surveillance communicable diseases rm_rimis2
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Assessment of the national surveillance of system of communicable diseases
Dr. Constantin Rîmiș
MINISTERUL SĂNĂTĂŢIIAL REPUBLICII MOLDOVA
Evaluarea Sistemului Naţional de Supraveghere a Bolilor Transmisibile și Evenimentelor de Sănătate Publică
31.03.2014 – 04.04.2014
1. Surveillance system description 2. International regulations3. National legislation, Protocol and Guidence 4. Surveillance system information flow 5. Human Resource development
MINISTERUL SĂNĂTĂŢIIAL REPUBLICII MOLDOVA
Content
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 SĂNĂTĂŢIIAL REPUBLICII MOLDOVA
Decizia 2119/98/CE a Parlamentului European si a Consiliului din 24 septembrie 1998 de creare a unei reţele de supraveghere epidemiologică şi control al bolilor transmisibile în Comunitate
Decizia Comisiei 2000/96/CE privind bolile transmisibile care vor fi incluse în mod progresiv în reţeaua Comunităţii în conformitate cu Decizia nr. 2119/98/CE a Parlamentului European şi a Consiliului
MINISTERUL SĂNĂTĂŢIIAL REPUBLICII MOLDOVA
International Regulations
Decizia Comisiei 2002/253/CE de stabilire a definițiilor de caz pentru raportarea bolilor transmisibile rețelei comunitare în conformitate cu Decizia 2119/98/CE a Parlamentului European și a Consiliului cu modificarile si completarile ulterioare.
Deciziei Comisiei 2000/57/CE privind sistemul de alertă precoce și de reacție pentru prevenirea și controlul bolilor transmisibile în temeiul Deciziei nr. 2119/98/CE a Parlamentului European și a Consiliului, cu modificarile si completarile ulterioare.
MINISTERUL SĂNĂTĂŢIIAL REPUBLICII MOLDOVA
International Regulations
MINISTERUL SĂNĂTĂŢIIAL 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=331169
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=334620
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=350538
MINISTERUL SĂNĂTĂŢIIAL 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 23.07.2010http://lex.justice.md/index.php?action=view&view=doc&long=1&id=335428
MINISTERUL SĂNĂTĂŢIIAL 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 SĂNĂTĂŢIIAL 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 10.06.2013http://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.
Guideline for the supervision and control of nosocomial infections
http://www.ms.md/sites/default/files/legislatie/ghidul_de_supraveghere_si_control_in-infectiile-nosocomiale1.pdf
Legislation, Protocols and Guidence
MINISTERUL SĂNĂTĂŢIIAL REPUBLICII MOLDOVA
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
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, toxi-infection 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
I. Notificare: Сообщение
1. Nr epidemiologic Эпидемиологический номер
2. Istituţia care a notificat 2.1 .Codul instituţiei Сообщившее учреждение Код учреждения
2.2 Clasificarea instituţiei conform serviciilor prestate: Класификация учреждения 2.3 Clasificarea instituţiei conform apartenenţei:1 Asistenţă medicală primară Первичная медпомощь Классификация учреждения по принадлежности
2 Asistenţă medicală spitalicească Госпитальная медпомощь 1 Publică Общественное
3 Asistenţă medicală de urgenţă Неотложенная медпомощь 2 Privată Частное
4 Asistenţă medicală consultativă Консультативная медпомощь 3 Departamentală Ведомственное
5 Laborator Лаборатория
6 Alte Другое
2.4 Raionul/Oraşul 2.5 Localitatea 2.6 Telefon Район/город Нас. Пункт Телефон
3. Numele persoanei care a notificat 3.1 Data notificării 3.2 Ora notificării Фамилия сообщившего Дата сообщения Час сообщения
Ministerul Sănătăţii al Republicii Moldova
Министерство здравоохранения
Республики Молдова
Formular nr. Форма № 058/е
Aprobat de MS RM Утверждена МЗ РМ
11.01.2011 nr. 13
Documentaţie medicală Медицинская документация
Fişa de notificare urgentă despre depistarea cazului de boală infecţioasă, intoxicaţie, toxicoinfecţie alimentară şi/sau
profesională acută, reacţie adversă după administrarea preparatelor imunobiologice
Экстренное извещение о случае инфекционного заболевания, пищевой интоксикации/токсикоинфекции, острого профессионального отравления, необычной реакции после
введения иммунобиологических препаратов
Register nr. 60
RegNr
Diagnosis by the emergency note
Established by the medical institution. Doctor's name, surname.date
Patient's name, surname
Birth date (day, month, year). For children up to 1 month please specify maternity hospital and date of discharge ment
Home address. Region, town, street, apartment
Place of work, studies, education, etc. Address.
