Community Research and Development Information Service - CORDIS

Periodic Report Summary 1 - PANDHUB (Prevention and Management of High Threat Pathogen Incidents in Transport Hubs)

Project Context and Objectives:
Efficient transport systems are of vital importance for modern, urban societies all over the world. They can, however, also play an important role in the spread of infectious diseases. The continuously growing air traffic facilitates the quick and uncontrollable spread of person-to-person transmissible pathogens around the world, as was the case for SARS in 2002/03 and influenza A(H1N1)pdm09 in early 2009. On the other hand, ground mass transportation systems may offer an effective way of accelerating the spread of infectious diseases locally within communities. This is due to the large number of passengers using mass transport for commuting, crowded areas and high contact rates, especially during peak hours.
The main objective of the PANDHUB project is to create an integrated toolbox to aid transport operators and relevant actors in major transport hubs in the development of their current pandemic and dangerous pathogen preparedness and response plans. The project is intended to cover the extraordinary aspects specific to serious natural or man-made pathogen threats in the transport environment by providing accurate, reliable and validated information for the threat assessment, preparedness, response and recovery phases.
The specific aims are to
• deepen the understanding of disease transmission mechanisms and control measures in transport environments thus allowing effective mitigation strategies
• create a toolbox to prepare for and efficiently respond to an intentional release of patho-gens in a major transport hub
• develop Guidelines for first responders and transport operators to prepare for and effi-ciently respond to pandemic situations in transport hubs.
The project will specify the needs and the requirements for the toolbox in close cooperation with transport operators, end-users and authorities responsible for public health emergency management. Therefore a Stakeholder Liaison Group has been established with members from ECDC, WHO, airport and mass transit operators as well as from security sector and a related project to give feedback and guide the work.

Project Results:
In its first half, the PANDHUB project has started gathering information about potential dis-eases relevant to transport hubs, their spread in transport environment, characteristics of transport hubs. The IT tool development started by defining the expectations and needs of end-users. The SLG has gathered semi-annually with the project partners to discuss the needs, progress and results of the project. The feedback from the SLG has been used to direct the research at points of interest.
To enable the development of effective tools for preparedness and response phases it is important to have a representative set of scenario agents. These agents (Pandemic influenza, Ebola virus disease, anthrax and plague) have been selected so that they cover as widely as possible the different preparedness and response aspects due to the different transmission modes, survival of the threat agents and decontamination needs in transport environments, burden on the public health system, and also their pandemic potential.
Within a transport hub environment there may be points or sites – hot spots - where the risk for microbial transmission is at least periodically increased due to favourable conditions or human behaviour. The processes and structures of traffic hubs (airport, metro and railway stations, and ports) have been described in detail for identifying the potential hot spots for transmission of microbes. The transmission mechanisms considered in this context are air-borne, droplet or contact, both direct and indirect contact, transmission Depending on the specific properties of a microbe, the potential sites for hot spots within a hub will vary in ac-cordance with the microbe. For example, influenza potential hot spots, at least periodically, are formed by high density of passengers, as well as frequently touched surfaces.
The health threat incidents will likely have cross-border implications and therefore under-standing coordination and communication at EU level in such crisis situations is vital. The health crisis management information flows have been reviewed and the various actors de-fined from the national level up to the European and international level. The operational management of the health crisis stays under the responsibility of the members states. Euro-pean and international bodies are informed in case of potential serious cases and in case of potential serious cross border issues. The information flows and the logic of alert triggering are well described for ports and airports. Regarding urban transportation however, the information flow is less clear, the transport organizations usually have their own crisis management cells. But regarding specific potential health crisis, they directly rely on the national health authorities.
In the preparedness area work has been done on surveillance tools and rapid detection. The rapid detection of new or emerging infections is essential to mounting an effective public health response. A scoping review has been undertaken to identify surveillance systems and data sources that may be useful in detecting communicable disease public health events (including new or emerging infections and other high threat pathogen incidents) in transport hubs of air, sea, rail, and ground transport. The most suitable surveillance systems for de-tecting events in transport hubs are likely to be twofold - Emergency Department systems, because the data are syndromic (therefore timely) and they originate from distinct geographic areas; and secondly the data generated through telephone helplines, which may supplement local surveillance efforts to detect events at transport hubs. In conclusion, whilst some sur-veillance systems have relevance to transport hub incidents, none are specifically linked to transport hubs, or can be certain of picking such signals up quickly. Using more than one system and integrating data sources together would be likely to increase detection of events in transport hubs.

Potential Impact:
In the European Union, over 80% of the population lives in urban areas and around one third in cities with population over one million people. Cities and urban areas are the economic motors that generate the wealth of the citizens, and public transport plays an important role in this. Similarly, air travel and industry is vital for the European economic and social welfare.

Major disturbances in the transport hubs could cause severe impact paralyzing the functioning of our society and undermining public confidence in governments and authorities ability to handle serious health threats. The PANDHUB project will significantly enhance the resilience of European urban mass transport as well as air traffic against pandemics and other high threat pathogen incidents in transport hubs. These enhancements can be achieved through the various measures. These include tools for threat assessment, preparedness and response taking into consideration the specific features of transmittable diseases and transport hub environment. The tools include also modelling tools for disease spread, epidemiological surveillance tools, and tracing and surveillance tools. The project will also identify cost-effective measures for mitigation of hazardous incidents on the site.

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