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MediPIET Modules 7 & 6, Cohort 2014-16 Page 1 of 9
Funded by the EU
MediPIET Diseases-Oriented
Training
Module 7: Food and Waterborne 18-20th April 2016
Module 6: Vectorborne and zoonosis 21-23rd April 2016
Athens, Greece
Implemented by the Consortium In collaboration with
Under the scientific leadership of
MediPIET Modules 7 & 6, Cohort 2014-16 Page 2 of 13
Background
The Mediterranean Program for Intervention Epidemiology Training (MediPIET) is a
sustainable training program in intervention epidemiology funded by the European
Commission and implemented by Spanish Consortium -National Public Health Institute
(ISCIII) and the International and Ibero-American Foundation for Administration and
Public Policies (FIIAPP)-, and under the scientific leadership of European Centre for
Disease Prevention and Control (ECDC). The purpose of the program is to consolidate
a competent workforce with the necessary competence in intervention epidemiology to
carry out essential public health functions for prevention and control of national and
cross-border challenges posed by communicable diseases (http://medipiet.eu/web/).
Title of the training module
Food, Waterborne, Vectorborne and zoonotic diseases
Dates, place and venue
18-23rd April 2016.
The training will take place at hotel Radisson Blue Park Athens, Greece
https://www.radissonblu.com/en/hotel-athens and on Thursday 21st April 2016, the
field exercise and laboratory demonstration will take place at the National Public Health
School of Greece.
Learning objectives
Learning objectives of each of the two modules included in this 6-days training, i.e module Module 7- Food and Waterborne diseases and Module 6- Vectorborne and zoonosis, and detailed contents of each section are provided in the next sections of the document.
Faculty
In collaboration with the Hellenic Center for Disease Prevention and Control, the Module
7 is coordinated by Kassiani Mellou, Head of Food and Waterborne diseases of the
Greek Center for Disease Control & Prevention and Module 6 is organized by Adela
Paez & Nikoletta Mavroeidi, MediPIET Scientific coordinators.
For this training, MediPIET mobilises the below listed group of experts, from both
participating countries and EU reference institutions, with large teaching and field
experience:
Kassiani Melou [email protected]
Angeliki Lambrou [email protected]
Adela Paez [email protected]
Nikoletta Mavroeidi [email protected]
Marie Belizaire Duvalsaint [email protected]
Ahmed Zaghloul [email protected]
Vinciane Sizaire [email protected]
Ettore Severi [email protected]
Kiki Trifinopolou [email protected]
MediPIET Modules 7 & 6, Cohort 2014-16 Page 3 of 13
Agoritsa Baka [email protected]
Danai Pervanidou [email protected]
Gordana Kuzmanovska [email protected]
Vesna Velikj Stefanovska [email protected]
Mohamed Kouni Chahed [email protected]
Laurence Marrama [email protected]
Paula Vasconcelos [email protected]
Javiera Rebolledo [email protected]
Mitra Drakulovic [email protected]
Takis Panagiotopoulous [email protected]
Elina Patsoula [email protected]
Evdokia Vassalou [email protected]
Gregory Spanakos [email protected]
Beleri Stavroula [email protected]
George Balatsos [email protected]
Antonios Michaelakis [email protected]
Target audience
Up to a total of 30 participants, expected attendees are:
MediPIET fellows from 2014-2016 Cohort Training Sites, i.e. Albania, fYROM, Lebanon, and Tunisia;
Public health epidemiologists and/or experts from related professions, who can participate in FWD and/or VBD outbreak investigations such as veterinarians, nominated by national authorities through the National MediPIET Committee from Albania, Algeria, Armenia, Bosnia & Herzegovina, Egypt, former Yugoslav Republic of Macedonia,Georgia, Israel, Kosovo 1 , Lebanon, Lybia, Jordan, Moldova, Montenegro, Morocco, Serbia, Palestine*, Tunisia, Turkey, Ukraine.
Pre-requisites
Since the course is intensive, a good command of the English language is essential. Also, it is required knowledge of:
- Principles of surveillance, - Outbreak investigation, - Epidemiological analytical methods, - Topics covered by, or participation in MediPIET Modules 1 (Introductory Course),
and 2 (Outbreak investigation tools).
