The burden of infectious diseases in Europe: a pilot study

The main objectives of this pilot study were to test the potential use of the disease burden concept in the field of infectious diseases, including data quality and availability; to recommend future studies; and to stimulate a debate. The disease burden of seven infectious diseases (influenza, measles, HIV, campylobacteriosis, infection with enterohaemorrhagic Escherichia coli, salmonellosis and tuberculosis) in Europe was estimated by calculating Disability Adjusted Life Years (DALYs), a composite measure that attempts to combine mortality, incidence and sequelae, taking duration and severity into account. The results show that the relative burden of diseases as measured by DALYs differs from that only measured by incidence or mortality. Several limitations regarding data availability and quality have been identified, resulting in an underestimation of the true burden of disease in this pilot. Notwithstanding these, HIV-infection, tuberculosis (TB) and influenza are estimated to cause the highest burden in Europe among the selected diseases. The burden of foodborne diseases (campylobacteriosis, infection with enterohaemorrhagic Escherichia coli and salmonellosis) and in particular of measles is lower. A consideration of the relative comparison of burden between diseases can be useful when tackling the difficult, sensitive but necessary task of identifying priority actions. A low burden stresses the need for continued support for prevention and control whereas a high burden indicates the need for additional interventions. Following this pilot project, a generalised burden of disease study for infectious diseases in Europe is recommended. Such a study would benefit from an approach that identifies and combines several methods of investigation, including epidemiological modelling, and it should be done in collaboration with other international efforts in this field.