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MINISTERUL

SNTII
AL REPUBLICII
MOLDOVA

Assessment of the national surveillance of


system of communicable diseases
Dr. Constantin Rmi

Evaluarea Sistemului Naional de Supraveghere a Bolilor Transmisibile


i Evenimentelor de Sntate Public
31.03.2014 04.04.2014

Content

1.
2.
3.
4.
5.

Surveillance system description


International regulations
National legislation, Protocol and Guidence
Surveillance system information flow
Human Resource development

MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

Definitions
Epidemiological surveillance - means the
systematic collection, recording, analysis,
interpretation and dissemination of data and
analysis on communicable diseases and related
special health issues (acc. to art.3 (d) of the
Decision 1082/2013/EU;
Event-based surveillance (EBS) - the organised
and rapid capture of information about events that
are a potential risk to public health including:
rumours/ad-hoc reports through formal channels
(no standard surveillance) or informal channels
(e.g. media reports, health workers, NGOs)

International Regulations
WHO International Health
Regulations (2005)
implemented by Governmental
Decision no. 475 from 26.03.2008
On the Approval of the Actions
Implementing the International
Health Regulations in the Republic
of Moldova
Official Monitor no. 69-71, art. 455
from 04.04.2008 http://www.who.org
MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

International Regulations
Decizia 2119/98/CE a Parlamentului European si a
Consiliului din 24 septembrie 1998 de creare a unei
reele de supraveghere epidemiologic i control al bolilor
transmisibile n Comunitate
Decizia Comisiei 2000/96/CE privind bolile
transmisibile care vor fi incluse n mod progresiv n
reeaua Comunitii n conformitate cu Decizia nr.
2119/98/CE a Parlamentului European i a Consiliului

MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

International Regulations
Decizia Comisiei 2002/253/CE de stabilire a definiiilor
de caz pentru raportarea bolilor transmisibile reelei
comunitare n conformitate cu Decizia 2119/98/CE a
Parlamentului European i a Consiliului cu modificarile
si completarile ulterioare.
Deciziei Comisiei 2000/57/CE privind sistemul de alert
precoce i de reacie pentru prevenirea i controlul
bolilor transmisibile n temeiul Deciziei nr. 2119/98/CE a
Parlamentului European i a Consiliului, cu modificarile
si completarile ulterioare.
MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

National legislation and regulations

Law on State Surveillance of Public Health nr.10-XVI from 03.02.2009,


Official Monitor no. 67, Art. 183 from 03.04.2009
http://lex.justice.md/index.php?action=view&view=doc&lang=1&id=331
169

Governmental Decision related to State Surveillance of Public

Health nr. 384 from 12.05.2010


http://lex.justice.md/index.php?action=view&view=doc&lang=1&id=334
620

Gov. Decision on approving Regulation related national surveillance


and control of communicable diseases and public health events nr. 951
from 25.12.2013,
http://lex.justice.md/index.php?action=view&view=doc&lang=1&id=350
538
MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

National legislation and regulations

National Extraordinary Public Health


Commission (for the integrated and coordinated
prevention and management of the threats and
hazards to public health and the multispectoral
mobilization of response assets) Governmental
Decision no. 820/2009

Sanitary rules of hygiene for medico-sanitary


institutions Governmental Decision no. 663 from
23.07.2010
http://lex.justice.md/index.php?
action=view&view=doc&long=1&id=335428
MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

National legislation and regulations

National Programs and Action Plans approved by


governmental decisions
Immunization for period 2011-2015
Surveillance and control on tuberculosis
Surveillance and control on hepatitis B and C
Surveillance and control on AIDS
Implementation of IHR 2005

MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

Legislation, Protocols and Guidence


MoH order nr. 385 from 12.10.2007 on approving of
case definition for diagnosis, recording and reporting of
communicable diseases in the Republic of Moldova
MoH order regarding the implementation of the
Programme for development of state surveillance
public health Laboratory Network in Republic of
Moldova nr.668 from 10.06.2013
http://www.cnsp.md/down/info1371468083ro.pdf
The protocols and guidance for clinical case
management are in place for almost of the notifiable
diseases, including case definition for surveillance.
MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

