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29 Nov 2002

Source: Catchpole M, Moren A. Correspondence -- Responses to Bioterrorism. The Lancet 358 (9296), December 1, 2001.

Sir--Bioterrorist events in the USA since Sept 11, 2001, and the threat of such events in Europe have highlighted the need for national and international preparedness to be able to respond to deliberate releases of biological agents.

An essential part of the response capacity to such events is to have available experts on the clinical and laboratory features of control and prevention of biological agents, and epidemiologists with expertise in the public-health features of the rapid investigation and control of environmental hazards.

Within 24 h of the attack on the World Trade Center in New York, the US Centers for Disease Control and Prevention deployed 25 epidemiologists from their Epidemiology Intelligence Service (EIS) training programme into New York. Since then, more than 100 of the 160 current EIS officers have been sent to investigate related bioterrorism threats in and beyond the USA. The ability to draw on such resources at short notice would be vital to the rapid assessment and containment of a substantial environmental release of a biological agent in Europe.

In the USA, the EIS programme, which is funded by the US federal government, has ensured the availability of this response capacity for the past 50 years; currently the EIS programme produces 50-80 trained epidemiologists every year and close to 2500 have been trained since 1951. Since 1995, the European Programme of Intervention Epidemiology Training (EPIET) has provided similar training for public-health professionals working in the European Union and Norway. At present, however, EPIET only produces eight trained professionals each year, and the European Commission, which is the programme's main funding agency, is questioning whether it will continue to fund the salaries of the fellows taking part in the 2-year programme.

At a time when epidemiology skills are at a premium, and the need to be able to pull together a response team from across the continent that can work together in response to a major release, increased investment in EPIET and related national training programmes would seem an obvious way of ensuring the future response capacity of Europe to bioterrorist attack.

At a more prosaic level, the EPIET programme has already provided Europe with an increased capability to investigate and control communicable disease threats1-5 within and without its borders, and is reducing inequalities between European Union member states in health-protection capacity. The usefulness of investment in such training has been recognised for many years in the USA. It is time that those who are mandated to develop the health-protection agenda at the European level also recognise this usefulness and place what has been one of the most successful, albeit limited, collaborative programmes in Europe on a sounder financial footing, along with other necessary developments, to strengthen and coordinate the European Unity capacity of response to public-health threats.

*Mike Catchpole, Alain Moren, on behalf of the EPIET Steering Committee

*Public Health Laboratory Service, London NW9 5EQ, UK; and Institut de Veille Sanitaire, F-94414 Saint Maurice, Paris, France


1 Crowcroft NS, Infuso A, Ilef D, LeGuenno B. Risk factors for human hantavirus infection: the first Franco-Belgian collaborative case-control study during the 1995/6 epidemic. BMJ 1999; 318: 1737-38.

2 Pebody RG, Furtado C, Rojas A, et al. An international outbreak of Vero cytotoxin-producing E coli 0157 infection amongst tourists: a challenge for the European infectious disease surveillance network.  Epidemiol Infect 1999; 123: 217-23.

3 Valenciano M, Baron S, Frish A, Desenclos JC. An investigation of concurrent outbreaks of gastro-enteritis and typhoid fever following a party on a floating restaurant, France, March 1998.  Am J Epidemiol 2000; 152: 597-606. 

4 Hutin YJ, Williams RJ, Malfait P, et al. Outbreak of human monkeypox, Democratic Republic of Congo, 1996 to 1997.  Emerg Infect Dis 2001; 7: 434-38. 

5 Hahné S, Aguilera JF, Henderson B, Ramsay M. Meningococcal infection in pilgrims returning from the 2001 Muslim pilgrimage in Mecca (the haj). Eurosurveillance Wkly 2001; 5: 010322.