Dates
Place of hospitalization. Stays at home.Of ilness
First request for medical asistence
Hospita-lization
Last visit to the place of work, studies, etc.
1 2 3 4 5 6 7 8 9 10 11 12
Register nr. 60
In case of poisoning Emergency note was accepted, dispatched to the CPH
Final diagnosis.
Established. (date)
Results of the
laboratory tests (type).
Research was
conducted by
(name,surname).
Notes.
Suspected
product
The product was bought: date and time. Number of people who have
consumed the product. Date Time
Name, surname of the person who has filled in
the form
13 14 15 16 17 18 19 20 21
MINISTERUL SĂNĂTĂŢIIAL REPUBLICII MOLDOVA
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)
Investigation form nr. 362/e ordinul MS 828 din 31.10.2011
Ministry of Health of the Republic of Moldova.
Medical documentation form # 362 eInstitution 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 data1Final diagnosis
Established : day month year
2Name, Surname
3Sex: male (1), female (2) 4.Date of birth: day month year
5Home address 6. Locality: urban (1), rural (2).
7Place of work, studies, education ocupation
8Last visited the place of work, studies, education (date)
9Health institution of place of permanent resedense 10Information about the patient was received by CPM (date, hour)
Health institution which send emergency note
Surveillance system includes all levels of health systems according Annex 1 IHR (2005)
Detect events&risksReportImplement preliminary
control measures
Primary medical care
Municipality/rayon/national
Early warning department
NCPH
Center of public health
municipal/rayon
MoHNational
Focal Point IHRNCPH
WHO Focal Point IHR
MoH Ord.368/2004on approving the list of evens for
obligatory reporting in case of emergency situation
and natural disasters
Confirmation NotificationAssesment
MoH Ord.268/2009on implementation
Gov.Decree nr.475 /2008
Assessment Notification Public health response
Legislation/regulation
Medical care institution
(army, police,etc.)
Center of preventive Medicine
(army, police,etc.)
Intermediate level
Local level
National level
MoH Ord.358/2009 on approving the Case Definitions
Flow of case information Înregistrarea cazului de bolă infecţioasă
Boala înregistrată este din categoria maladiilor
imediat raportabile
Raportarea imediată la nivel raional (raional/municipal)
Ancheta epidemiologică a cazului
Este depistată o izbucnire epidemică?
