The ethics of PH surveillance

Public health officials regularly collect and analyse data to map disease, spot patterns, identify causes and respond to outbreaks. Surveillance, when conducted ethically, is the foundation for programs to promote human well-being at the population level and can contribute to reducing inequalities.

However, it is not without risks for participants and sometimes poses ethical dilemmas. It can lead to harm if people’s privacy is violated, or they are stigmatized on the basis of the information they provide about themselves.

The WHO have produced Guidelines on Ethical Issues in Public Health Surveillance – the first international framework of its kind. It outlines 17 ethical guidelines that can assist everyone involved in public health surveillance, including officials in government agencies, health workers, NGOs and the private sector.

To read the Guidelines on Ethical Issues in Public Health Surveillance

EU rules on medical devices

The EU has produced new rules on medical devices to enhance patient safety and modernise public health.

There are over 500,000 types of medical devices and in-vitro diagnostic medical devices on the EU market. Examples of medical devices are contact lenses, x-ray machines, pacemakers, breast implants and hip replacements and sticking plasters. In vitro diagnostic medical devices, which are used to perform tests on samples, include HIV blood tests, pregnancy tests and blood sugar monitoring systems for diabetics.

The new Regulations will help to ensure that all medical devices – from heart valves to sticking plasters to artificial hips – are safe and perform well. The new rules will improve market surveillance and traceability as well as make sure that all medical and in vitro diagnostic devices are designed to reflect the latest scientific and technological state-of-the art. The rules will also provide more transparency and legal certainty for producers, manufacturers and importers and help to strengthen international competitiveness and innovation in this strategic sector.

For more information on the new rules about medical devices on the europa.eu website

Measles outbreaks across Europe

Over 500 measles cases were reported for January 2017 in Europe with 85% of them coming from 7 of the 14 endemic countries (France, Germany, Italy, Poland, Romania, Switzerland and Ukraine). Measles continues to spread within and among European countries, with the potential to cause large outbreaks wherever immunization coverage has dropped below the necessary threshold of 95%.

As the WHO Regional Director for Europe pointed out:   “Today’s travel patterns put no person or country beyond the reach of the measles virus. Outbreaks will continue in Europe, as elsewhere, until every country reaches the level of immunization needed to fully protect their populations.”

Preliminary information for February indicates that the number of new infections is sharply rising. In all of the countries listed above, estimated national immunization coverage with the second dose of measles-containing vaccine is less than the 95% threshold.

For more information about measles in Europe from the euro.who.int website

Risk assessment in the EU

The EU has produced an infographic to show how the EU’s Scientific Committees assess risks. It not only shows in a clear and concise way how the Committees function but also provides concrete examples of how their work impacts EU legislation.
To download the infographic on Risk Assessment from the ec.europa.eu website

Pharmacovigilance

All medicinal products in the EU are subject to a strict testing and assessment of their quality, efficacy and safety before being authorised. Once placed on the market they continue to be monitored to ensure that any aspect which could impact the safety profile of a medicine is detected and assessed and that necessary measures are taken. This monitoring is called pharmacovigilance.

Pharmacovigilance activities include:

  • Collecting and managing data on the safety of medicines.
  • Looking at the data to detect “signals” (any new or changing safety issue).
  • Evaluating the data and making decisions with regard to safety issues.
  • Pro-active risk management to minimise any potential risk associated with the use of the medicine.
  • Acting to protect public health (including regulatory action).
  • Communicating with and informing stakeholders and the public.
  • Audit, both of the outcomes of action taken and of the key processes involved.

For more information about pharmacovigilance on the ec.europa.eu website

Resistant bacteria spreading in hospitals across Europe

Antibiotic resistance is widespread across the whole of Europe. High resistance, often seen in the southern and eastern countries of the European Union, is also found in the eastern part of the European Region. In particular, resistant bacteria are spreading in hospitals and health care settings, putting patients at risk of contracting incurable diseases. This is the concerning picture painted by the second Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR) report, published by WHO.

