Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015

1. ECDC MRSA molecular typing
initiative: current status
Daniel Palm
European Centre for Disease Prevention and Control
EARS-Net network meeting, Stockholm, 13 February, 2015

2. 1
Which diseases? Typing method?
Sampling method?
Public health value?
implementation processes
ECDC Roadmap for molecular
surveillance implementation
(2012-2016)
ECDC typing activities

3. 2
• Disease Network and Member States involvement in
implementation process
• Advisory Forum gives go/no go signal for molecular
surveillance strategy
• National Focal points for Surveillance review and give input
to the business case
ECDC typing roadmap implementation
process
Molecular
surveillance
strategy
Business case
System
implementation
Routine use

4. 3
ECDC molecular typing roadmap development
and implementation
Pathogens/ AMR
issue proposed for
implementation
Typing
method
EU public health objective/sampling design Disease specific roadmap step/year
Surveillance,
continuous
Surveillance,
prevalence
surveys
Multi-state
outbreak
investigation
Molecular
surveillanc
e strategy
Business
case
System
implem.
Routine
use from
Salmonella enterica PFGE, MLVA * * 2011 2012 2013 2014
Shiga-Toxin
producing E. coli
(STEC)
PFGE * * 2011 2012 2013 2014
Listeria
monocytogenes
PFGE * * 2011 2012 2013 2014
MDR
Mycobacterium
tuberculosis
MIRU-VNTR,
spoligotyping
* * 2012 2012 2013 2014
Influenza virus sequencing * 2014 2015 2016 2017
Human
Immunodeficiency
Virus (HIV)
sequencing * 2015 2016 2017 2018
Neisseria
meningitidis
sequencing * * 2014 2015 2016 2017
Legionella
pneumophila
sequencing * 2015 2016 2017 2018
Neisseria
gonorrhoeae/MDR
sequencing * 2014 2015 2016 2016
CPE sequencing * 2014 2015 2016 2017
MRSA sequencing * 2014 2015 2016 2017

5. 4
ECDC molecular typing roadmap development
and implementation
Pathogens/ AMR
issue proposed for
implementation
Typing
method
EU public health objective/sampling design Disease specific roadmap step/year
Surveillance,
continuous
Surveillance,
prevalence
surveys
Multi-state
outbreak
investigation
Molecular
surveillanc
e strategy
Business
case
System
implem.
Routine
use from
Salmonella enterica PFGE, MLVA * * 2011 2012 2013 2014
Shiga-Toxin
producing E. coli
(STEC)
PFGE * * 2011 2012 2013 2014
Listeria
monocytogenes
PFGE * * 2011 2012 2013 2014
MDR
Mycobacterium
tuberculosis
MIRU-VNTR,
spoligotyping
* * 2012 2012 2013 2014
Influenza virus sequencing * 2014 2015 2016 2017
Human
Immunodeficiency
Virus (HIV)
sequencing * 2015 2016 2017 2018
Neisseria
meningitidis
sequencing * * 2014 2015 2016 2017
Legionella
pneumophila
sequencing * 2015 2016 2017 2018
Neisseria
gonorrhoeae/MDR
sequencing * 2014 2015 2016 2016
CPE sequencing *
2014 2015 2016 2017
MRSA sequencing *
2014 2015 2016 2017

6. 5
MRSA typing plans: Current status
Strategy (2014):
• Refinement of specific objectives and public health benefits
of molecular typing data integration
• Proposed typing method(s) and outline of surveillance
design/sampling frame, analysis and reporting strategy
suitable to the public health objectives
Business case (2015):
• Joint work between ECDC and network experts
• Planned to be presented for review and inputs by the
National Surveillance Focal Points and National Microbiology
Focal Points by end 2015
AF39-7 Strategic direction and plan for revision of the ECDC molecular surveillance roadmap

7. 6
Objectives for MRSA typing
Objective EU level risk assessment Potential risk management
implication(s)
To inform about the
occurrence and dynamics of
“high-risk” MRSA clones of
critical public health
importance in Europe.
Detection and genotypic
identification of high-risk clones
Monitoring pluri-annual trends in
the frequency of occurrence of
particular genotypes in the
population and identification of
high-prevalence human
population groups
Identification of high-prevalence
geographical areas associated
with spreading of specific high-
risk clones
Detection/delineation of cross-
region or cross-border
dissemination of high-risk clones
between repeat surveys
Initiation, implementation,
evaluation and/or revision of
local, regional and national
infection control and prevention
programme.
Contribution to the impact
evaluation of hospital and
community antibiotic policies and
stewardship programmes

8. 7
Proposed structure of the repeated surveys
The study design follow the basic structure of previous surveys
• The proposed frequency of the structured surveys is every
third year
• Isolates from in/out patients from any clinical isolate
• 10 isolates of MRSA from consecutive patients per
participating hospital/laboratory and pre-defined sampling
period (six months)
• Genotypic characterisation: Whole genome sequence

9. 8
The molecular typing business case
• Performance indicators
• Verification of the molecular typing method(s) applied,
including current capacities in the Member States
• Resources including the need for TESSy update
• External quality assessments, training and other technical
support
• Collaborative agreement to ensure protection of data
privacy, intellectual ownership and data access rules in
accordance with ethical and legal requirements

10. 9
Next steps
• Development of the MRSA/CPE molecular typing business
cases part of the 2015 ECDC work plan
• Continued collaboration with network experts in the
development of the business case needed. Concrete steps
yet to be defined.
• Target: Business case finalized in 2015
• Implementation and setting up infrastructure
• First survey in the new system planned for 2016/2017

11. 10
Acknowledgements
Expert consultation group
Amos Adler, Arjana Tambić Andrašević, Christian Giske,
Youri Glupczynski, Hajo Grundmann, Radoslaw Izdebski,
Vincent Jarlier, Barry Kreiswirth, Frederic Laurent, Alkis
Vatopoulos, Rumyana Markovska, Helena Žemlicková,
Robert Skov, Jari Jalava, Dag Harmsen, Harald Seifert,
Annalisa Pantosti, Arta Balode, Rafael Canton, Angela
Kearns, Ed Feil
ECDC
Marc Struelens, Polya Rosin, Barbara Albiger, Liselotte Diaz
Högberg, Ole Heuer, Dominique Monnet, Karin Johansson
Microbiology and Surveillance Steering Committee members