Of note, the free software Epi Info 7™ will be used during the case studies in the afternoons. It can be download at the following link: http://www.cdc.gov/epiinfo/support/downloads.htm It is advised participants get familiar with this software before the start of the training.
1 This designation is without prejudice to positions on status, and is in line with UNSC 1244 and the ICJ
Opinion on the Kosovo Declaration of Independence.
*This designation shall not be construed as recognition of a State of Palestine and is without prejudice to
the individual positions of the Member States on this issue
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Expected participants
Fellows Cohort 1, 2014-2016
1. Ivana Capo ALBANIA [email protected]
2. Elona Kureta ALBANIA [email protected]
3. Vladimir Mikik FORMER YUGOSLAV REPUBLIC of MACEDONIA [email protected]
4. Kristina Stavridis FORMER YUGOSLAV REPUBLIC of MACEDONIA [email protected]
5. Hala Abou Naja LEBANON [email protected]
6. Nadine El Haddad LEBANON [email protected]
7. Hajer Letaief ép Mrad TUNISIA [email protected]
8. Salsabil Rejaibi TUNISIA [email protected]
External participants
9. Liana Torosyan ARMENIA [email protected]
10. Lusine Paronyan ARMENIA [email protected]
11. Semra Cavaljuga BOSNIA and HERZEGOVINA [email protected]
12. Alis Kozica BOSNIA and HERZEGOVINA [email protected]
13. Mai Arafa EGYPT [email protected] 14. Mohamed Nasr Gouda el-Sayed EGYPT [email protected]
15. Erjona Shakjiri FORMER YUGOSLAV REPUBLIC of MACEDONIA [email protected]
16. Irine Kalandadze GEORGIA [email protected]
17. Alina Pakhuridze GEORGIA [email protected]
18. Fatmire Kollçaku KOSOVO1 [email protected]
19. Shqipe Krasniqi KOSOVO1 [email protected]
20. Natalia Caterinciuc MOLDOVA [email protected]
21. Ion Birca MOLDOVA [email protected]
22. Maja Milanović-Menyhart MONTENEGRO [email protected]
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23. Darinka Brković (Marković) MONTENEGRO [email protected]
24. Shadi Adawi PALESTINE* [email protected]
25. Tareq Hawwash PALESTINE* [email protected]
26. Dragan Ilic SERBIA [email protected]
27. Slavica Maris SERBIA [email protected]
28. Oksana Tsyganchuk UKRAINE [email protected]
29. Oksana Artemchuk UKRAINE [email protected]
Participants from MediPIET observer countries
30. Rami Grifath ISRAEL [email protected]
31. Gamze Aktuna TURKEY [email protected]
Evaluator/Observer
Enver Roshi, Supervisor Albania
Schedule The schedule of the training is in the following page.
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Monday 18th Tuesday 19th Wednesday 20th Thursday 21st Friday 22nd Saturday 23rd
9:00-9:45
Welcome and Introduction to the
course [KASSIANI & ADELA]
5 mins. wrap-up 5mins. wrap-up
Introduction to VBD [LAURENCE MARRAMA]
5mins. wrap-up 5mins. wrap-up
Environmental methods [ANGELIKKI
LAMBROU]
International outbreaks [ETTORE
SEVERI]
Overview of zoonotic diseases [NIKOLETTA]
VBD Environmental/ entomological aspects
[ANTONIS MICHAELAKIS] One Health Approach
[JAVIERA REBOLLEDO]
9:45-10:30
FWD introduction [KASSIANI MELLOU]
PH response & preparedness in
foodborne diseases [NIKOLETTA]
Lessons learnt from international outbreaks [ETTORE]
WNV in Serbia [MITRA
DRAKULOVICH]
VBD preparedness: generics on simulation
exercises [PAULA VASCONCELOS]
Brucellosis in the Former Yugoslav Republic of Macedonia [VESNA
VELIJK]
10:30-11:00 Break Break Break Break Break Break
11:00-12:00
Investigation of foodborne outbreaks
[VESNA VELIKJ]
Investigation of waterborne outbreaks
[GORDANA KUZMANOVSKA ]
Hepatitis A outbreak in Scandinavian countries [ALL
FACILITATORS]
Outbreak investigation in VBD
[LAURENCE MARRAMA]
Leishmaniasis in Tunisia [MOHAMED]
Introduction to the exercise [PAULA]
Malaria in Greece [DANAI PERVANADIOU]
Working groups on simulation exercise – Session 1 [ALL]
12:00-13:00
Laboratory investigation [KIKI TRIFINOPOLOU]
PH response response &
preparedness in waterborne outbreaks [MOHAMED CHAHE]
Laboratory methods in VBD [ELINA PATSOULA, E. VASSALOU, G.
