National resources: Norway

Introduction

This page discusses infectious disease research in Norway and provides information on relevant health authorities and initiatives. In addition, the page offers a collection of key considerations for researchers such as regulations for data handling and disease control. While the primary target audience is the scientific community in Norway, you will also find open-access resources (e.g. on Research Data Management (RDM) topics) that could be useful for the wider community.

Health Authorities in Norway

The Norwegian Directorate of Health (Helsedirektoratet), the [Norwegian Veterinary Institute] (https://www.vetinst.no/en) and the Norwegian Institute of Public Health (Folkehelseinstituttet, referred to as FHI from here onwards) work jointly to provide an effective and coordinated effort towards the prevention and control of infectious diseases. The agencies also ensure that public health data is collected, stored, and shared in compliance with applicable laws and regulations.

The Directorate of Health monitors public health issues to develop national guidelines and strategies for surveillance, prevention, and response activities. Together with local health authorities and healthcare providers, the directorate implements relevant policies and communicates these guidelines to the public. The directorate coordinated the national response to the COVID-19 pandemic, establishing national recommendations for testing, tracing, and isolation.

The Norwegian Veterinary Institute conducts surveillance programs to montitor terrestrial and aquatic animal diseases. The surveillance is carried out under the direction of the Norwegian Food Safety Authority and implemeted by the Norwegian Veterinary Institute.

The FHI advises health authorities on public health issues, including disease prevention, outbreak control, and preparedness for national health emergencies. The institute works with the Directorate of Health to develop vaccination programs, guide infection control measures, and support healthcare providers and related institutions. The Division of Infection Control within FHI supports infectious disease research, monitors infectious disease outbreaks, and analyses data related to these outbreaks. During the recent pandemic, FHI published a handbook for medical researchers to understand the handling of SARS-CoV-2 variants data.

Several governmental organisations collaborate with FHI to monitor pathogenic data and support surveillance initiatives:

• The Norwegian Environment Agency oversees detection of pathogens in wastewater and tracks occurrences of antimicrobial resistance (AMR) in natural areas and wild species. The agency is known as Miljødirektoratet in Norwegian and has a Norwegian homepage too.
• The Norwegian Veterinary Institute conducts surveillance programs montitoring terrestrial and aquatic animal diseases under the direction of the Norwegian Food Safety Authority (Mattilsynet) which is working towards ensuring the safety of food and drinking water in Norway.
• The Norwegian Medicines Agency (Legemiddelverket) regulates and supervises medicine, medical devices, and clinical trials in Norway. In addition to the national-level health authorities and agencies, there are regional/municipality-level efforts taking place across hospitals in Norway to combat infectious diseases:
• Norwegian National Advisory Unit on Tropical Infectious Diseases

Disease surveillance initiatives

Projects

The FHI maintains a wastewater monitoring project to better understand the spread of SARS-CoV-2 variants, and provides the latest results from wastewater surveillance page.

FHI plans to consolidate their Health Emergency Preparedness and Response (HERA) and microbial whole-genome sequencing analysis initiatives in a project to enhance microbial surveillance and preparedness (2022-25).

You will find information on other surveillance systems and databases under the sections Dashboards and visualisation platforms and National data sources

Reports

• Weekly reports for COVID-19, influenza, and other respiratory tract infections
• Yearly reports from active and former surveillance programs on animal diseases
• National Strategy against Antibiotic Resistance 2015-2020 (in PDF).
• The renewed (2020) Norwegian National Strategy against Antimicrobial Resistance
• Overview of Norwegian Environment Agency reports on antimicrobial resistance in nature (in Norwegian)
• The NORM/NORM-VET report on antimicrobial use and resistance in Norway (1999 - 2021) (in PDF).

Dashboards and visualization platforms

Several national registries, involved in tracking infectious disease cases, have their own dashboards for viewing data. All these platforms are available in Norwegian only:

• Norwegian Immunisation Registry (SYSVAK) for COVID-19 and influensa vaccinations.

