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European outbreaks primarily driven by travel, tourism
A recently published analysis of European outbreaks suggests travel and tourism are the greatest influences on infectious disease events occurring in this region.
Other leading outbreak drivers included food and water quality, the natural environment, global trade and climate, according to the report.
“The context of infectious disease emergence has changed over the centuries, but Europe has remained and even intensified as a hot spot for emerging infectious diseases over recent decades,” the researchers wrote. “The effect of [infectious disease threat events] on public health can be attenuated by strengthening the detection of and early response to the threats. However, more important, the likelihood of [infectious disease threat events] originating in the first place can be reduced by intervening directly on their underlying drivers.”
To identify these, the researchers evaluated outbreaks detected within the European Union by the European Centre for Disease Prevention and Control (ECDC) between July 2008 and Dec. 31, 2013. Infectious disease threat events (IDTEs) examined in the study were those affecting more than five persons living in the EU, and included events in which a person was infected while abroad and returned with illness. After collecting information about these outbreaks from various sources, each EDTE was categorized by its individual driving influence into one of three major groups: globalization and environment, sociodemographics and public health system failure. These events and driver categories — which were initially outlined by the ECDC in 2008 — were evaluated for quality and subjected to descriptive analyses, which included frequency rates, ranking and Euclidian distance assessment.
There were 116 IDTEs during the study period that met the researchers’ inclusion criteria. Among these, foodborne and waterborne events were the most frequent (n = 48), and were followed by vector-borne and rodent-borne IDTEs (n = 27), airborne IDTEs (n = 10) and vaccine-preventable IDTEs (n = 10).
Although approximately three-quarters of IDTEs were placed in multiple-driver categories, single-driver IDTEs most often fell into the globalization and environment driver category (61%), with fewer attributed to public health system failure (21%) or sociodemographic factors (18%). Frequency ranking of all events found the five leading drivers of outbreaks, in order, to be travel and tourism, food and water quality, the natural environment, global trade and climate. Hierarchical cluster analysis also found travel and tourism to follow a different distribution pattern than other outbreak clusters, whereas climate and the environment, as well as migration and social inequality, were considered to be related.
Although these findings provide an “early warning system” that could accelerate public health’s response to outbreaks, the researchers wrote, pre-emptive action in these areas could prevent their emergence altogether.
“Thus, the most cost-effective strategy would be to directly tackle the underlying drivers of an IDTE rather than deal with the actual IDTE after the fact,” they wrote. “Intervening directly on drivers may prevent the occurrence of IDTEs and reduce the human and economic cost associated with IDTEs.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.