SPANAKOS]
From WNV to Zika: lessons learnt [TAKIS PANAGITOPOLOUS]
13:00-14:00 Lunch Lunch Lunch Lunch Lunch Lunch
14:00-15:15
Brucellosis outbreak in Thassos, Greece,
2008 [ALL FACILITATORS]
Waterborne outbreak in Greece, 2009 [ALL
FACILITATORS]
14.00-14.45 Hep A CS Group
presentations
Lab & field demonstration of larvae and adult mosquito sample [E.PATSOULA, B. STAVROULA, G.
BALATSOS ]
Case study West Nile Virus in Serbia [ALL
FACILITATORS]
Working groups on simulation exercise – Session 2 [ALL]
Break
15:15-15:45 Break Break FWB & VBD in the refugee settings in Greece [KASSIANI
& AGORITSA BAKA]
Break Break Break
15:45-17:00 Brucellosis outbreak
(cont.) [ALL] Waterborne outbreak
(cont.) [ALL]
Lab & field demonstration (cont.) [ALL]
Case study West Nile Virus in Serbia (cont.)
[ALL]
Plenary session [PAULA
VASCONCELOS]
Evaluation Evaluation & Closure
[ADELA]
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Module 7 Food and waterborne diseases, 18-20th April 2016
Athens, Greece
Course Program
About the course
(a) Learning objectives
At the end of the introductory course, participants will have and be able to:
Refreshed knowledge of food and waterborne (FWD) diseases epidemiology;
Apply principles of surveillance systems in human, vectors and animals;
Propose evidence based Public Health response;
Get acquainted with risk and impact communication;
Practice intersectoral collaboration;
Integrate aspects of emerging diseases and generic preparedness;
Exchange best practices to minimise negative health outcome of migration process among refugees and asylum seekers in the current crisis situation.
(b) Course format
Teaching will be through interactive lectures in the morning and practical sessions in the afternoon. Such practical sessions in small groups of 6-8 participants will use case studies, which will allow participants to explore how what they have learned in the lectures applies to real situations. These case studies will include use of Epi Info 7 software.
(c) Course content
DAY 1 - Monday 18 April 2016 Presentation 1. FWD introduction - KASSIANI MELLOU Content
- Basic terms – review - Surveillance of FWD - FWD epidemiology - Epidemiological data in the Mediterranean - priorities - Public health significance of FWD - burden - Diversity of investigation methods, prevention and control measures
Presentation 2: Investigation of foodborne outbreaks - VESNA VELIKJ Content
- Investigation – goals - Basic principles - Investigation methods (Ten steps) - Operational aspects of outbreak investigation - Examples of foodborne outbreaks
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- Response - Risk communication
Presentation 3: Laboratory investigation of FWD outbreaks (clinical and food samples) - KIKI TRIFINOPOLOU. Content:
- Appropriate collection of samples (clinical samples, food and water) and transportation
- Identification of aetiological agents - Antimicrobial resistance patterns - Molecular typing methods used in foodborne outbreak investigations - Microbiological cluster definition, epitypes - Interpretation of laboratory results - Data flow between laboratories and epidemiologists
Afternoon Case study: Outbreak investigation of brucellosis in Thassos, Greece, 2008 [1]. Learning Objectives: At the end of this exercise, the participants should be able to:
Apply principles of outbreak investigation in humans, food, and animals;
Construct an epidemic curve;
Interpret descriptive data;
Conduct univariate and multivariable analysis with the use of Epi Info 7;
Interpret results of univariate and multivariable analysis in a case control study;
List the environmental and laboratory investigations needed;
Discuss the risk of re-emergence of a brucellosis in an area under eradication;
Propose short-term and long-term public health action and preventive measures;
DAY 2 - Tuesday 19 April 2016 Presentation 1: Environmental methods & trace back methods - ANGELIKKI LAMBROU Content:
- Inspections of structural and operational hygiene in implicated food premises - Trace back and forward investigations - European legislation on traceability
Presentation 2: Preventive and control measures of foodborne outbreaks – NIKOLETTA MAVROEIDI Content:
- Prevention and control of foodborne outbreaks (“farm to fork” approach) - Preparedness issues - Intersectoral collaboration - Food safety - Implementation of HACCP
Presentation 3. Investigation of waterborne outbreaks - GORDANA KUZMANOVSKA
Content: - Investigation - goals - Investigation methods (Ten steps) - Operational aspects of outbreak investigation - Examples of different outbreaks
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- Risk communication Presentation 4. Preventive and control measures of waterborne outbreaks - MOHAMED CHAHE
- Water safety - Preventive and control measures for outbreaks due to drinking water (tap water,
well water, bottled water, contaminated water served as ice or in beverages, etc.) - Preventive and control measures for outbreaks due to recreational water
(swimming pools, interactive fountains, water slides, lakes, rivers, streams, hot springs etc.)
