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ECDC. Risk assessment guidelines for diseases transmitted on aircraft. 2nd ed. (Extract)

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  • ECDC. Risk assessment guidelines for diseases transmitted on aircraft. 2nd ed. (Extract)

    Risk assessment guidelines for diseases transmitted on aircraft (ECDC, 2nd edition, December 2010, extract, edited)


    [Source: European Centre for Disease Prevention and Control, full PDF document, (LINK). Extract, edited.]

    ECDC GUIDANCE

    Risk assessment guidelines for diseases transmitted on aircraft

    Second edition

    PART 2: Operational guidelines for assisting in the evaluation of risk for transmission by disease


    The production of this guidance was coordinated by Katrin Leitmeyer, Preparedness and Response Unit, ECDC.

    The expert working groups included the following members:
    • Members of the tuberculosis expert group
      • Ibrahim Abubakar, chair Health Protection Agency - United Kingdom
      • Jacques Chemardin - Direction g?n?rale de la sant? - France
      • Annick Darrieu-Merlou - Direction g?n?rale de la sant? - France
      • Jos? Figueroa, reporter City and Hackney Teaching Primary Care Trust - United Kingdom
      • Peter Helbling - Federal Office of Public Health - Switzerland
      • Jean-Paul Klein - Bundesministerium f?r Gesundheit - Austria
      • Vladimir Prikazsky - European Centre for Disease Prevention and Control - Sweden
      • Gerard De Vries - KNCV Tuberculosis Foundation - Netherlands
    • Members of the SARS expert group
      • Philippe Barboza - Institut National de Veille Sanitaire - France
      • Christian Drosten - University of Bonn - Germany
      • Tim Eckmans, chair Robert-Koch-Institute - Germany
      • Celine Gossner - European Centre for Disease Prevention and Control - Sweden
      • Helge Hollmeyer - World Health Organization - Switzerland
      • Katrin Leitmeyer - European Centre for Disease Prevention and Control - Sweden
      • Masja Straetemans, reporter KNCV Tuberculosis Foundation - Netherlands
      • Sylvie Van der Werf - Institut Pasteur - France
      • Peter White - Health Protection Agency United - Kingdom
    • Members of the meningococcal disease expert group
      • Suzanne Cotter, chair Health Protection Surveillance Centre - Ireland
      • Ida Czumbel - European Centre for Disease Prevention and Control - Sweden
      • Paolo D'Ancona - Instituto Superiore di Sanit? - Italy
      • Wiebke Hellenbrand - Robert Koch Institute - Germany
      • Sigrid Heuberger - AGES ? ?sterreichische Agentur f?r Gesundheit und Ern?hrungssicherheit - Austria
      • Isabelle Parent du Chatelet - Institut National de Veille Sanitaire - France
      • Pawel Stefanoff - National Institute of Public Health - Poland
      • Lena de Vries, reporter Consultant - Netherlands
    • Members of the measles and rubella expert group
      • Kevin Brown - Health Protection Agency - United Kingdom
      • Donato Greco, chair Instituto di Sanita - Italy
      • Susan Hahn? - RIVM - Netherlands
      • Peter Kreidl - European Centre for Disease Prevention and Control - Sweden
      • Claude Muller - Laboratoire National de Sant? and CRP-Sant? - France
      • Mark Muscat - Statens Serum Institut - Denmark
      • Darina O?Flanagan - Health Protection Surveillance Centre - Ireland
      • Anette Siedler - Robert-Koch-Institut - Germany
    • Members of the viral haemorrhagic fevers expert group
      • Roberta Andraghetti - WHO Regional Office for Europe - Denmark
      • Ray Arthur - Centers for Disease Control and Prevention (CDC) - USA
      • Andreas Gilsdorf - Robert-Koch-Institut - Germany
      • Stephan G?nther - Bernhard-Nocht-Institut - Germany
      • Michel van Herp - MSF - Belgium
      • Katrin Leitmeyer - European Centre for Disease Prevention and Control - Sweden
      • Dilys Morgan, chair Health Protection Agency - United Kingdom
      • Aura Timen - RIVM - Netherlands
      • Maggie Tomlinson - Department of Health - United Kingdom


    Suggested citation: European Centre for Disease Prevention and Control. Risk assessment guidelines for diseases transmitted on aircraft. 2nd ed. Stockholm: ECDC; 2010. Second edition: Stockholm, December 2010

    First published November 2009
    ISBN 978-92-9193-234-4
    doi 10.2900/37002

    ? European Centre for Disease Prevention and Control, 2010
    Reproduction is authorised, provided the source is acknowledged.