The aim of the report is to provide guidance and inspiration to countries that are building or strengthening their national AMR surveillance and to stimulate the sharing of data internationally. 19 non-EU countries are engaged in CAESAR (Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, the Republic of Moldova, the Russian Federation, Serbia, Switzerland, Tajikistan, the former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Ukraine, Uzbekistan.)

More information about Anti-Microbial Resistance in Europe on the euro.who.int website

Toxoplasmosis: greater awareness needed

Toxoplasmosis, caused by the parasite Toxoplasma gondii, is estimated to affect more than 2 million people every year in the European Region. Although most people do not have symptoms, if a woman becomes infected just before or early in her pregnancy, it can have very serious health consequences for her child.

Toxoplasma can be acquired trans-placentally (mother to baby), through contact with infected soil or water, ingestion of contaminated food, or in very rare cases through blood/organ donation. It is assumed that half the cases come from eating contaminated food, such as inadequately cooked animal meat, or raw fruits and vegetables. Infection can also occur through contact with cat faeces in the environment, but cats only shed oocysts for a few weeks of their life, usually when kittens. Cats play an important role in the life cycle of the parasite, but they are not the main vehicle of infection.

To prevent food-borne toxoplasmosis, hand-washing and the use of clean water in food production and preparation is critical. Pregnant women should avoid undercooked meat. Fruits and vegetables should be thoroughly washed with clean water.

For more information about Toxoplasmosis on the euro.who.int website

Water, sanitation and health

14 people die every day in the pan-European region, due to inadequate water, sanitation and hygiene.

In response a Protocol on Water and Health has been developed which urges an holistic approach to water, sanitation and health, enabling countries to use the Protocol as a tool to implement Strategic Development Goals SDG) at national levels. Through improving their water, health and environmental situations, countries also support and reinforce the benefits to many other areas of development. This creates positive, interlinked and mutually supportive outcomes that reduce poverty, address inequality and promote sustainability – all of which are overarching themes of the SDGs.

More information about the Protocol on Water and Health on the euro.who.int website

European Knowledge Hub on Health and Migration

Although the number of refugee and migrant arrivals has seen an overall reduction in recent months, migration to Europe continues at a steady rate. In 2016 more than 330,000 refugees and migrants reached Italy and Greece with over 4,200 being found dead or reported missing at sea, compared to 3,771 in 2015.

The health systems in countries receiving refugees and migrants should be able to deal with the immediate health needs of new arrivals, as well as diagnose and treat common infectious diseases and noncommunicable illnesses. They should have effective disease surveillance and reporting systems in place to investigate and respond to outbreaks.

WHO has launched the first ever European Knowledge Hub on Health and Migration to support the work of those who deal directly with the health aspects of migration, serving as a repository for scientific evidence on the subject. It will act as a learning platform for all stakeholders working in the field of migration and health, including policy-makers, health professionals, social workers, managers of migration centres and first-line responders.

More information about Migrants and Health on the euro.who.int website

Tracing donated tissue and cells

The EU has recently launched a Coding Platform to support healthcare professionals and national authorities in tracing donated tissues and cells from donor to recipient in the entire EU. The EU Directive on standards for quality and safety of human tissues and cells sets standards for tissues and cells such as bone marrow, reproductive cells, corneas, skin, etc., that are used within the EU and which will be identified by a Single European Code (SEC).

This SEC is an important tool for better patient safety as it enables the tracing of tissues and cells along the supply chain – from the donor to the patient receiving it. In case of a quality or safety issue, it allows appropriate action, including – where necessary, withdrawing or recalling all tissues and cells from the same donor, to be taken quickly. The EU Coding Platform contains information on all 2800 tissue establishments authorised in the EU as well as categories of tissue and cell product codes. It provides users with a free, simple and efficient tool, to build their SEC for a tissues and cells product, and takes into account the needs of small-sized and not-for-profit tissue establishments.

For more information about the Single European Code on the webgate.ec.europa.eu website