Determinants and Drivers of Infectious Disease Threat Events in Europe

Abstract

Infectious disease threat events (IDTEs) are increasing in frequency worldwide. We analyzed underlying drivers of 116 IDTEs detected in Europe during 2008-2013 by epidemic intelligence at the European Centre of Disease Prevention and Control. Seventeen drivers were identified and categorized into 3 groups: globalization and environment, sociodemographic, and public health systems. A combination of >2 drivers was responsible for most IDTEs. The driver category globalization and environment contributed to 61% of individual IDTEs, and the top 5 individual drivers of all IDTEs were travel and tourism, food and water quality, natural environment, global trade, and climate. Hierarchical cluster analysis of all drivers identified travel and tourism as a distinctly separate driver. Monitoring and modeling such disease drivers can help anticipate future IDTEs and strengthen control measures. More important, intervening directly on these underlying drivers can diminish the likelihood of the occurrence of an IDTE and reduce the associated human and economic costs.

Keywords: Europe; antimicrobial resistance; climate change; demographic; determinants; drivers; environment; food and water; global trade; globalization; infectious diseases; natural environment; public health systems; social; tourism; travel.

Figure 1

Number of observed infectious disease threat events (IDTEs) in relation to number of drivers for each IDTE group, Europe, 2008–2013.

Figure 2

Infectious disease threat events (IDTEs), by contributing drivers, observed in Europe, 2008–2013. The 3 IDTE categories are represented by green (globalization and environment), red (sociodemographic), and blue (public health systems) symbols, the sizes of which are proportional to the overall frequency of the driver. A) Foodborne and waterborne IDTEs. B) Vectorborne and rodentborne IDTEs. C) Other zoonoses IDTEs. D) Vaccine preventable IDTEs.

Figure 3

Cluster dendrogram from hierarchical cluster analysis of drivers contributing to observed infectious disease threat events (IDTEs), Europe, 2008–2013. Individual segments (leaves) on the lower part of the tree are more related to each other, as indicated by distances between the branches. Drivers below travel and tourism also occurred less often as underlying drivers of IDTEs and tended to be more contextual in nature. Scale bar indicates dissimilarity distance for drivers, as measured by frequency of pairwise co-occurrence in clusters. Similar drivers (e.g., that co-occurred in outbreaks) are at a close distance, and those that were more independent of other drivers show higher dissimilarity.