Operations on the ECDC/WHO
joint TB information system
Annual Meeting on TB Surveillance in Europe
Dubrovnik, Croatia; 25 - 26 May 2009
Andrei Dadu
Communicable Diseases Unit,
WHO Regional Office for Europe
Conceptual aspects
ƒ
Keep the geographic coverage of the System avoiding efforts duplication
ƒ
Simplify the data base content and keep it historically consistent (core
components: TB cases and programme data)
ƒ
Member States are the data owners
ƒ
Collaboration between ECDC and WHO to ensure the Executive of the joint
surveillance System
ƒ
Standardize the data management by ensuring of unique case definition (at
least not mutual exclusive)
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
25 - 26 May 2009
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European
Joint TB information system
ƒ The joint TB IS database is jointly hosted by
ECDC and WHO/EURO:
– EU countries are able to upload their:
• case management data via TESSy
• programme management data via CISID
– Non-EU countries are reporting all data via CISID
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
25 - 26 May 2009
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Country participation on data
reporting, EUR, 2008
52 out of 53+1
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
25 - 26 May 2009
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Framework of collaboration
with MS
ƒ The Network (members states)
– EU/EEA and EFTA: country TB contact point
• Epi
• Lab
– Non-EU: TB surveillance national correspondents
ƒ The Network executive and coordination:
– ECDC and
– WHO
ƒ Executive advisory:
– discuss and advise ECDC and WHO on any technical,
epidemiological and other scientific aspects of TB surveillance
that will enable the network to develop further and improve its
effectiveness and added value
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
25 - 26 May 2009
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Data processing tools
ƒ Joint website www.ecdcwhosurveillance.org
ƒ TESSy - The European surveillance system
(TUB specific component)
ƒ CISID the Centralized Information System
for Infectious Diseases (TUB specific
component)
ƒ TB data questionnaire (optional)
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
25 - 26 May 2009
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TB Data
53+1 MS of the Region
ECDC-WHO/EURO
‘joint web website’
http://www.ecdcwhosurveillance.org
WHO/EURO
validation of
non-EU/EEA/EFTA
countries data
Common rules for validation
Data bases
synchronization
CISID
ECDC
TB experts
Validated TB data in
joint ECDC/WHO database
ECDC
validation of
EU/EEA/EFTA
countries data
TESSy
WHO/Europe
TB experts
Common
Rules for
Access &
Data Use
53 TB national contact points
Annual
Report
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
Website reports
and information
25 - 26 May 2009
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Data processing
For EU/EEA & EFTA, submission of
TB notification
Country
1
correspondent
Log in
www.ecdcwhosurveillance.org
2
4
For all 53 (except step 2),
submission of all data
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
Public
users
TESSy
3
3
TESSy data push out
Aggregated data extraction
from individualized data set
CISID data push out
Public
users
Log in
25 - 26 May 2009
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Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
25 - 26 May 2009
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Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
25 - 26 May 2009
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Username/password (i.e. RUS-TUB / rustbrustbrustb)
• defined by CISID manager
• based on the country name (ISO3) and module name
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
25 - 26 May 2009
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Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
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Content of the Joint TB IS, since 2009
Countries data reporting workload
according
• High incident (-60%)
• Low incidence (-80%)
From EU via TESSy:
• with case based data,
then
& XDR-TB
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
25 - 26 May 2009
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MDR-TB prevalence, EUR,
2007
high sensitivity vs. low specificity
Estimated, among new – 10.35% (43 600)
Estimated, among re‐treatment
– 43,41%
Notified, among new Notified, among re‐treatment
– 9,59 % (7 351)
– 38,55 % Detection rate, new
‐ 17%
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
25 - 26 May 2009
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Can we trust DRS data?
CHALLENGES
SOLUTION
COMMENT/IMPLICATION
EQA, international:
ƒ EUR: 36 out of 53
ƒ EU: 21 out of 24
ƒ Balkans: 2 out of 6
ƒ 18 EEUR: 11 out of 18
Acting via EUR and EU lab
strengthening task-forces
Coverage, country-wide
ƒ EUR: 34 out of 53
ƒ 18 EEUR: 7 out of 18
ƒ Expending DST network
with keeping QA at high level
and then integrate DRS into
routine TB surveillance
ƒ Providing DRS surveys or
establishing ongoing DRS
sentinel surveillance
Duplication of MDR-TB data
collection at supra-national
level
Merging the existing tools
TESSy/DRS.QES to => CISID
XDR-TB surveillance
Expanding the existing tools
and make them more specific
TESSy <=> CISID
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
Cooperate with:
ƒ EUR lab task-force,
ƒ countries NRL
ƒ technical agencies
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DRS integration into the System
Include DRS
questionnaire
questions
(sections A&B)
that are
missing in
CISID
From all MS
via CISID
From EU via TESSy:
• with case based data,
then
• aggregated into CISID
From non-EU via CISID
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
& XDR-TB
25 - 26 May 2009
Expend CISID
with content
from DRS
questionnaire,
section “TT
status” and ad
2nd line drugs 16
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Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
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HIV prevalence among new
TB cases, EUR, 2007
low sensitivity & low specificity
Estimated, among new Notified, among new Detection rate
– 9.8 % (42.322)
– 4.0 % (6.710)
‐ 16 %
Compared to previous year: less tests ‐ more cases
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
25 - 26 May 2009
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Challenges of HIV-TB data
collection?
CHALLENGES
SOLUTION
Low country response rate
to TB/HIV co-infection
surveillance:
ƒ country legislation
ƒ infrastructure challenges
(unlinked HIV databases)
ƒ no or poor collaborative
data management
Exclude/keep the section of
TB care among PLWHA
from CISID
Duplication of HIV-TB data
collection at supra-national
level
Extract data from HIV data
bases
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
Emphasize data collection
on TB case finding among
PLWHA
COMMENT/IMPLICATION
ƒHIV finding among TB
ƒCPT
ƒARV
ƒTB finding among PLWHA
ƒIPT
ƒARV
TESSy/HIV => CISID/TB
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Expectation from 2008 data
collection & analysis
ƒ Data with standardized case definition used throughout
the Region or SOPs for data reading;
ƒ Integrated approach on TB data collection at the
Regional level (formats, channels/tools, responsibilities);
ƒ An increased response rate and better data quality.
for
ƒ emphasising the use of cohort analysis for treatment
outcome monitoring;
ƒ developing a better insight into the TB/HIV co-epidemic;
ƒ conducting careful assessments of prevalence and
trends of MDR-TB at country and regional level.
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
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Helpdesks at your service
ƒ ECDC/SUN/TUB
ƒ ECDC/SUN/TESSy
ƒ Tel. No: +46 (85) 8601601
ƒ Email: [email protected]
ƒ Skype: TESSyHelpdesk
Annual Meeting on TB Surveillance in Europe, Dubrovnik, Croatia
ƒ WHO/SAM/TUB
ƒ WHO/SAM/CISID
ƒ Tel. No: +45 (39) 171418
ƒ Email: [email protected]
[email protected]
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