• Norwegian Surveillance System for Communicable Diseases (MSIS) shows registered cases of infectious diseases in Norway by month, year, age, region, and more. The data is also available in table format.

• Norwegian Surveillance System for Antimicrobial Drug Resistance (NORM) atlas visualizes NORM database entries over time, divided by regions.

National data sources

The FHI operates three national electronic reporting systems that are involved in surveillance of infectious diseases. Healthcare providers and laboratories use the following three systems to register cases, allowing health authorities to access data in real-time.

Norwegian Surveillance System for Communicable Diseases (MSIS)

MSIS collects data on infectious diseases in Norway. The registry provides a comprehensive overview of the incidence, distribution, and trends of infectious diseases. FHI uses the data to monitor disease outbreaks, identify emerging threats, and evaluate the effectiveness of infectious disease control measures.

Norwegian Surveillance System for Antibiotic Use and Hospital-Acquired Infections (NOIS)

NOIS (in Norwegian) monitors the occurrence of hospital-acquired infections and tracks the use of antibiotics within Norwegian health services. Public health authorities use the registry to identify areas of concern within infection control measures to limit the spread of infections and the development of antibiotic-resistant bacteria.

Norwegian Surveillance System for Viral Resistance (RAVN)

RAVN tracks antiviral resistance to viruses that present a significant public health concern in Norway. Healthcare providers and local microbiological laboratories submit both suspected and confirmed cases for genotypic analysis and phenotypic resistance testing, typically at national reference laboratories.

Norwegian Surveillance System for Antimicrobial Drug Resistance (NORM)

NORM monitors antimicrobial resistance (AMR) incidences in humans over time. Its partner project NORM-VET tracks AMR in animals, food, and animal feed.

As the Norwegian node for the European Antimicrobial Resistance Surveillance Network, the University Hospital of North Norway (UNN) operates a national health registry that collects and processes AMR data. FHI manages data handling. To access the data, you need to print out and mail in an application available on UNN’s website. Available in Norwegian only.

Data Access to the Registries

Since the registries contain data that can potentially be linked to individuals, you have to apply for access. Applications are free for students up to master’s level who want to access anonymous aggregated data. Other types of applications as well as access to personally identifiable data require paying a fee. The Health Data Service (Helsedataservice) at the Norwegian Directorate of e-Health handles the applications.

In addition to health registries, Biobank Norway serves as a national data source and it is part of the European biobanking research infrastructure (BBMRI-ERIC) that maintains clinical and population-based data including infectious disease data. For a collection of DNA and sample cultures, the microbiology portal (mikrobiologiportalen) provides a database of various bacterial and viral species, including a collection of methods for antigen-antibody detection methods performed across laboratories.

Regulations

The Section for Public Health within the Norwegian Ministry of Health and Care Services (Helse- og omsorgsdepartementet) oversees FHI and emergency preparedness for infectious disease outbreaks. The ministry’s Department of Health Legislation enacts regulations that provide a legal framework for disease outbreak response and other public health emergencies.

Norway introduced the infectious disease control act back in 1994; the act addresses various considerations such as health measures and risk assessments of infectious diseases for the prevention of transmission. You can read the latest version of the act at Protection against infectious diseases act (Smittevernloven 1994) (in Norwegian). Past experiences with epidemics and pandemics have taught us that emergency preparations are absolutely necessary. That is where the Health preparedness act (Helseberedskapsloven 2000) (in Norwegian) comes into the picture that addresses considerations for preparedness plans that could help health and care services and legal authorities to control outbreaks of infectious diseases.

The recent SARS-CoV-2 pandemic brought new challenges for the country that resulted in establishing new regulations, for example, for quarantine rules and administration of vaccinations. The new regulations were published as changes to the infectious disease control act and health preparedness act, read more at: Changes to reflect handling the coronavirus pandemic (2021) (in Norwegian).