Legislation, Protocols and Guidence

Guideline for
the supervision
and control of
nosocomial
infections
http://www.ms.m
d/sites/default/fil
es/legislatie/ghid
ul_de_supravegh
ere_si_control_in
-infectiilenosocomiale1.pd
f

System for epidemiological surveillance


of communicable diseases
72 nosological forms
6 public health problems (nosocomial infections, antimicrobial
resistance, etc)
Standard case definitions for priority infectious diseases approved by
the MOH order no.385/2007 (aligned to 2119/98/EC, 2000/96/EC,
2002/253/EC, 2003/542/EC)
List of events for emergency notification of MoH in 24 hours
(outbreaks, natural disasters, chemical and radiological accidents)
Prioritization (national consensus) - 30 priority diseases and public
health problems

MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

Reporting
Cases of infectious diseases are reported by
health care workers from the primary,
emergency, and specialized (infectious
diseases) healthcare and hospitals using
standard form approved by MoH order on
approving reporting form about detection of
communicable disease, intoxication, toxiinfection caused by food and/or occupation
site, adverse effect after vaccination nr.13
from 11.01.2011
http://ms.gov.md/sites/default/files/legislatie
/ordinul_nr._13_din_11.01.2011.pdf

Reporting formular

Register nr. 60
Dates

Established
by the
medical
institution.
Diagnosis by Doctor's
the
name,
Reg emergency surname.
Nr note
date

Birth date
(day, month,
year). For
children up to
1 month
please
specify
maternity
hospital and
Patient's date of
name,
discharge
surname ment

Place of
Home
work,
address.
studies,
Region,
education,
town, street, etc.
apartment Address. Of ilness

First
reque
st for
medic
al
asiste Hospitance lization

10

Last
visit to
the
place of
work,
studies,
etc.

Place
of
hospita
lization.
Stays
at
home.

11

12

Register nr. 60
In case of poisoning

Emergency note was accepted,


dispatched to the CPH

Notes.
The product was
bought: date and
time. Number of
Final
Suspec people who have
Name, surname of the diagnosis.
ted
consumed the
person who has filled in Established
product
product.
Date Time
the form
. (date)

13

14

15

16

17

18

Results
of the
laborator
y tests
(type).

Research
was
conducted
by
(name,surn
ame).

19

20

21

Notifiable diseases reported immediately

The Ministry of Health Order No. 368 /13 December 2004


on mandatory notification of MoH related to emergencies
and natural disasters, approved the list of diseases and
public health events, established the algorithm for
detection and reporting of outbreaks at early stages.
For zoonotic disease was developed and approved the
Regulation on data change with veterinary service
between 2 information system (animal and human health)

MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

Investigation form nr. 362/e


ordinul MS 828 din 31.10.2011
Ministry of Health of the Republic of Moldova.

Medical documentation form # 362 e


Institution name:

Confirmed by the order of MH of RM # 828 dated 31.10.2011

Report of the epidemiologic research of the infection source.

I. Patient data
1 Final diagnosis
Established : day

month

year

4.Date of birth: day

month

year

2 Name, Surname

3 Sex: male (1), female (2)

Surveillance system includes all levels of health


systems according Annex 1 IHR (2005)
WHO
Focal Point IHR

National
Assessment
level

MoH

Notification
Public health response

Intermediate level
Confirmation
Notification
Assesment

Local level
Detect events&risks
Report
Implement preliminary
control measures

National
Focal Point IHR
NCPH
Early warning
department
NCPH

Legislation/
regulation
MoH Ord.268/2009
on implementation
Gov.Decree
nr.475 /2008

MoH Ord.358/2009
on approving the
Center of public Center of preventive Case Definitions
health
municipal/rayon

Medicine
(army, police,etc.)

MoH Ord.368/2004
on approving the
list of evens for
Primary medical
Medical care
obligatory reporting in
care
institution
case of emergency situation
Municipality
(army, police,etc.)
and natural disasters
/rayon/national

Flow of case information


nregistrarea cazului de bol
infecioas
Boala nregistrat
este din categoria
maladiilor imediat
raportabile

Nu

Da

Raportarea la
nivelul naional,
investigarea
erupiei,
elaborarea
planului de
aciuni
Implementarea
planului, raport
final
nivel naional
Analiza
datelor la
nivel naional,
diseminarea
informaiei
Nivel

nregistrarea
zilnic n
registru

Raportarea imediat la nivel


raional (raional/municipal)

Generalizarea
datelor n
instituia
medical

Ancheta epidemiologic a
cazului

Raportarea
datelor la nivel
raional
(municipal)

Da
Este depistat o izbucnire
epidemic?

