Communicable disease outbreaks involving more than one country: systems approach to evaluating the response

doi:10.1136/bmj.323.7317.861

BMJ 2001;323:861-863 ( 13 October )

Education and debate

Communicable disease outbreaks involving more than one country: systems approach to evaluating the response

Laura MacLehose, research fellow ^a, Helmut Brand, director ^b, Ivonne Camaroni, European Programme for Intervention Epidemiology Training fellow ^c, Naomi Fulop, senior lecturer, health services delivery and organisational research ^a, O Noel Gill, consultant epidemiologist ^d, Ralf Reintjes, consultant in communicable disease epidemiology ^b, Oliver Schaefer, specialist registrar in public health medicine ^a, Martin McKee, professor of European public health ^a, Julius Weinberg, provice chancellor (research) ^e.

^a London School of Hygiene and Tropical Medicine, London WC1E 7HT, ^b Institute of Public Health for North Rhine-Westfalia, Münster, Germany, ^c PHLS Communicable Disease Surveillance Centre, Cardiff CF4 3QX, ^d PHLS Communicable Disease Surveillance Centre, London NW9 5EQ, ^e City University, London EC1 0HV

Correspondence to: J Weinberg j.r.weinberg@city.ac.uk

The first 150 words of the full text of this article appear below.

	Introduction

The growth in international trade and travel has increased the likelihood that outbreaks of infection will involve more thanone country. The response to such an international epidemiologicalemergency is complex, involving national and international agencies.We evaluated responses to five outbreaks, with various transmissionroutes, involving more than one member state of the EU. We examinedthe complex nature of the collaboration required for an effectiveresponse and identified critical weaknesses in coordination, funding,and reporting.

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Methods

We studied five past outbreaks, selected primarily to capture different routes of disease transmission (table). We compiledthese case studies using various data sources.⁸ Over 50 semistructuredinterviews were undertaken to determine what happened, what shouldhave happened, why the difference, and what improvements couldbe made. Interviewees were selected through the relevant Europeandisease surveillance network(s), member states national communicabledisease surveillance centres, the World Health Organization, andthe Centers for Disease Control . . . [Full text of this article]

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