The Joint Action EMERGE is working to deliver an efficient response to emerging and high-threat pathogens at the EU level, as Roland Grunow, of the Robert Koch Institute’s Centre for Biological Threats and Special Pathogens, explains.
No one would question the need to improve preparedness and responsiveness against outbreaks of highly infectious bacteria or viruses, even if it is unpredictable where and when an outbreak – natural or intentional – might occur. As shown by recent outbreaks in Africa, two extremely contagious diseases, Ebola and plague, clearly had the potential of being imported into Europe. The preparedness and responsiveness against such diseases is complex and involves many aspects of the International Health Regulations (2005). The need for an efficient, rapid and co-ordinated response to serious cross-border health threats is defined in the European policy: Decision No 1082/2013/EU.1 Based on the possible risk of such an event, the European Commission has been funding initiatives to improve European capacities for diagnostics and outbreak management regarding high-threat pathogens over several years.2 One of these initiatives started as a laboratory consortium uniting two well-established EU-funded networks of high containment biosafety level (BSL) 3 and BSL 4 laboratories.
EMERGE – Efficient response to highly dangerous and emerging pathogens at EU level
The Joint Action EMERGE is co-funded by the European Commission within the framework of the Third EU Health Programme (2014-2020) and by member states to enable an efficient response to serious emerging and re-emerging infectious diseases with cross-border outbreak potential.3 All partners have been officially nominated by the EU member states. They represent highly specialised laboratories focusing on the identification of the most dangerous bacteria and viruses classified into the highest risk groups of infectious agents known today (risk groups 3 and 4). Besides the aim to maintain and improve their high diagnostic standard by performing external quality assurance exercises and training courses and sharing best practices,4 an important aim is the linking-up with other relevant networks and key players to strengthen interoperability in outbreak situations.
EMERGE comprises about 40 partner laboratories in 22 EU member states and two EEA/EFTA states. The project is designed for two action modes: the ‘inter-epidemic mode’ (IEM) and the ‘outbreak response mode’ (ORM). Currently, all work packages are run in the IEM aiming to reach the best possible preparedness of all participating countries and to allow a smooth co-operation with other relevant networks. In the event of need, the EMERGE network will be switched from IEM to ORM, according to a detailed plan for transition, directing all activities towards the laboratory management of cross-border outbreaks caused by high-threat pathogens. This transition plan has been agreed with the European Commission’s Directorate General for Health and Food Safety (DG SANTE) and the European Centre for Disease Prevention and Control (ECDC). If no outbreak occurs and the acute activation of the network will not take place, a simulation exercise is planned, starting with consultations and ending in a concerted transnational interaction between partner laboratories. As in a real emergency event, the network aims to identify the causative agent and to develop diagnostic capacities and set recommendations on collection, transport of samples, and support for the laboratory clinical management together with other key stakeholders to provide a co-ordinated response.
To ensure high-level laboratory diagnostics, external quality assurance exercises are performed regularly and best practices are shared. A precondition for all participating laboratories is to certify a well-functioning bio-risk management system of high-containment facilities by completing the ECL checklist.4 Target agents to be diagnosed during these exercises are selected according to a systematic assessment of recent health threats caused by risk group 3 bacteria (e.g. causing anthrax or plague) and risk group 4 viruses (e.g. causing Ebola or Lassa5). The participating laboratories are provided with individual recommendations for improvement based on the results they achieved and are enabled to improve their detection methodologies and response capabilities, if needed.
To work on crucial diagnostic aspects more profoundly, three thematic working groups have been set up:
- Metagenomics, evaluating possibilities to include genome analyses in diagnostics and characterisation of highly pathogenic micro-organisms (e.g. testing of DNA extraction kits, processes of library constructions, quality assurance of procedures and data mining);
- Detection methods suitable for risk group 4 viruses under special consideration of their high contagiousness (e.g. testing, evaluation, development of commercial detection kits, sharing and comparison of in-house tests, inactivation procedures); and
- Antimicrobial susceptibility testing of risk group 3 bacteria, due to lacking standards for these highly pathogenic microbes in Europe (e.g. development of standard operational procedures, determination of breakpoints).
All activities described above are supported and complemented by a customised training programme which is regularly adapted depending on the partners’ capabilities, methodologies and type of laboratory facilities.
Achievements and future outlook
A survey recently circulated among the EMERGE partners confirmed a broad scope of fundamental benefits gained from participating in the joint action.
To date, the EMERGE network has actively contributed to laboratory management of Lassa fever in 2016, especially in cases imported into Europe, to Ebola virus diagnostics in West Africa in 2013-2016, and to diagnostic preparedness against Yersinia pestis in Europe during the plague outbreak in Madagascar in 2017.
The strengthening of the European laboratory preparedness for high-consequence pathogens will be continued in the framework of a new joint action presumably starting at the end of 2018.
We would like to thank the European Commission’s Consumers, Health, Agriculture and Food Executive Agency (Chafea) and the European Commission’s Directorate General For Health and Food Safety (DG SANTE) for co-funding and constantly supporting the Joint Action EMERGE in any possible way. We are also very grateful to the Advisory Board for providing their expertise and advice to the consortium. And, of course, we would like to thank all EMERGE partners, especially the Steering Committee, who are filling the project with scientific knowhow and considerable personal commitment.
Disclaimer: This document has been produced with the support of the European Commission’s Consumers, Health, Agriculture and Food Executive Agency (Chafea). Its content is the sole responsibility of the Robert Koch Institute, Centre for Biological Threats and Special Pathogens, and can in no way be taken to reflect the views of the CHAFEA or any other body of the European Union.
- Front Public Health. 2014 Nov 11;2:199. doi: 10.3389/fpubh.2014.00199 Clin Microbiol Infect. 2017 Feb;23(2):58-60. doi: 10.1016/j.cmi.2016.07.003 Clin Microbiol Infect. 2009 Aug;15(8):720-6. doi: 10.1111/j.1469-0691.2009.02946 PLoS Pathog. 2013 Jan;9(1):e1003105. doi: 10.1371/journal.ppat.1003105
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Facts and figures
Co-ordinator: Robert Koch Institute (RKI), Germany. Contact: Roland Grunow
Co-coordinator: National Institute for Infectious Diseases ‘L. Spallanzani’ (INMI), Italy. Contact: Giuseppe Ippolito, Antonino Di Caro
Total EU co-funding (60%): €3,500,000
Total estimated project costs: €5,800,000
Duration of the joint action: Three years (June 2015 – May 2018)
Roland Grunow (corresponding author),1 Sandra Appelt,1 Daniela Jacob,1 Anna-Maria Rohleder,1 Antonino Di Caro,2 and Giuseppe Ippolito,2 on behalf of the steering committee and the whole consortium of the EU-funded Joint Action EMERGE
1.Robert Koch Institute, Berlin, Germany
2.National Institute for Infectious Diseases ‘L. Spallanzani’, Rome, Italy
This project has received funding from the European Union’s Health Programme under Grant Agreement No. 677066.
Robert Koch Institute
Centre for Biological Threats and Special Pathogens
+49 (0)30 18754 2100
This is a commercial article that will appear in SciTech Europa Quarterly issue 27, which will be published in June, 2018.