The Norwegian Data Protection Authority (Datatilsynet) is an independent body that oversees the processing of personal data in Norway, including data related to public health and infectious disease outbreaks. Datatilsynet upholds compliance with Norwegian data protection laws and the General Data Protection Regulation (GDPR) of the European Union. The regulations for sensitive/personal research data and clinical data, in Norway, are implemented in Health Research Act (Helseforskningsloven). RDMkit provides general data management guidelines for handling of sensitive data and human data.

When it comes to scientific research, the Nowegian goverment has published a strategy on research data in 2018 which is implemented by the Norges Forskningsråd (Research Council of Norway) it its policy that requires open access to research data (revised 2017, in PDF). The council highlights the importance of open science with useful resources.

Domain-specific infrastructures or resources

National infrastructures

• The Norwegian Institute of Public Health’s Antibiotic Committee (Folkehelseinstituttets antibiotikakomitéen). The FHI provides a general information and resources on antibiotic resistance, useful for both public, researchers, and health service professionals
• The National Advisory Unit on Detection of Antimicrobial Resistance (K-res) provides laboratory-based services for the detection and surveillance of antimicrobial resistance in Norway. The unit offers diagnostic and advisory services, trains healthcare professionals, and advises on appropriate antibiotic distribution and use.
• Norwegian Society for Medical Microbiology (Norsk forening for medisinsk mikrobiologi (NFMM) is a national association to bring together experts from medical microbiology fields for knowledge-exchange. NFMM also provides a database of clinical laboratories that take care of infectious disease, pathogen, and related sampling.

Institutional initiatives on antimicrobial resistance (AMR)

There are national research projects focused towards pathogenomics to help improve agriculture, food, public health, environment, and biodiversity in Norway. Also, higher education institutions and industrial organisations have forums and research centres dedicated to addressing the topics of antimicrobial resistance and pandemic preparedness.

• Antimicrobial restistance research at the Norwegian Veterinary Institute
• PathoSeq, a project on sequencing pathogenic bacteria for food safety. More information is available on the University of Oslo PathoSeq page.
• Interdisciplinary Forum for Research on Antimicrobial resistance (INFRA), University of Oslo
• CAMRIA (Combatting Antimicrobial Resistance with Interdisciplinary Approaches), launched at the University of Bergen (UiB), is a research centre with multiple partners (Haukeland University Hospital and Stavanger University Hospital) that work together to address AMR topics in a context of microbial genomics and related areas.
• The Antibiotic Centre for Primary Care, University of Oslo
• The Centre for new antibacterial strategies (CANS) at the Arctic University of Norway (UiT) comprises 16 research groups across three faculties, dedicated to AMR-related marine bioprospecting, pharmacology, and surveillance.

Institutional initiatives on epidemic/pandemic research

• Pandemic Centre at the University of Bergen aims to address the topic of how to handle and prevent pandemics, and raise awareness through knowledge-exchange activities.
• The Influenza Centre: Research, Prevention, and Control of Influenza
• Centre for Epidemic Interventions Research (CEIR), at the FHI, works towards understanding and further improving epidemic preparedness and risk control.

In addition to national and municipality-level efforts, Norway has also been involved in international projects and initiatives to help address infectious disease control and contribute to research in the field .

• OneHealth
• Network for One Health Resistome Surveillance (NORSE)
• Nordic Vets Against AMR (Article by Sternberg-Lewerin et al (2022)
• Nordic Society of Clinical Microbiology and Infectious Diseases (NSCMID)
• Norwegian Society for Medical Microbiology (Norsk forening for medisinsk mikrobiologi (NFMM) is a national association to bring together experts from medical microbiology fields for knowledge-exchange.
• Nordic Ovine Research, Surveillance and Epidemiology, part of the Nordic Joint Committee for Agricultural and Food Research

Tools and resources

Tailored to users in Norway

Developed and/or deployed by institutions and organisations in Norway.

More information

Erin Calhoun

ELIXIR Norway

Nazeefa Fatima

ELIXIR Norway