A new training program in Europe

EUPHEM - Fellowship in Microbiolgy
By Sabine Dittrich (EUPHEM Fellow Cohort 14, RIVM, NL) and Satu Kurkela (EUPHEM Fellow Cohort 14, HPA/CfI, UK)

Intro
ECDC has recently launched a new programme to train public health microbiologists. The programme, known as EUPHEM (European Public Health Microbiology Training Programme, not sure where the E came from) runs parallel to the EPIET programme, but its curriculum is distinct from EPIET.
The EUPHEM programme aims at developing a European network of public health microbiologists to strengthen communicable disease surveillance and control through an integrated laboratory-field epidemiology network for outbreak detection, investigation and response.
The first two fellows, Sabine and Satu (or as they call themselves: "the guinea pigs") are pioneering this new program and are actively involved in defining and identifying the objectives, potential modules and had even a say on the name of the programme (yes, really this was the best option). This involves a lot of long teleconferences and to be honest a lot of frustrating days... but both of them strongly believe it is a great idea! So hopefully by the time the next cohort of EUPHEMs starts, a lot of the starting problems will be ironed out and a long line of EUPHEMs with a programme as well known as EPIET will follow in the future. That's the dream!

The LAB4EPI MODULE
To start giving the new EUPHEMs some work and show what lab people do, the EPIET fellows could this year select a Lab4Epi module, with the EUPHEM fellows strongly involved in organisation, facilitation and lecturing. The Lab4Epi module, or as it is officially called the "Laboratory Essentials in Field Epidemiology" has the purpose of increasing the understanding between lab and epi people and to give the EPIETs a better understanding of different diagnostic tests, sampling methods and in general show them that lab life is not as simple as it looks.
Part of the module consisted of lectures on different diagnostics and typing methods and when they are useful, as well as lectures on safety issues in the lab. In addition to lectures the program featured "meet the experts" talks were Ab Osterhaus (Erasmus University Rotterdam, the David Beckham of virology, according to a Dutch newspaper) and Kathrin Tintelnot (RKI) gave an insight into emerging viruses and the outbreak potential of fungal infections.
To not make it more interactive, most lectures were followed-up by an active session for example on sampling and packing in a lab. During that exercise participants wrapped, packed and unpacked (supposedly…) highly contagious samples and checked with fluorescent dye how much they spilled in the process. If this would have been for real, probably no one would have left the building alive, but now everybody knows how to do it right!
Of course we had case studies as well, but to make it a bit more exciting the fellows had to present their plans for sampling and diagnostics in a real hospital microbiology lab to the two microbiologists in charge and the emergency room physician, and believe us, not everything worked according to the epidemiologists plans.
The module took place at RIVM in the Netherlands and Sabine as the local EUPHEM fellow had the great chance to be actively involved in all organisational matters of the planning, including the exciting and important question "how many cups of coffee do we need?". It was a lot of work in the planning and preparing, but also a lot of fun for both EUPHEM fellows and they hope that not only they enjoyed learning more about diagnostics, hearing about the experience in a containment level 4 lab or to see the mosquitoes in the environmental public health-lab flying around.
Overall, Sabine and Satu probably speak on behalf of all "lab people" when they hope that this module strengthened the relations between epi and lab and brought the point across that even though microbiologists look very glamorous in their white lab coats, they don't know everything and sometimes it's not their fault when something goes wrong, it just really is not that easy.

PORTON DOWN, where the magic happens
One of the exciting features for a London-based EUPHEM fellow are regular visits in the Centre for Emergency Preparedness and Response (CEPR) in Porton Down in Salisbury, a town which is home also to the prehistoric monument Stonehenge. The CEPR provides the fellow with practical and theoretical training in safe handling of dangerous pathogens e.g. in outbreak situations, and in the management of high containment laboratories.
A first-time visitor to Porton Down will be somewhat surprised to find oneself in the middle of -practically- nowhere. There is no access to Porton Down with public transport, and indeed the impression of mystery is enhanced by the presence of a military base in close proximity. The history of Porton Down goes back to the world wars, during which the UK prepared for chemical warfare. The CEPR was built in 1950's, and has until to date amazingly endured all the modern requirements for handling of dangerous pathogens, such as Crimean-Congo haemorrhagic fever, Lassa, and Ebola viruses. Today, the Centre works to prepare for disease outbreaks and other healthcare emergencies, including deliberate release of biological agents.
Entering the site naturally involves heightened security measures, and access to some of the crucial zones of the area is heavily restricted. At first glance the facilities seem old, but as soon as one takes a closer look at the range of hazard group 3 and 4 pathogens routinely handled inside these walls, there is no question there are a number of very skilled people using some highly modern technology. A special training unit at the Novel and Dangerous Pathogens Laboratory makes sure that all staff is trained for meticulous working techniques and safety procedures. They also run training courses for other healthcare professionals and co-ordinate emergency exercises.
The enthusiasm and dedication of the public health microbiologists and clinical scientists working at the CEPR is very easy to grasp. It is also the dream of one unmentioned London-based EUPHEM fellow to engage in some of their projects during the two-year fellowship. One of the recent incidents the CEPR laboratories investigated involved a lethal case of inhalation anthrax in a drum-maker in London (Anaraki et al. 2008). Environmental investigations undertaken by the CEPR identified anthrax spores in drums, from which the patient is believed to have acquired the infection. For a newly-fledged EUPHEM fellow, it was most exciting and educational to follow the investigations on this incident - a fine example in which several disciplines, including microbiologists and epidemiologists worked together to implement appropriate environmental, epidemiological, and laboratory investigations, as well as control measures. Enabling such a successful collaboration between public health microbiologists and field epidemiologists is one of the major goals of the EUPHEM programme in general.
Epi4Lab: Participants of the Lab4Epi Module learn how to deal with dangerous pathogens: "Ah, we can read much better with these fancy glasses".