    Introduction

    The founding regulation(i)

    The emergence of severe acute respiratory syndrome (SARS) illustrated the potential for a new disease to suddenly appear, spread and threaten the health, economic and social life of European citizens. The fact that there are more than 800 million passengers carried on national and international flights within the European Union (EU) establishing the European Centre for Disease Prevention and Control (ECDC) gives ECDC a mandate to strengthen the capacity of the EU for the prevention and control of infectious diseases. One of the approaches is to provide independent scientific advice, as well as scientific and technical assistance to assess health threats.(ii)

    In order to assist national authorities in the EU Member States in the assessment of risks associated with the transmission of various infectious agents on board airplanes, ECDC commissioned the production of this guidance documents through a call for tender with the Robert Koch Institute, Germany in 2007. Hereafter, this project will be referred to as ?the risk assessment guidance for diseases transmitted on aircraft?, or RAGIDA.


    The RAGIDA project

    The project consisted of two different parts, described below.


    Part 1: Systematic literature review and expert interviews

    As a first step, a systematic review of over 3700 peer-reviewed articles and grey literature was performed for the following 12 diseases: tuberculosis, influenza, severe acute respiratory syndrome, meningococcal disease, measles, rubella, diphtheria, Ebola haemorrhagic fever, Marburg haemorrhagic fever, Lassa fever, smallpox and anthrax. In addition, general guidelines on risk assessment and risk management from international aviation boards and national or international public health agencies were systematically searched. Standardised questionnaires were used to interview national and international experts to systematically assess case-based information on events.

    The results of this first part of the project are available from (LINK)


    Part 2: Operational guidance for assisting in the evaluation of risk for transmission by disease

    As a second step, the production of a series of operational guidance documents for assisting in the evaluation of risk for transmission of ten diseases prioritised by the Advisory Forum (AF17/2008) was initiated. In June 2009, ECDC convened a technical expert consultation that focused on tuberculosis, new emerging airborne diseases (e.g. SARS) and meningococcal infections. In 2010, other expert consultations will follow covering diseases such as measles, rubella, haemorrhagic fevers, diphtheria, and bioterrorism agents (smallpox, anthrax). Described below are both the methodology and the structure of the guidance documents finalised in part 2 of the project.


    Methodology

    A) Selection of the working group participants

    Small, multidisciplinary expert working groups were established for each of the following diseases: tuberculosis, new emerging airborne diseases, meningococcal infections, viral haemorrhagic fevers, measles, and rubella. The participants were selected to include:
    • representatives of national public health authorities, including those with experience in the investigation and follow-up of incidents involving infectious diseases in travellers;
    • European and international disease experts;
    • international experts in microbiology and mathematic modelling;
    • representatives of the ECDC disease specific programmes;
    • representatives of the European Commission; and
    • representatives of the WHO International Health Regulations Coordination Programme, Geneva.

    All participants completed a Declaration of Interest form. No conflicts of interest were declared by any of the participants.


    B) Base of evidence

    Evidence obtained for the three guidance documents included:
    • the review of the published literature by disease, related to air travel (see RAGIDA, Part 1);
    • the review of data in air travellers obtained from national public health authorities (see RAGIDA, Part 2);
    • expert opinions from the working group participants.

    The quality of available evidence was assessed by the experts, using elements of the ?Scottish Intercollegiate Guidelines Network? (SIGN) and the ?Grading of Recommendations Assessment, Development and Evaluation? (GRADE), by not only taking into consideration the available scientific evidence for transmission but also wider aspects including the following examples: case fatality rate, the potential for public health intervention and availability of treatment.

    An illustration of the type of considerations used by the experts in order to assess the evidence can be found in Annex.


    C) Development of the final guidance documents

    The final recommendations proposed by the three expert groups were shared for comments and suggestions with the members of the ECDC Advisory Forum (AF19/2009 and AF23/2010).


    Structure and use of the guidance document

    The current document consists of three disease-specific chapters, using the following outline:
    • Literature review
    • Suggested approach
    • Criteria to be considered
    • Other considerations
    • Draft Q&A for contact tracing

    These guidance documents may be adapted to the local situation, national and international regulations or preparedness plans.

    These guidance documents represent the views of the experts. If new, relevant evidence becomes available, the RAGIDA documents will be updated accordingly.

    (...)

    (i) Regulation 851/2004 of the European Parliament and of the Council.
    (ii) Total number of passengers carried in 2008 (arrivals and departures for national and international), Europe in figures, Eurostat yearbook 2010.

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