Nu

nregistrarea suspeciei la
erupie n registru

Investigarea
selectiv,
raportarea
datelor la nivel
naional
Analiza datelor,
diseminarea
informaiei

Instituiilor medicale raionale ,


municipale

Instituiilor medicale raionale ,


municipale

AMP

AMP

Notification of nominal cases


of communicable diseases in
accordance with International
Classification of Diseases
(ICD)-10

Case classification
according standard case
definitions, adjusted at the EU
Decisions:
Possible
Probable
Confirmed

Notification of all kind of


events:

Biologic
Chemical
Radiological
Assessment based on
Decision instrument (Annex
2 IHR (2005))

Status of cases

Rapoarte: Date agregate

Rapoarte: Sistem GIS

Rapoarte: Rapoarte
universale

Case Information
The event-based surveillance system is still in its implementation phase,
but it will eventually provide data regarding public health events.
Collected data are summarized in weekly, monthly and annual reports,
such as statistical evidence form no. 2 entitled Statistical report on
communicable and parasitic diseases.
Weekly surveillance report on Acute Diarrheic Diseases, and sentinel ILI,
ARI, SARI syndromes - weekly, routine surveillance data of infectious
morbidity - monthly and annually .
http://cspchisinau.md/ro/buletine-si-rapoarte/buletin-epidemiologic (Public Health Center
mun. Chisinau)

MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

Formular nr. 2

Sentinel surveillance
ILI, ARI, SARI (MoH order on the improvement of surveillance system for
influenza and acute respiratory infections nr.824 from 31.10.2011,
http://ms.gov.md/legislatie?field_legtip_tid=16&=Caut%C4%83,
Rotavirus infection (MoH order nr. 252 from 20.06.2008 on the
implementation of sentinel surveillance for rotavirus infection in the
Republic of Moldova, and MoH order 1238 from 07.12.2012 on the
assessment of the impact the introduction of rotavirus vaccine,
Pneumonia (MoH order regarding epidemiological sentinel surveillance of
community acquired pneumonia in children under 5 years MoH order
nr.1190 from 23.10.2013,
http://ms.gov.md/sites/default/files/legislatie/ord._1190_din_23.10.3_s
upravegherea_epidem._pneumonii_comunitare.pdf

Information dissemination
Scientific meetings
http://cnsp.md/submeniu.php?id1=50&id2=0,
Inter-sectoral governmental meetings, national
conferences, professional forum ,
http://ms.gov.md/?q=colegiul-ministerului
http://www.gov.md/libview.php?l=ro&id=6459&idc=4
36

MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

Information dissemination

Annual report
http
://cnsp.md/info.
php?id1=37&id2=2
1

MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

Protection of personal data

The protection of personal data handled by the


communicable diseases surveillance and early detection
and response systems is provided by:
Law no. 133 of 8 July 2011 on the protection of
personal data,
http://lex.justice.md/index.php?action=view&view=do
c&lang=1&id=340495
Law on prophylaxis of HIV/AIDS nr. 23-XVI from
16.02.2007
http://lex.justice.md/index.php?action=view&view=do
MINISTERUL
c&lang=1&id=323271
SNTII
AL REPUBLICII
MOLDOVA

Human resource capacity development


State Medical and Pharmaceutical Univesrity Nicolae
Testemitanu public health specialty, rezidenture on
epidemiology;
School of Public Health Management, master in public
health management;
National College of Medicine and Pharmacy Raisa Pacalo
epidemiologist assistant
Centers of Public Health National, Municipal and Raional
training at the work place, seminars, workshops

MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

Field of training and education

Applied epidemiology
Interventional epidemiology
Clinical infectious diseases
Public health management
Clinical microbiology

MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

MINISTERUL
SNTII
AL REPUBLICII
MOLDOVA

Multumesc de atenie

Evaluarea Sistemului Naional de Supraveghere a Bolilor Transmisibile


i Evenimentelor de Sntate Public
31.03.2014 04.04.2014