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Risk-ranking review completed for the European Centre for Disease prevention and Control

February 16th 2015

The European Centre for Disease prevention and Control (ECDC) is the agency of the European Union that identifies and assesses current and emerging threats to human health from communicable diseases. In June 2014, ECDC asked Bazian to produce a literature review to identify and evaluate the range of methods used to rank the risk of different communicable disease outbreaks for the purposes of emergency preparedness planning. The literature review has been published on ECDC’s website here.

The threat of serious, cross-border infectious disease outbreaks in Europe is a significant challenge in terms of emergency preparedness. The types of threats are constantly shifting, with previously “tropical” diseases emerging in Europe and disease spread affected by changing factors such as global travel and environmental factors. Sovereign nations and the EU do not have limitless resources to allocate to emergency preparedness. Therefore, to effectively target the allocation of resources to manage the consequences of outbreaks, it is necessary to formulate rankings or prioritisation of human and/or animal pathogens. The WHO has produced guidance on how to use a Delphi methodology to set priorities in infectious disease surveillance. However, there is currently no consensus on the best methodology to use for risk-ranking exercises.

The literature review identified 17 studies, using one of five different methodologies (bibliometrics, Delphi technique, multi-criteria decision analysis, qualitative algorithms, questionnaires). We formulated a bespoke quality appraisal checklist – based on the AGREE II criteria – to assess the validity and reliability of the studies, regardless of methodology. A narrative review enabled us to evaluate the strengths and limitations of individual methodologies, as well as compare across different methodologies. No single methodology emerged as superior. Therefore we developed a best practice framework that was designed to be a practical tool to reduce bias and strengthen the credibility of risk-ranking exercises, whichever methodology is used. The literature review is designed to help decision-makers to choose an appropriate methodology and to then follow best practice when undertaking their risk-ranking exercise.

The findings from this literature review will be incorporated into the development of an ECDC handbook on risk-ranking for communicable diseases.