Burden of infectious diseases in Europe: methodological challenges and opportunities for public health policy

In this thesis we describe tools, resources and methodological options for estimating the
burden of infectious diseases (IDs) in the European Union (EU)/European Economic Area
(EEA) expressed in disability-adjusted life years (DALYs). The objectives were to promote
evidence-based methods in epidemiology, facilitate planning and prioritization of public
health decision making, identify gaps in surveillance data availability and quality, and provide
a comprehensive framework for communicating complex information to decision-makers.
The thesis presents the methodological challenges and solutions for calculating DALYs for
the main community-acquired infections, antimicrobial resistance (AMR), and healthcareassociated
infections (HAIs), while taking into consideration different approaches to
efficiently use data sources depending on their availability and quality. The results were put
into perspective and compared with data from other studies estimating DALYs for IDs.
Our studies found that:
• Influenza, tuberculosis and HIV/AIDS have the highest burden measured in DALYs
among the most common community-acquired infections. Vaccine-preventable
diseases have lower burden, although in countries where coverage is low the burden
can be comparable to the top three diseases.
• The burden of AMR was comparable to the cumulative burden of influenza, tuberculosis
and HIV/AIDS. It is mainly healthcare-associated (which has increased significantly in
the past decades), hence, antibiotic stewardship and enforced IPC in hospitals are the
most effective interventions.
• The burden of HAIs was twice of the other IDs under surveillance in EU/EEA countries,
making HAIs the major ID problem in the region.
• The burden of IDs varies greatly between countries and interventions to reduce the
burden need to be adapted or tailored.
The methods developed in this thesis were used to provide data to decision-makers and
promote evidence-based change. Examples included in the thesis was the shift towards
universal vaccination against tick-borne encephalitis in children in Slovenia, EU/EEA
legislation for campylobacter control in the poultry industry and the validation of strategies to combat AMR in Swiss hospitals.