ECDC MRSA molecular typing initiative: current status Daniel Palm European Centre for Disease Prevention and Control

EARS-Net network meeting, Stockholm, 13 February, 2015

1

Which diseases? Typing method?

Sampling method?

Public health value?

implementation processes

ECDC Roadmap for molecular surveillance implementation

(2012-2016)

ECDC typing activities

2

• Disease Network and Member States involvement in implementation process

• Advisory Forum gives go/no go signal for molecular surveillance strategy

• National Focal points for Surveillance review and give input to the business case

ECDC typing roadmap implementation process

Molecular surveillance

strategy Business case

System implementation

Routine use

3

ECDC molecular typing roadmap development and implementation Pathogens/ AMR

issue proposed for implementation

Typing method

EU public health objective/sampling design Disease specific roadmap step/year

Surveillance,

continuous

Surveillance,

prevalence

surveys

Multi-state

outbreak

investigation

Molecular

surveillanc

e strategy

Business

case

System

implem.

Routine

use from

Salmonella enterica PFGE, MLVA * * 2011 2012 2013 2014

Shiga-Toxin

producing E. coli

(STEC)

PFGE * * 2011 2012 2013 2014

Listeria

monocytogenes

PFGE * * 2011 2012 2013 2014

MDR

Mycobacterium

tuberculosis

MIRU-VNTR,

spoligotyping

* * 2012 2012 2013 2014

Influenza virus sequencing * 2014 2015 2016 2017

Human

Immunodeficiency

Virus (HIV)

sequencing * 2015 2016 2017 2018

Neisseria

meningitidis

sequencing * * 2014 2015 2016 2017

Legionella

pneumophila

sequencing * 2015 2016 2017 2018

Neisseria

gonorrhoeae/MDR

sequencing * 2014 2015 2016 2016

CPE sequencing * 2014 2015 2016 2017

MRSA sequencing * 2014 2015 2016 2017

4

ECDC molecular typing roadmap development and implementation Pathogens/ AMR

issue proposed for implementation

Typing method

EU public health objective/sampling design Disease specific roadmap step/year

Surveillance,

continuous

Surveillance,

prevalence

surveys

Multi-state

outbreak

investigation

Molecular

surveillanc

e strategy

Business

case

System

implem.

Routine

use from

Salmonella enterica PFGE, MLVA * * 2011 2012 2013 2014

Shiga-Toxin

producing E. coli

(STEC)

PFGE * * 2011 2012 2013 2014

Listeria

monocytogenes

PFGE * * 2011 2012 2013 2014

MDR

Mycobacterium

tuberculosis

MIRU-VNTR,

spoligotyping

* * 2012 2012 2013 2014

Influenza virus sequencing * 2014 2015 2016 2017

Human

Immunodeficiency

Virus (HIV)

sequencing * 2015 2016 2017 2018

Neisseria

meningitidis

sequencing * * 2014 2015 2016 2017

Legionella

pneumophila

sequencing * 2015 2016 2017 2018

Neisseria

gonorrhoeae/MDR

sequencing * 2014 2015 2016 2016

CPE sequencing * 2014 2015 2016 2017

MRSA sequencing * 2014 2015 2016 2017

5

MRSA typing plans: Current status

Strategy (2014):

• Refinement of specific objectives and public health benefits of molecular typing data integration

• Proposed typing method(s) and outline of surveillance design/sampling frame, analysis and reporting strategy suitable to the public health objectives

Business case (2015):

• Joint work between ECDC and network experts

• Planned to be presented for review and inputs by the National Surveillance Focal Points and National Microbiology Focal Points by end 2015

AF39-7 Strategic direction and plan for revision of the ECDC molecular surveillance roadmap

6

Objectives for MRSA typing

Objective EU level risk assessment

Potential risk management implication(s)

To inform about the

occurrence and dynamics of

“high-risk” MRSA clones of

critical public health

importance in Europe.

Detection and genotypic identification of high-risk clones

Monitoring pluri-annual trends in the frequency of occurrence of particular genotypes in the population and identification of high-prevalence human population groups

Identification of high-prevalence geographical areas associated with spreading of specific high-risk clones

Detection/delineation of cross-region or cross-border dissemination of high-risk clones between repeat surveys

Initiation, implementation, evaluation and/or revision of local, regional and national infection control and prevention programme.

Contribution to the impact evaluation of hospital and community antibiotic policies and stewardship programmes

7

Proposed structure of the repeated surveys

The study design follow the basic structure of previous surveys

• The proposed frequency of the structured surveys is every third year

• Isolates from in/out patients from any clinical isolate

• 10 isolates of MRSA from consecutive patients per participating hospital/laboratory and pre-defined sampling period (six months)

• Genotypic characterisation: Whole genome sequence

8

The molecular typing business case

• Performance indicators

• Verification of the molecular typing method(s) applied, including current capacities in the Member States

• Resources including the need for TESSy update

• External quality assessments, training and other technical support

• Collaborative agreement to ensure protection of data privacy, intellectual ownership and data access rules in accordance with ethical and legal requirements

9

Next steps

• Development of the MRSA/CPE molecular typing business cases part of the 2015 ECDC work plan

• Continued collaboration with network experts in the development of the business case needed. Concrete steps yet to be defined.

• Target: Business case finalized in 2015

• Implementation and setting up infrastructure

• First survey in the new system planned for 2016/2017

10

Acknowledgements

Expert consultation group

Amos Adler, Arjana Tambić Andrašević, Christian Giske, Youri Glupczynski, Hajo Grundmann, Radoslaw Izdebski, Vincent Jarlier, Barry Kreiswirth, Frederic Laurent, Alkis Vatopoulos, Rumyana Markovska, Helena Žemlicková, Robert Skov, Jari Jalava, Dag Harmsen, Harald Seifert, Annalisa Pantosti, Arta Balode, Rafael Canton, Angela Kearns, Ed Feil

ECDC

Marc Struelens, Polya Rosin, Barbara Albiger, Liselotte Diaz Högberg, Ole Heuer, Dominique Monnet, Karin Johansson

Microbiology and Surveillance Steering Committee members