Systemic resilience to cross-border infectious disease threat events in Europe
Systemic resilience to cross-border infectious disease threat events in Europe
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DOI：
10.1111/tbed.13211
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发表时间：
2019-09-01
影响因子：
4.3
通讯作者：
Rocklov, Joacim
中科院分区：
文献类型：
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作者：
Semenza, Jan C.;Sewe, Maquines Odhiambo;Rocklov, Joacim
反复出现的突发卫生事件威胁着全球卫生安全。《国际卫生条例》旨在通过提高国家公共卫生核心能力来预防、发现和应对此类威胁，但《国际卫生条例》核心能力的实施是否必要和充分一直存在争议。通过一项纵向研究，我们将2010年至2016年期间国家《国际卫生条例》核心能力的变化与跨境传染病威胁事件（IDTE）的变化联系起来，这些变化是通过欧洲疾病预防和控制中心（ECDC）的流行病情报收集的。通过将所有《国际卫生条例》核心能力合并为一项综合措施，我们发现，该综合《国际卫生条例》核心能力的平均值每增加10%，欧盟跨境IDTE发病率就会下降19% （p = 0.017）。就具体的《国际卫生条例》核心能力而言，个别增加国家立法、政策和融资；与有关部门协调沟通；监测;反应;准备;风险沟通;人力资源能力；或实验室能力与跨境IDTE发病率的显著降低有关。相比之下，我们的分析表明，在欧盟，与入境点、人畜共患事件或食品安全有关的《国际卫生条例》核心能力与IDTE无关。由于核心容量之间的高度内部相关性，我们进行了主成分分析，证实核心容量评分每增加10%，IDTE风险降低20% （95% CI: 0.73, 0.88）。在全球范围内（欧盟除外），所有《国际卫生条例》核心能力的平均值每增加10%，跨境IDTE发病率就会下降14% （p = 0.077）。我们提供的定量证据表明，国家层面《国际卫生条例》核心能力的改善与欧盟跨境IDTE的减少有关，这可能也适用于世界其他地区。
Recurrent health emergencies threaten global health security. International Health Regulations (IHR) aim to prevent, detect and respond to such threats, through increase in national public health core capacities, but whether IHR core capacity implementation is necessary and sufficient has been contested. With a longitudinal study we relate changes in national IHR core capacities to changes in cross-border infectious disease threat events (IDTE) between 2010 and 2016, collected through epidemic intelligence at the European Centre for Disease Prevention and Control (ECDC). By combining all IHR core capacities into one composite measure we found that a 10% increase in the mean of this composite IHR core capacity to be associated with a 19% decrease (p = 0.017) in the incidence of cross-border IDTE in the EU. With respect to specific IHR core capacities, an individual increase in national legislation, policy & financing; coordination and communication with relevant sectors; surveillance; response; preparedness; risk communication; human resource capacity; or laboratory capacity was associated with a significant decrease in cross-border IDTE incidence. In contrast, our analysis showed that IHR core capacities relating to point-of-entry, zoonotic events or food safety were not associated with IDTE in the EU. Due to high internal correlations between core capacities, we conducted a principal component analysis which confirmed a 20% decrease in risk of IDTE for every 10% increase in the core capacity score (95% CI: 0.73, 0.88). Globally (EU excluded), a 10% increase in the mean of all IHR core capacities combined was associated with a 14% decrease (p = 0.077) in cross-border IDTE incidence. We provide quantitative evidence that improvements in IHR core capacities at country-level are associated with fewer cross-border IDTE in the EU, which may also hold true for other parts of the world.