Afternoon Case study: A waterborne Campylobacter jejuni outbreak in Greece, 2009 [2].
Learning objectives: By the end of this case study, participants should be able to:
list the investigations needed in a waterborne outbreak;
describe the steps followed in an outbreak investigation;
undertake descriptive analysis and univariate analysis with Epi Info 7;
compute and interpret unadjusted odds ratios in a case-control study;
perform stratified analysis and identify effect modification and confounding;
compute and interpret stratum-specific and Mantel-Hänszel odds ratios;
list the most important measures required in the context of a waterborne outbreak.
DAY 3 - Wednesday 20 April 2016 Presentation 1. International outbreaks – ETTORE SEVERI
Content:
Definition of international outbreaks
Consequences (economic, political, etc.)
Coordination of investigation – difficulties – who is in charge
The role of different bodies in investigation of food-borne outbreaks and legal framework (WHO, DG SANTE, ECDC, EFSA)
International alert systems o International Health Regulation o INFOSAN o European alert systems (EWRS, RASSF, EPIS-FWD etc.)
Communication plan (type of information to be shared, by whom, how) Presentation 2. Examples of past international outbreaks and Lessons learned – ETTORE SEVERI
Content:
Multistate foodborne hepatitis A outbreak among European tourists returning from Egypt, November 2012 to April 2013 [3]
Multicountry outbreak of Salmonella Stanley infections associated with turkey meat in the European Union, 2012 -2015 [4]
Multicountry outbrek of Salmonella Chester ex Morocco, 2014-2015
Multi-country outbreak of Shiga toxin-producing Escherichia coli infection associated with haemolytic uraemic syndrome in Romania, 2016.
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Case-study: Outbreak with Hepatitis A virus in Scandinavian countries, 2013 [5,6]. Learning objectives: After completing the case study, participants should be able to critically examine:
Under which circumstances a cluster of patients constitutes an international outbreak;
Which international networks/institutions to alert in case of an international outbreak and when;
What are the main challenges you anticipate during investigation of an international outbreak and necessary steps to deal with them;
The value of performing an analytical epidemiological study when more than one countries are implicated in the outbreak;
What kind of measures should be taken and by whom. Presentation 3 and Plenary discussion: Implications for the epidemiological surveillance system of arrival of a sizeable migrant population: the experience of Greece. Foodborne and Vectorborne diseases – KASSIANI MELLOU & AGORITSA BAKA
Content:
what type of pathogens in general could we expect to cause outbreaks in the current migrant situation (foodborne and vectorborne diseases)
methodological and logistic aspects related to outbreak investigation in migrant populations,
the experience of Greece from surveillance and response to foodborne diseases (hep A, shigella)
the experience of Greece from surveillance and response to vectorborne diseases (malaria, leishmaniasis)
Last session: Course evaluation.
References
[1] Karagiannis I, et al. Outbreak investigation of brucellosis in Thassos, Greece, 2008. Euro Surveill. 2012 15;17(11). pii: 201
[2] Karagiannis I, Sideroglou T, Gkolfinopoulou K, Tsouri A, Lampousaki D, Velonakis EN, Scoulica EV, Mellou K, Panagiotopoulos T, Bonovas S. A waterborne Campylobacter jejuni outbreak on a Greek island. Epidemiol Infect. 2010;138(12):1726-1734.
