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Table 7 Recurring strengths, lessons learned, ongoing actions and related strategic lines, WNV AARs in Slovenia, Italy, Greece and Serbia, April–May 2019*

From: West Nile virus in Europe: after action reviews of preparedness and response to the 2018 transmission season in Italy, Slovenia, Serbia and Greece

Recurring Strengths Lesson Learned Ongoing actions Derived Strategic Line
1. Intersectoral preparedness and planning, with availability of One Health Plans for surveillance and response has been consistently described as supportive to the management of the WNV transmission season. A formal legal framework and mandate sustaining the implementation of One Health activities including, but not limited to, surveillance is recurrently recognized as a strength. In reaction to the WNV transmission season 2018 Italy, Slovenia and Serbia increased formalization of existing committees (through the formal nomination of higher level/broader groups). Italy engaged in the production of a longer term and higher-level preparedness and response plan.
Greece has an established national inter-sectoral committee (under the MoH) and a multi-sectoral working group which provides criteria for the designation of affected areas.
Invest in, and if possible strengthen the formal inter-sectoral framework that is supportive to the implementation of coordinated One Health surveillance and inter-sectoral response during the WNV transmission seasons
2. Inter-sectoral collaboration Established (formal and informal) mechanisms of collaboration and communication (including rapid sharing of surveillance data) across the human public health, animal health, medical entomology, and Substances of Human Origin (SoHO) safety sectors were described in all the countries. Technical experts in the different sectors are described consistently as strongly interconnected with a clear understanding of respective roles and responsibilities. All countries identified the rapid detection and investigation of human cases of West Nile Neuroinvasive Disease (WNND) infection through enhanced human surveillance and information sharing as a point of strength. Activities around entomological surveillance and vector control appear more consolidated in countries where transmission has been documented for a long time. A project has been approved in Slovenia to pilot mosquito surveillance of WNV
The Region of Vojvodina in Serbia will design and pilot the implementation of a One Health surveillance platform. This project, funded in 2019, will be implemented in 2020.
Where feasible, establish mosquito and bird surveillance of WNV integrated with the surveillance of cases in human and, if possible, equids. An added value has been consistently reported by countries implementing One Health surveillance for WNV in terms of early warning and early activation of prevention measures, in particular when combining mosquito and bird surveillance with surveillance in cases in humans due to the fact that on average virus detection by PCR occurs earlier in those species.
3. Enhanced surveillance timeliness and integration at the human-animal interface
4. Strong commitment of engaged institutions
5. Diagnostic capacity (human and veterinary health) Capacity within national (and in some countries regional) laboratories for the detection of WNV infection in humans, birds, horses and mosquitoes was highlighted in all countries.   Strengthen technical capacity and the network of reference laboratories for WNV wherever needed. Capacity building or maintenance to detect infection in humans, mosquitoes, birds and horses was consistently highlighted as crucial in ensuring timeliness and completeness of surveillance.
  1. * The identified points of strength were commonly identified by all the four countries that conducted the AAR on the WNV 2018 transmission season.