Communicable Diseases Prioritized According to Their Public Health Relevance, Sweden, 2013

To establish strategic priorities for the Public Health Agency of Sweden we prioritized pathogens according to their public health relevance in Sweden in order to guide resource allocation. We then compared the outcome to ongoing surveillance. We used a modified prioritization method developed at the Robert Koch Institute in Germany. In a Delphi process experts scored pathogens according to ten variables. We ranked the pathogens according to the total score and divided them into four priority groups. We then compared the priority groups to self-reported time spent on surveillance by epidemiologists and ongoing programmes for surveillance through mandatory and/or voluntary notifications and for surveillance of typing results. 106 pathogens were scored. The result of the prioritization process was similar to the outcome of the prioritization in Germany. Common pathogens such as calicivirus and Influenza virus as well as blood-borne pathogens such as human immunodeficiency virus, hepatitis B and C virus, gastro-intestinal infections such as Campylobacter and Salmonella and vector-borne pathogens such as Borrelia were all in the highest priority group. 63% of time spent by epidemiologists on surveillance was spent on pathogens in the highest priority group and all pathogens in the highest priority group, except for Borrelia and varicella-zoster virus, were under surveillance through notifications. Ten pathogens in the highest priority group (Borrelia, calicivirus, Campylobacter, Echinococcus multilocularis, hepatitis C virus, HIV, respiratory syncytial virus, SARS- and MERS coronavirus, tick-borne encephalitis virus and varicella-zoster virus) did not have any surveillance of typing results. We will evaluate the possibilities of surveillance for the pathogens in the highest priority group where we currently do not have any ongoing surveillance and evaluate the need of surveillance for the pathogens from the low priority group where there is ongoing surveillance in order to focus our work on the pathogens with the highest relevance.为明确瑞典公共卫生署（Public Health Agency of Sweden）的战略优先级，我们依据病原体在瑞典境内的公共卫生相关性开展优先级排序，以指导公共卫生资源的优化配置。随后将该排序结果与当前正在开展的公共卫生监测工作进行对照分析。本次研究采用了德国罗伯特·科赫研究所（Robert Koch Institute）开发的改良版优先级排序方法。在德尔菲法流程中，专家依据十项评估变量对各类病原体进行评分。我们根据总得分对病原体进行排名，并将其划分为四个优先级组别。随后将各优先级组别与流行病学家自行上报的监测时长，以及通过强制/自愿通报机制开展的监测项目、病原体分型结果监测工作进行对照分析。本次共有106种病原体参与评分。本次优先级排序的结果与德国国内同类排序的结果基本一致。常见病原体如杯状病毒（calicivirus）、流感病毒，血源性病原体如人类免疫缺陷病毒（human immunodeficiency virus, HIV）、乙型及丙型肝炎病毒，胃肠道感染相关病原体如弯曲杆菌（Campylobacter）、沙门氏菌，以及虫媒病原体如伯氏疏螺旋体（Borrelia）均被归入最高优先级组别。流行病学家用于监测工作的总时长中，有63%投入在最高优先级组别的病原体上；除伯氏疏螺旋体与水痘带状疱疹病毒（varicella-zoster virus）外，最高优先级组别的所有病原体均通过通报机制开展监测。最高优先级组别中共10种病原体未开展分型结果监测，分别为：伯氏疏螺旋体、杯状病毒、弯曲杆菌、多房棘球绦虫（Echinococcus multilocularis）、丙型肝炎病毒、人类免疫缺陷病毒、呼吸道合胞病毒（respiratory syncytial virus）、SARS冠状病毒及MERS冠状病毒、蜱传脑炎病毒（tick-borne encephalitis virus）以及水痘带状疱疹病毒。后续我们将评估针对当前暂无监测工作的最高优先级组病原体开展监测的可行性，并评估针对当前已有监测工作的低优先级组病原体增设监测的必要性，从而将工作重心聚焦于公共卫生相关性最高的病原体。