|Document "Emerging zoonoses": English Abstract|
In this advisory report addressed to the Minister of Health, Welfare and Sport, and to the Minister of Agriculture, Nature and Food Quality, a Committee of the Health Council provides answers to questions about the risks of infectious diseases that can be transmitted from animals to humans (“zoonotic diseases”) and about the possibilities of reducing these risks. The report will serve as the basis for a European policy conference on 16 and 17 September 2004 during the Dutch presidency of the European Union: The European Response to Public Health Risks from Emerging Zoonotic Diseases. At the request of the Ministers, the Committee has consulted with the WHO about matters of substance. These consultations resulted in an international conference entitled WHO/FAO/OIE Joint Consultation on Emerging Zoonotic Diseases in Collaboration with the Health Council of the Netherlands, which took place in Geneva from 3 to 5 May 2004. A second component used as a basis for the advisory report is a background document produced by the Dutch National Institute for Public Health and the Environment (RIVM) containing data about zoonotic risks of significance for Europe.
As is already clear from the titles of the European policy conference and of the meeting in Geneva, emerging zoonotic diseases are the central focus of the advisory report: it is precisely these diseases that, because of their sudden emergence, constitute a threat to public health. An emerging zoonosis is a zoonosis that is newly recognized or newly evolved, or that has occurred previously but shows an increase in incidence or expansion in geographic, host or vector range. The advisory report addresses the following questions.
Which factors influence the emergence of zoonotic diseases?
The Committee explains that many risk factors are involved in the emergence of diseases of this kind: from ecological, demographic and technological developments to changing patterns of behaviour and political and social factors. Because these determinants are highly complex and variable, it is almost impossible to predict what the next outbreak of an infectious zoonotic disease will be and where exactly it will take place. Yet, the Committee concludes that due to the big political and economic changes Europe is a risk area.
Which emerging zoonotic diseases constitute the main risks for public health?
According to the Committee, RNA viruses are most likely to emerge, because it is these pathogens that are able to adapt rapidly to changing circumstances. The pathogens that constitute the most serious risks for public health are zoonotic viruses that can be transmitted from humans to humans, such as the agent of SARS and a possible new influenza virus.
How can the emergence of zoonotic diseases be prevented?
Primary prevention, in other words, preventing the emergence of zoonotic diseases, is only possible to a very limited extent because of the numerous factors involved in the process. Risk situations are, for example, farms with free-ranging poultry or with a range of domesticated livestock, and markets selling different live animals. Strict compliance with hygiene guidelines or regulations can reduce the risk of an outbreak in these circumstances. However, the Committee thinks it is preferable to pay more attention to rapid detection and response.
How can emerging zoonotic diseases be detected in good time?
The Committee briefly sketches how the detection in the Netherlands has been organised. It points out some relevant issues in this connection. A well-organised network of experts in both the medical and veterinary areas is of vital importance for the timely detection and identification of emerging zoonotic diseases. The quality of the network depends on the alertness of doctors and veterinaries (professional associations should encourage alertness through additional training), on the smooth communication of reports and signals (to local, national and international bodies) and on adequate laboratory capacity (in terms of both people and resources).
“Syndromic surveillance” (in which the focus is on categories of disease symptoms) is an important development for the early detection of an epidemic involving an unknown pathogen. This research field should be stimulated in the years to come.
What steps should be taken when bringing such zoonotic diseases under control?
There are scenarios and protocols containing instructions relating to surveillance, information exchange, interventions and communications. These arrangements have a monodisciplinary tendency, i.e. they pertain to either the medical or the veterinary sector. Collaboration between the medical and veterinary sectors clearly leaves something to be desired. When addressing the last two questions, the Committee makes a number of recommendations for improvement.
Which requirements should apply to communications?
Two issues are involved: on the one hand the information exchange between the different parties working in this field and on the other hand the information given to the public. When making procedural arrangements it would be advisable to involve representatives from all parties in this process as well as communications experts.
Communicating risks to the public should have two objectives: preventing excessive concern and encouraging desirable behaviour (compliance with hygiene regulations, for example).
Follow-up care for victims (for example, farmers who have lost their livestock) should also be included in preparatory plans.
To what extent should national arrangements relating to public and animal health be better coordinated?
The Committee is of the opinion that various administrative links need to be established in order to improve the effectiveness of the detection and control of emerging zoonotic diseases. This includes a periodical exchange of information between the medical and veterinary sectors.
The Minister of Health, Welfare and Sport has recently announced the establishment of a coordinating body which will be responsible in the Netherlands for, among other things, central control during outbreaks involving a widespread or acute threat to public health. No attention has yet been paid to the relationship between this body and organisations in the veterinary field. The Committee believes that clarity is required here.
To what extent is additional European policy required?
This lack of clarity in the Netherlands is, in a sense, reflected on the level of the European Community. There, the ECDC (European Centre for Disease Prevention and Control, which is active in the medical domain) and the EFSA (European Food and Safety Authority, which is active in the veterinary domain) will both be involved from 2005 onwards in the collection and analysis of data relating to zoonotic diseases in the member states. At present, the arrangements for collaboration between them are inadequate. The Committee believes that this problem should be dealt with as a priority.
The statutory powers for tracing and combating infectious diseases in humans reside with national governments. When transboundary outbreaks are involved, the ECDC does not have any mandate to override national authorities and ensure that there is a coordinated response on the Community level. Given European experience with SARS and avian influenza (when the steps taken by the EU were not very effective), the Committee is in favour of an arrangement in which the ECDC can provide more centralised control. This centre should therefore be given adequate resources for the specific deployment of laboratory capacity.
The Committee emphasises that better European coordination and harmonisation mechanisms are required but that they do not constitute a universal remedy. The infrastructure, including the knowledge infrastructure, for combating infectious diseases should also be stimulated. In addition, there is a demand for a multi-year Community research plan in the area of emerging zoonotic diseases.
Finally, improvement in the area of collaboration should not be confined to collaboration within the EU. The Union should also establish clear agreements with global organisations, and in particular with the WHO, FAO (Food and Agricultural Organisation) and OIE (Office International des Epizooties – World Organisation for Animal Health).
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