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INFECTION CONTROL
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Statens Serum Institut is a central, integrated part of the Danish National Health Service. The Institute’s activites to prevent and control infectious disesase forms part of a prevention cycle in which the occurence of infectious diseases is continuously monitored, outbreaks are traced back, and possible interventions are evaluated. As a part of these control activities, the Institute performs surveillance functions based upon data reporting from various parts of the Danish National Health Service, concerning incidence and clinical manifestation of a large number of diseases as well as treatment complications, vaccination coverage, etc. Moreover, the Institute has a permanent operative preparedness for biological threats, including bioterror.
The SSI’s activities to control infections are research-based and under constant development. In order to be able to intervene and break chains of transmission as rapid and effective as possible, the Institute has built up and developed expertise within epidemiological and microbiological methods which are to complete each other.
Technological development makes it still more possible to improve the surveillance functions, including diagnostic PCR methods which may make it possible to identify infectious agents more rapidly and specifically.
Modern outbreak management includes confirmation of suspected outbreaks, elaboration of case-definitions, diagnosis verification, elucidation of the descriptive epidemiology of the outbreak, including spread and possible area or population at risk, development of a hypothesis as to the source of infection and risk factors, testing of this hypothesis by means of microbiological examinations and analytical epidemiology, development of a prognosis, and, finally, evaluation of the effect of countermeasures.
Modern typing methods are able to analyse how close micro-organisms are related, thus determining whether they might originate from a common source of infection. This makes it possible to find the source of infection and to stop the spread, faster and more goal-oriented. In a
large number of cases, surveillance combined with new diagnostic and epidemiologic methods has led to effective recognition of outbreaks as well as valuable contact tracing and limited spread of infections, e.g. food-borne diseases, where it has been possible to identify and destroy infected food stuff.
Abroad, problems concerning antibiotic-resistant bacteria and hospital- acquired infections have become quite enormous. In Denmark however, the problems seem to be more limited. The Institute has analysed data and participated in the elaboration of quality standards for hospital hygiene which, followed properly, are expected to further reduce the number of hospital- acquired infections. The Institute is currently elaborating a plan of action for the future securing of this. Moreover, a goal-oriented effort is being planned in order to limit the antibiotic-resistance development so that Denmark may avoid problems concerning treatment deficiency.
The benefits of surveillance are closely related to size, validity, and flow of the basic reports. The Institute is continuously working hard to improve all elements within surveillance. Besides research and development of methods of analysis and tools for data processing, SSI wishes to pave the way for the still more widespread and improved communication media to be used for easier, faster, and better coordinated reporting, analyses, and use of data across the Health Service.
Finally, surveillance registries provide the possibility of determining morbidity, mortality and costs in relation to infectious diseases. Linking to other registries makes it possible to answer research questions concerning these outcomes. For instance, the Danish registry of gastrointestinal pathogens has been used to determine disease burden, sequelae and mortality of bacterial food-borne diseases, including the health effects of resistance in Salmonella. |
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