Înregistrarea suspecţiei la erupţie în registru
Înregistrarea zilnică în registru
Generalizarea datelor în instituţia
medicală
Raportareadatelor la nivel
raional (municipal)
Investigarea selectivă, raportarea
datelor la nivel naţional
Analiza datelor, diseminarea
informaţiei
Insti
tuţii
lor m
edic
ale
raio
nale
, m
unic
ipal
e
Raportarea la nivelul naţional,investigarea erupţiei, elaborarea planului de acţiuni
Implementareaplanului, raport final
nivel naţional
Analiza datelor la nivel naţional, diseminarea
informaţiei
Nivel Internaţional
Insti
tuţii
lor m
edic
ale
raio
nale
, m
unic
ipal
e
Da
Nu
Da
Nu
AMP
AMP
• Notification of nominal cases of communicable diseases in
accordance with International Classification of Diseases (ICD)-10
Case classificationaccording standard case definitions, adjusted at the EU Decisions:
PossibleProbableConfirmed
• 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
MINISTERUL SĂNĂTĂŢIIAL REPUBLICII MOLDOVA
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)
Formular nr. 2
2012 2013 2012 2013 2012 2013 2012 2013 2012 2013mun. Chisinau 1 3 0 0 7 14 0 0 0.88 1.76 7 cazurimun. Balti 0 2 0 0 5 4 0 0 3.35 2.68 -1 cazuri
Total pe municpii 1 5 0 0 12 18 0 0 1.27 1.90 6 cazuriAnenii-Noi 0 0 0 0 0 1 0 0 0.00 1.20 1 cazuriBasarabeasca 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriBriceni 0 0 0 0 1 0 0 0 1.34 0.00 -1 cazuriCahul 0 1 0 0 2 1 0 0 1.60 0.80 -1 cazuriCantemir 0 0 0 0 0 1 0 0 0.00 1.60 1 cazuriCalarasi 0 0 0 0 1 0 0 0 1.27 0.00 -1 cazuriCauseni 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriCimislia 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriCriuleni 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriDubasari (Cosnita) 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriDonduseni 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriDrochia 0 0 0 0 1 0 0 0 1.12 0.00 -1 cazuriEdinet 0 0 0 0 1 1 0 0 1.22 1.22 100 %Falesti 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriFloresti 0 0 0 0 0 2 0 0 0.00 2.24 2 cazuriGlodeni 1 0 0 0 1 0 0 0 1.63 0.00 -1 cazuriHincesti 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriIaloveni 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriLeova 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriNisporeni 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriOcnita 0 0 0 0 1 0 0 0 1.80 0.00 -1 cazuriOrhei 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriRezina 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriRiscani 0 0 0 0 3 2 0 0 4.33 2.89 -1 cazuriSingerei 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriSoroca 0 0 0 0 1 0 0 0 1.00 0.00 -1 cazuriStraseni 1 0 0 0 1 2 0 0 1.09 2.18 1 cazuriSoldanesti 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriStefan-Voda 0 0 0 0 1 1 0 0 1.40 1.40 100 %Taraclia 0 0 0 0 1 0 0 0 2.27 0.00 -1 cazuriTelenesti 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriUngheni 0 0 0 0 3 2 0 0 2.56 1.71 -1 cazuriComrat 1 0 0 0 1 1 0 0 1.40 1.40 100 %Ciadir-Lunga 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuriVulcanesti 0 0 0 0 0 0 0 0 0.00 0.00 0 cazuri
UTA Gagauzia 1 0 0 0 1 1 0 0 0.62 0.62 100 %Total pe raioane 3 1 0 0 19 14 0 0 0.75 0.54 -5 cazuriTotal MS malul drept 4 6 0 0 31 32 0 0 0.89 0.90 1 cazuri
Inclusiv copii
Date cumulative, Ianuarie - Iunie
Total Inclusiv copii
Denumirea teritoriilor administrative
Hepatita virala B (HVB) acuta, totalIndicele morbiditatii
la 100000 de oameni
Indicele de raport
2013 /2012(%.caz.ori)
Numar absolut de cazuri, Iunie
Total
Filtru Toate
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_supravegherea_epidem._pneumonii_comunitare.pdf
MINISTERUL SĂNĂTĂŢIIAL REPUBLICII MOLDOVA
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=436
MINISTERUL SĂNĂTĂŢIIAL REPUBLICII MOLDOVA
Information dissemination
Annual report http://cnsp.md/info.php?id1=37&id2=21
MINISTERUL SĂNĂTĂŢIIAL 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=doc&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=doc&lang=1&id=323271
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 SĂNĂTĂŢIIAL REPUBLICII MOLDOVA
Human resource capacity development
• Applied epidemiology• Interventional epidemiology• Clinical infectious diseases• Public health management• Clinical microbiology
MINISTERUL SĂNĂTĂŢIIAL REPUBLICII MOLDOVA
Field of training and education
Multumesc de atenție
MINISTERUL SĂNĂTĂŢIIAL REPUBLICII MOLDOVA
Evaluarea Sistemului Naţional de Supraveghere a Bolilor Transmisibile și Evenimentelor de Sănătate Publică
31.03.2014 – 04.04.2014