[3] Sane J, et al. Multistate foodborne hepatitis A outbreak among European tourists returning from Egypt– need for reinforced vaccination recommendations, November 2012 to April 2013. Euro Surveill. 2015;20(4):pii=21018. Article DOI: http://dx.doi.org/10.2807/1560-7917 .ES2015.20.4.21018
[4] Kinross P, et al. Multidisciplinary investigation of a multicountry outbreak of Salmonella Stanley infections associated with turkey meat in the European Union, August 2011 to January 2013. Euro Surveill. 2014;19(19):pii=20801. Article DOI: http://dx.doi.org/10.2807/1560-7917.ES2014.19.19.20801.
[5] Nordic Outbreak Investigation Team C. Joint analysis by the Nordic countries of a hepatitis A outbreak, October 2012 to June 2013: frozen strawberries suspected. Euro Surveill. 2013 4;18(27). pii: 20520. Erratum in: Euro Surveill. 2013;18(30): pii: 20537.
[6] Gillesberg Lassen S, et al. Ongoing multi-strain food-borne hepatitis A outbreak with frozen berries as suspected vehicle: four Nordic countries affected, October 2012 to April 2013. Euro Surveill. 2013 25;18 (17):20467.
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Module 6 Vector borne diseases, 21-23 April 2016 Athens, Greece
Course Program
About the course
(a) Learning objectives
Refresh knowledge of epidemiology of vector borne diseases (VBD);
Understand the specificity of VBD outbreak investigations, and become familiar with methods complementary to epi investigations;
Gain knowledge in VBD surveillance (human and animal), including real time reporting, and in vector surveillance activities;
Become familiar with VBD risk assessment tools and VBD preparedness principles, stressing the importance of intersectoral collaboration;
Discuss implications for the epidemiological surveillance system and options to minimise negative health outcomes of migration process among refugees and asylum seekers.
(b) Course format Teaching will be through interactive lectures in the morning and practical sessions in the afternoon. Such practical sessions in small groups of 6-8 participants will use case studies, which will allow participants to explore how what they have learned in the lectures applies to real situations. These case studies will include use of Epi Info 7 software.
(c) Course content
DAY 1 - Thursday 21st April 2016
Lecture 1. Introduction to VBD – LAURENCE MARRAMA Content: What is important to know about VBD and vectors to handle VBD in outbreak investigation, surveillance and preparedness. Lecture 2. Outbreak of West Nile Virus in Serbia and implementation of surveillance, 2013 [1] – MITRA DRAKULOVICH Lecture 3. Specificities of VBD outbreak investigation - LAURENCE MARRAMA Content: Review of the ten steps of the outbreak investigations in the case of VBD, focusing on aspects of cases detection, appropriate collection of samples and transportation, specific protocols and data analysis. Lecture 4. Laboratory methods in VBD – ELINA PATSOULA, EDVOKIA VASSALOU & GREGORY SPANAKOS Afternoon Field Exercise: Laboratory and field demonstration of larvae and adult mosquito sample, National School of Public Health. ELINA PATSOULA, BELERI STAVROULA & GEORGE BALATSOS.
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Learning objectives:
Raise awareness about ecological and environmental issues for control of vectors;
Become familiar with the key aspects of sample larvae, pupae and adult mosquito sampling and transportation from natural habitats;
Understand purpose of the analysis carried out in the lab and interpretation of the results.
The participants will be divided in two groups and will alternatively participate in two sessions: one in the backyard of the school to understand sampling principles and another session in the lab for a practical demonstration.
DAY 2 - Friday 22nd April 2016
Lecture 1. Overview of zoonotic diseases. NIKOLETTA MAVROEIDI. Content: Content: review of zoonotic diseases, including outbreak investigation and human and animal surveillance.
Lecture 2. Intersectoral collaboration “One Health” approach. JAVIERA REBOLLEDO Lecture 3. Brucellosis in the Former Yugoslav Republic of Macedonia. VESNA VELIJK
Lecture 4. Cutaneous leishmaniasis surveillance and control activities in Tunisia [2]. MOHAMED CHAHE.
