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Communicable Diseases Surveillance in Estonia, 2005 Kuulo Kutsar MD, PhD Health Protection Inspectorate, Estonia.

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Presentation on theme: "Communicable Diseases Surveillance in Estonia, 2005 Kuulo Kutsar MD, PhD Health Protection Inspectorate, Estonia."— Presentation transcript:

1 Communicable Diseases Surveillance in Estonia, 2005 Kuulo Kutsar MD, PhD Health Protection Inspectorate, Estonia

2 MAIN OBJECTIVES OF THE NATIONAL COMMUNICABLE DISEASE SURVELLANCE SYSTEM Public health decision-making Priority setting Planning Resource mobilization & allocation Early detection of outbreaks/epidemics and response Implementation of immunization programme Monitoring & evaluation of communicable disease prevention & control programmes

3 CORE FUNCTIONS OF THE NATIONAL SURVEILLANCE SYSTEM Case detection Case reporting Case investigation & confirmation Analyses & interpretation Action - response - control - feedback - decision/policy making

4 SUPPORT FUNCTIONS OF THE NATIONAL SURVEILLANCE SYSTEM Setting of standards/case definitions Training Supervision Laboratory support Communication Resource management

5 SURVEILLANCE TASKS AT LOCAL LEVEL Case identification/diagnosis & case management Case reporting to intermediate level SURVEILLANCE TASKS AT REGIONAL LEVEL Case management and reporting Data analysis at local level for - epidemiological links and trends - achievement of control targets Laboratory support/diagnosis Outbreak investigation Feedback to local level Reporting to national level

6 SURVEILLANCE TASKS AT NATIONAL LEVEL Co-ordination of surveillance activities verification of laboratory diagnosis Data analysis at intermediate level for - epidemiological links and trends - achievement of control targets Support to regional level for outbreaks control: case management, laboratory support, epidemiological investigation, logistics, training Feedback to regional & local levels Collaboration with interested parties Reporting to international organizations

7 PRIORITY DISEASES FOR SURVELLANCE Commission Decision 2000/96/EC Criteria: high disease impact, high epidemic potential, target of national/international programme, info leads to important public health activities Vaccine-preventable diseases Viral hepatitis B & C HIV- infection & AIDS Other sexually transmitted diseases Food & water-borne diseases Diseases of environmental origin Zoonoses Air-borne diseases Serious imported diseases Nosocomial infections Antimicrobial resistance

8 PRIORITIES IN SURVEILLANCE CAPACITY BUILDING A disease is frequent and has a high political priority: HIV/AIDS, tuberculosis A disease is of rare and of high public health importance: with bioterrorism potential (anthrax, malaria, a disease of unknown origin etc) A disease is moderate frequency and high public health importance: food-borne diseases and intoxications Diseases included into regional/global elimination/eradication programmes: poliomyelitis, measles, congenital rubella

9 STRATEGIC PRIORITIES IN CD SURVEILLANCE Keeping ministries and politicians informed on CD problems Co-operation with neighbouring countries: - exchange of CD surveillance info - operational early warning system - integrated outbreak/epidemic response - integration of prioritized diseases - implementation of common standards/case definitions Strengthening microbiological & other laboratories capacity - common standards for quality assessment Training in field epidemiology - co-operation with MS & neighbouring countries - training manuals Harmonization of epidemiological & microbiological investigation methods used by MS - integrated approach to CD surveillance

10 DISEASE SPECIFIC SURVEILLANCE SYSTEMS Case identification/diagnosis & case management Case reporting to intermediate level SURVEILLANCE TASKS AT REGIONAL LEVEL Case management and reporting Data analysis at local level for - epidemiological links and trends - achievement of control targets Laboratory support/diagnosis Inspected outbreak investigation Feedback to local level Reporting to national level

11 National legislation Public Health Act (1995, 2004) Communicable Diseases prevention and Control Act (2003) and regulations of the Minister of SA Emergency Preparedness Act (2000, 2002) Special Situation Act (2002) EU legislation 2119/98/EC 2000/57/EC 2000/96/EC 2002/253/EC; 2003/534/EC 2003/542/EC 1999/72/EC; 2003/72/EC 2003/99/EC


13 Health Protection Inspectorate responsibilities surveillance of communicable diseases (62 notifiable diseases, 88 etiological agents) outbreak management management and surveillance of immunization EWRS

14 Health Protection Inspectorate responsibilities on CD surveillance Surveillance of communicable diseases (62 notifiable diseases, 88 agents) data collection analysis (epidemiological links, trends) control early warning & response CD register established 1.07.2004, in action 1.01.2005

15 Health Protection Inspectorate responsibilities on CD surveillance Outbreak investigation & management Epidemiological investigation Epidemiological risk assessment Laboratory investigation Communication

16 Health Protection Inspectorate responsibilities on immunization Management of National Immunization Programme Data collection Immunization analyses: coverage, timeliness Vaccines procurement & logistics (storage & distribution) Cold chain management Immunization safety Supervision

17 Health Protection Inspectorate responsibilities on epidemic/pandemic preparedness Planning and coordination Situation monitoring and risk assessment Prevention and control Health system response a) health care, b) public health Communication


19 Exchange of information in the public health system

20 Communication on CD surveillance

21 Communicable diseases notification under the Communicable Diseases Prevention and Control Act & Gov. Regulation no. 297, 2003 Physician notifies 62 CD diseases Record list: patient name, birth date, gender, address, date of onset, date of notification, diagnose (ICD-10), method of lab investigation, history of immunization, date of hospitalization Laboratory notifies 88 biological agents Record list: patient name, birth date, gender, diagnose (ICD-10), sample, method of lab investigation, identified biological agent

