Points the same institutions designated as EWRS contact points. 
The  Commission  chairs  this  group  twice  a  year;  the  WHO  participates  in  the 
meetings, which also offer an opportunity to review the events notified through the 
EWRS  and  discuss  their  implications  for  notification  through  the  IHR.  The 
Commission envisages offering additional solutions to strengthen IHR notifications, 
which will be closely associated with the existing EU electronic notification systems 
and fully recognised by the WHO. 

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8. 

TRANSFER OF THE EWRS TO THE ECDC  

Under  its  founding  Regulations  the  ECDC  has  since  17  November  2007  been 
operating the EWRS application. As in the past the Commission remains responsible 
for  the  other  aspects,  including  the  ‘user’s  management  authorisation’.  EWRS 
contact  points  in  Member  States  are  still  formally  appointed  by  addressing 
designations  and 
the  Commission  via  Permanent 
Representations. 

for  access 

requests 

to 

The current application is no different from the previous EWRS application, so there 
is  no  difference  in  using  the  system  except  for  passwords  and  logins,  as  a  new 
password  policy  has  been  introduced  to  strengthen  security  (the  new  application  is 
now  accessible  via  the  internet).  Since  17  November  2007  the  new  application  has 
been accessible at: https://ewrs.ecdc.europa.eu.  

9. 

CONCLUSIONS 

Figures for the EWRS in 2006 and 2007 confirm previous years' trends. The number 
and typology of messages notified were comparable to 2004 and 2005. ‘Information 
level’  messages  accounted  for  most  of  the  EWRS  messages.  The  total  number  of 
messages circulated in 2007 was fewer than in 2006. This most probably results from 
the  higher  number  of  messages  related  to  avian  influenza  events  notified  in  2006 
rather  than  from  a  change  in  the  notification  process.  Additional  analysis  of  the 
messages  notified  since  the  EWRS  IT  tool  was  launched  (1999)  is  planned  and 
should  generate  further  evidence  on  the  trend  of  EWRS  use  over  time  and  will  be 
instrumental  in  streamlining  the  use  of  the  system,  focusing  more  on  management 
issues than on assessment. 

As in previous years, only a limited number of the events reported in 2006 and 2007 
required Community-wide coordination. The present report has focused on the events 
which  triggered  such  responses  at  different  levels  and  which  have  spotlighted  a 
number of specific areas calling for closer attention.  

The Chikungunya outbreak in Italy highlighted the potential role of climate change 
in  modifying  vector-borne  disease  epidemiology  in  the  EU  and  the  need  for  a 
regional  approach  to  monitoring  and  responding  to  these  diseases  (e.g.  West  Nile 
virus). In particular, it demonstrated that a disease that has never been reported in the 
EU  can  always  challenge  the  capacities  to  respond  and  coordinate  at  Community 
level.  

The upsurge of measles cases reported by a number of Member States highlights the 
importance  of  having  a  coordinated  approach  to  achieving  and  maintaining  a  high 
level of vaccination coverage throughout Europe, with a view to the elimination of 
measles targeted for 2010.  

Contact  tracing  procedures  were  implemented  on  several  occasions.  The  results 
revealed  that,  although  coordination  procedures  were  swiftly  put  in  place, 
mechanisms should be strengthened so as to trace rapidly the persons concerned and 
at the same time comply with current legislation on the protection of personal data. 
The major difficulties in obtaining data from airlines still persist.  

A  number  of  events  required  agreement  on  media  messages  addressed  to  large 
audiences. Coordination meetings of the EWRS authorities in Member States proved 
particularly useful for sharing common lines to be taken with the media; however, it 

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was  clear  that  further  work  is  still  needed  to  develop  a  more  structured  form  of 
response. 

The Commission and the Member States, assisted by the ECDC, adapted swiftly to 
the  challenge  of  the  new  IHR.  Existing  legislation  on  communicable  diseases  has 
already  been  adapted  and  will  be  followed  in  2010  by  a  proposal  for  a  package  of 
legal  instruments  covering  health  threats  from  non-communicable  diseases.  In  the 
short  term,  specific  instruments  to  strengthen  contact  tracing  for  public  health 
purposes  will  be  proposed.  Mechanisms  to  address  the  global  dimension  of  events 
reported outside the EU but with possible impact at Community level were activated, 
when  needed,  in  order  to  facilitate  and  strengthen  the  management  of  those  events 
taking stock of the available resources like the European Programme for Intervention 
Epidemiology  Training  (EPIET),  that  is  now  coordinated  by  the  ECDC  with  close 
collaboration of the WHO. 

A  substantial  upgrade  of  the  EWRS  IT  application  is  planned  in  order  to  achieve 
consistency with the new communication  platforms which the Commission and the 
ECDC  are  developing.  In  particular,  the  link  with  the  ECDC  EPIS  platform3  will 
provide solid ground for exchanging epidemiological information on specific events. 
The  Commission’s  tools  for  helping  Member  States  to  share  data  and  information 
during  crisis  situations  will  help  the  EWRS  to  work  smoothly  whenever  a  large 
number of messages are posted through the system.  

Finally,  some  minor  modifications  to  the  ‘simple  search’  application  (closure  of 
events, message content, syndrome/disease, pathogen, reporting reason, and country 
of occurrence) are necessary and will be introduced soon. The need for these ‘minor’ 
modifications was identified in the previous report too, but the EWRS transfer phase 
prevented this kind of upgrading.  

3 

. 

EN 

10 

   EN