Lecture 5. Enhanced malaria surveillance activities in Greece [3]. DANAI PERNAVANADIOU. Lecture 6. From WNV to Zika virus: lessons learnt. TAKIS PANAGITOPOLOUS Afternoon Case-study: West Nile virus outbreak in Serbia, 2013. Learning objectives:
Understand the operational and epidemiological steps of an outbreak investigation of an emerging VBD,
Understand principles and steps to set up a surveillance system in an outbreak setting,
Develop a case definition for an emerging disease
Draw and interpret an epidemic curve & characterize an outbreak by time, place and person
Understand principles of mosquito based-surveillance and define mosquito-based indicators.
DAY 3 - Saturday 23rd April 2016
Lecture 1. Environmental / Entomological aspects in the control and prevention of VBDs. ANTONIS MICHAELAKIS. Content:
Ecological & environmental investigation in the framework of VBDs control and prevention;
Key aspects of mosquito sampling, transportation and laboratory investigation.
Entomological surveillance Lecture 2. VBD preparedness and available tools: generic principles and introduction to simulation exercises (SE). PAULA VASCONCELOS.
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Practical exercise: Exercise on preparedness and response: training approach to a discussion-based simulation exercise on VBD [4]. Learning objectives:
Apply principles of outbreak investigation & risk assessment to the current situation with zika epidemics
Propose public health action and preventive measures according to available evidence
Last session: Evaluation of the module (satisfaction survey) and Closure
References
[1] European Centre for Disease Prevention and Control. Guidelines for the surveillance of
invasive mosquitos in Europe [Internet]. Stockholm: ECDC; 2012. Available from:
http://ecdc.europa.eu/en/publications/Publications/TER-Mosquito-surveillance-
guidelines.pdf.
[2] World Health Organization. Vector surveillance and control [Internet]. Geneva: WHO; 2016
[cited 2016 29 March 2016]. Available from: http://www.euro.who.int/en/health-
topics/emergencies/microcephalyzikavirus/technical-reports-and-guidelines-on-zika-
virus/vector-surveillance-and-control.
[3] World Health Organization. Mosquito (vector) control emergency response and
preparedness for Zika virus [Internet]. Geneva: WHO; 2016 [updated 18 March 2016 ].
Available from:
http://www.who.int/neglected_diseases/news/mosquito_vector_control_response/en/ [4] Popović N, Milošević B, Urošević A, Poluga J, Lavadinović L, Nedelijković J, Jevtović D,
Dulović O. Outbreak of West Nile virus infection among humans in Serbia, August to October
2012. Euro Surveill. 2013 Oct 24;18(43). pii: 20613.
[5] Chraiet-Rezgani K, Bouafif-Ben Alaya N, Habboul Z, Hajjej Y, Aoun K. [Epidemiological
and clinical features of cutaneous leishmaniasis in Kairouan-Tunisia and characteristics in
children]. Bull Soc Pathol Exot. 2016 Feb 5.
[6] Tseroni M, Baka A, Kapizioni C et al.; MALWEST Project. Prevention of Malaria
Resurgence in Greece through the Association of Mass Drug Administration (MDA) to
Immigrants from Malaria-Endemic Regions and Standard Control Measures. PLoS Negl Trop
Dis. 2015 Nov 19;9 (11):e0004215. doi: 10.1371/journal.pntd.0004215.
[7] European Centre for Disease Prevention and Control. Zika virus disease epidemic:
Preparedness planning guide for diseases transmitted by Aedes aegypti and Aedes albopictus.
Stockholm: ECDC; 2016.
[8] European Centre for Disease Prevention and Control. Rapid Risk Assessment. Zika virus
disease epidemic: potential association with microcephaly and Guillain–Barré syndrome.
Second update, 8 February 2016. Stockholm: ECDC; 2016.
[9] European Centre for Disease Prevention and Control. Dengue outbreak in Madeira, Portugal,
March 2013.[Internet]. Stockholm: ECDC; 2014. Available from:
http://ecdc.europa.eu/en/publications/Publications/dengue-madeira-ECDC-mission-
2013.pdf. [10] Centers for Disease Control and Prevention. Interim CDC Recommendations for Zika Vector Control in the Continental United States [Internet]. Atlanta: CDC; 2016. Available from: http://www.cdc.gov/zika/publichealth-partners/vector-control-us.html.