22 Reporting of CD surveillance data HPI website Data provided to EU BSN & DSN and WHO Monthly summary report to MoSA Monthly bulletin EstEpiReport (in English) to counterparts and interested countries Annual report to MoSA Annual report to the EpiNorth (Bulletin of the Network for CD Control in Northern Europe & Baltic Sea Region)


24 CO-OPERATION WITH INTERNATIONAL COMMUNICABLE DISEASE SURVEILLANCE NETWORKS Global Salmonella Surveillance Network EU DSN ( Influenzae, measles, pertussis, HIV-infection, Haemophilus influenzae b, salmnellosis, Enterohaemorrhagic E. coli, meningococcal disease, diphtheria, TB, CJD, legionellosis) Inventory on resources on CD control (IRIDE) - Inventory of Communicable Disease Control Resources in the Baltic states. Project Report. Stockholm, 2001 European Project on Surveillance of Vaccine-preventable Diseases (EUVAC-NET). EUSAFEVAC Project. International Tick-borne Encephalitis Working Group Network for Communicable Disease Control in Northern Europe (CD Surveillance in Baltic Sea Region) CCEE-Baltics Communicable Disease Network (WHO/Euro) European Food-borne Diseases and Intoxications Surveillance System (WHO/Euro)


26 KEYSTONES OF RAPID RESPONSE Simple decision taking Minimum involved hierarchical structures Coordinated response Maximum complexity - Ministry of Defense, Min of Justice, Min of Agriculture, Ministry of Inner Affairs, Ministry of Environment Funding Risk assessment Proposed prevention/control measures

27 NATIONAL EWRS CAPACITIES 1. Interventional epidemiology 2. Clinical microbiology 3. Research microbiology Epidemiological and clinical microbiology/virology capacities are integrated in Health Protection Inspectorate, some clinical microbiology - in hospital labs Research microbiology is provided by Tartu University Microbiology Institute

28 EWRS FLOWCHART 1. Case identification from surveillance activities 2. Case/cluster confirmation 3. Outbreak identification 4. Early warning message 5. Assistance request FOCAL POINT 6. Assessment for collaboration investigation 7. Epidemiological investigation team in the field media communication logistic support management/co-operation epidemiological investigation implementation of control measures 8. Outbreak controlled epidemiological-analytical study 9. Outbreak report 10. Feedback and ongoing surveillance

29 LIST OF PRIORITY COMMUNICABLE DISEASES FOR RESPONSE A. Required special action for public health preparedness: smallpox, anthrax, plague, botulism, tularemia, viral hemorrhagic fevers (Ebola, Marburg, Lassa, Junin etc) B. Required specific diagnostic capacity and enhanced surveillance response: brucellosis, Q-fever, glanders/malleus, meningococcal infection, Clostridium perfringens epsilon toxin, Staphylococcus enterotoxin B C. Food- and waterborne diseases: salmonellosis, shigellosis, enterohaemorrhagic E. coli O157:H7 infection; cholera D. Diseases having epidemic characteristics: HIV/AIDS, tuberculosis

30 GENERIC EPIDEMIOLOGICAL EXPERTISE IS OFFERED TO IMMIDIATE PUBLIC HEALTH THREATS Food-borne diseases and intoxications Food safety Veterinary issues Environmental disasters Chemical disasters Nuclear pollution Military deployment Bioterrorism

31 PERMANENT LINKS WITH OTHER NATIONAL ALERT SYSTEMS Food-borne diseases (Ministry of Agriculture) Zoonoses (Ministry of Agriculture) Consumers protection (Ministry of Economy)

32 PRE-EARLY WARNING BETWEEN MINISTERIES/INSTITUTES IS OPERATIONAL Inquiry from involved partners may activate the system Technical capacity with skilled epidemiologists is available Verification of disseminated information Consultation is essential part of the system Disease specific surveillance systems and reference labs are involved

33 STRENGTHENING OF NATIONAL EWRS Improvement of the quality of epidemiological surveillance Increasing of public health information availability Efficient and timely risk analysis Standardization of epidemiological and microbiological investigation methods Available high quality scientific expertise Providing training Networking Promotion of research Advise for public health policy Strengthening communication Co-operation with EC, WHO and other international organisations Identification of public health threats of cross-border nature

34 Current situation & perspectives CDS system is well adopted to implement EU guidlines and priorities for data reporting, outbreak investigation, early warning & response Legislation covers not all aspects of CD surveillance & response 1.List of CD for mandatory notification consists of 62 diseases & 88 biological agents, including EC covered diseases 2.Case definitions have developed in May 2004 as guidelines 3.Data protection should be improved 4.Preparedness for health threats: smallpox, bioterrorism, influenza and SARS preparedness plans are developed, but not implemented Several fields of activities are not legaly covered: EWRS is operating only on initiative of HPI, Quarantine Act is not developed, epidemic preparedness & epidemic response are poorly funded, immunisation programme is poorly funded

35 Current situation & perspectives Improvement of institutional capacity 1.Administrative capacity, participation in EC committees, working groups and DS Networks is problematic due to limited human resources and funding 2.Laboratory capacity: needs to be improved, reference lab system should be developed, standard test procedures for priority diseases should be implemented, national manuals for lab procedures, biosafety and quality control should be improved BSL-3 microbiology & virology labs should be established in public health system SARS diagnostic lab should be established

36 Current situation & perspectives Development of national guidelines on CD surveillance, epidemic response capacity, guarantine, control & prevention Development of computerized CD reporting system EU funded project in co-operation with SMI, Sweden (2005-2006) Strengthening of CD control capacity Development of national education and training system for public health professionals/epidemiologists


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