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1 Dlhý Jozef

2 xxxxx Geographical size: km² Population: (2014) EU member country since: 1 May 2004

3 REGIONS (kraje): 14 (13 + capital city Prague with regional status) DISTRICTS (okresy): 76

4 Organizational Structure of Public Health Focusing on Surveillance in the Czech Republic Chief Public Health Officer Ministry of Health Dept. of PH Protection and Promotion Epidemiology Unit National Institute of Public Health Regional Public Health Authorities Regional Institutes of Public Health

5 Regional PHAs: 14 Institutes of PH: 2 Local PHAs: 81 National PH Institute

6 Public Health Institutions and their main surveillance tasks (1) National competent PHP authority Central authority of state administration for surveillance tasks (responsible for related legislation including harmonization of Czech legislation with the EU and related methodical guidelines) Management of national vaccination strategy Management of national sero-surveys of VPD National authority for PH threat detection / PH preparedness and response (in accordance with the EU / ECDC requirements) Cooperation with the Veterinary Service in implementing zoonoses surveillance at national level Ministry of Health

7 Public Health Institutions and their main surveillance tasks (2) National Institute of Public Health (1) State health care establishment for basic preventive disciplines (hygiene, epidemiology, microbiology and occupational medicine) with National reference laboratories Monitoring and analysis of the epidemiological situation of communicable diseases at both the national and international levels Involvement in the preparation of infectious diseases surveillance programmes Cooperation in implementing surveillance programmes and ongoing assessment of outcomes of surveillance programmes Participation in the implementation and assessment of molecular epidemiology programmes Cooperation with the Veterinary Service in implementing zoonoses surveillance at national level

8 Public Health Institutions and their main surveillance tasks (3) National Institute of Public Health (2) Participation in the European, WHO, and ECDC communicable disease notification networks Data collection and exchange, ensuring the compatibility of the data from the national notification systems Participation in the preparation of national legislation and methodical guidelines Processing the reported cases of infectious diseases at a country-wide level and providing information on the epidemiological situation in the Czech Republic in The Bulletin of the Centre for Epidemiology and Microbiology (ISSN ).

9 Public Health Institutions and their main surveillance tasks (4) National Institute of Public Health (3) Weekly, monthly and yearly analyses of epidemiological data. Participation in the maintenance and management of the reporting system of acute respiratory infections (ARI). Monitoring of the incidence of natural focus infections and participation in the national tick activity forecast system along with the Czech Hydrometeorological Institute

10 NIPH - National Reference Laboratories Complex of 25 national reference laboratories in December 2011 newly accredited as public health laboratories under related standards NRL - The Czech National Collection of Type Cultures NRL for Antibiotics NRL for Disinfection and Sterilization NRL for Diagnostics of Syphilis NRL for Electron Microscopy Virus Detection NRL for E.coli and shigellas NRL for Enteroviruses NRL for Haemophilus Infections NRL for Herpetic Viruses NRL for Chlamydia NRL for HIV/AIDS NRL for Influenza NRL for Leptospira NRL on Lyme borreliosis NRL for Measles, Mumps, Rubella, and Parvovirus B19 NRL for Meningococcal Infections NRL for Mycobacteria NRL for Nonflu Respiratory Viruses NRL for Pertussis and Diphtheria NRL for Salmonella NRL for Staphylococci NRL for Streptococcal Infections NRL for Toxoplasmosis NRL for Vector Control NRL for Viral Hepatitis

11 Public Health Institutions and their main surveillance tasks (5) Institues of Public Health State health care establishments sharing duties with NIPH and MoH in the area of epidemiological surveillance: Monitoring of population health status Monitoring of environmental factors and their influence in public health Provision of specialized care in microbiology, virology and parasitology Analysis of biological material

12 Public Health Institutions and their main surveillance tasks (6) Regional Public Health Authorities National competent PHP authorities Regional PHP competent authority Responsible for the basic surveillance Organization of communicable disease prevention and control Organization of emergency measures in case of epidemics Monitoring and analysis of the epidemiological situation of communicable diseases at regional level Cooperation with the Veterinary Service in implementing zoonoses surveillance at regional level

13 Legislation covering key aspects of epidemiological surveillance Act No. 258/2000 on Public Health Protection and Amendments to other Related Acts (as amended) Decree of the MoH of the Czech Republic No 275/2010 Coll. Amending the Decree No 473/2008 Coll. on Surveillance System for Selected Infectious Diseases Decree of the MoH of the Czech Republic No 306/2012 Coll., the Terms and Conditions for the Prevention of Development and Spreading of Infectious Diseases and Hygiene Requirements for Hospitals and other Health Services Decree of the MoH of the Czech Republic No 537/2006 Coll. on vaccination against infectious diseases

14 CZ EU Harmonisation of Legislation (1) Decision No 2119/98/EC of the European Parliament and of the Council of 24 September 1998 setting up a network for the epidemiological surveillance and control of communicable diseases in the Community 1. Designation of competent authorities at national level which are charged with collecting information relating to the epidemiological surveillance of communicable diseases, and by establishing procedures for the dissemination of the relevant surveillance data at Community level. Act No. 258/2000 on Public Health Protection and Amendments to other Related Acts (as amended) 75a, paragraph 1 Designation of MoH as Competent Authority

15 CZ EU Harmonisation of Legislation (2) Decision No 2119/98/EC of the European Parliament and of the Council of 24 September 1998 setting up a network for the epidemiological surveillance and control of communicable diseases in the Community 2. Notification of CDs in accordance with EU case definitions Act No. 258/2000 on Public Health Protection and Amendments to other Related Acts (as amended) 75a, paragraph 4 Decree of the MoH of the Czech Republic No 473/2008 Coll. on Surveillance System for Selected Infectious Diseases 13 CDs included

16 CZ EU Harmonisation of Legislation (3) Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council Decree of the MoH of the Czech Republic No 275/2010 Coll. Amending the Decree No 473/2008 Coll. on Surveillance System for Selected Infectious Diseases 13 CDs included in the original decree (No 473) were supplemented through the amendment to 28 CDs

17 CZ EU Harmonisation of Legislation (4) Decree of the MoH of the Czech Republic No 306/2012 Coll., the Terms and Conditions for the Prevention of Development and Spreading of Infectious Diseases and Hygiene Requirements for Hospitals and other Health Services A three-tiered system with following levels is for the first time used: possible case probable case confirmed case

18 CZ EU Harmonisation of Legislation (5) Decree of the MoH of the Czech Republic No 306/2012 Coll., the Terms and Conditions for the Prevention of Development and Spreading of Infectious Diseases and Hygiene Requirements for Hospitals and other Health Services New 22nd item in the List of CDs for which the isolation is necessary: Manifestations of disease or event that represents the possibility outbreaks under Article 1 of the International Health Regulations, which is in accordance with the Annex to Decision 2119/98 communicable diseases

19 ICT Systems used by PHA for the purpose of CDs Surveillance Surveillance of CDs except AIDS, TB, STI Based on EpiInfo v.6 Surveillance of Acute Respiratory Infections Build as WEB application (on ORACLE server) Surveillance of Tuberculosis Build as WEB application (on ORACLE server) Surveillance of Sexually Transmitted Infections Build as WEB application (on ORACLE server)

20 Weekly data export Local Epid. Dept. Local Epid. Dept. Local Epid. Dept. 81 LPHA Regional Epid. Dept. Regional Epid. Dept. 14 regions National Institute of Public Health All three levels of database (central, regional and local) are synchronized by the end of week NIPH presents weekly reports on the WEB for general public and professionals.

21 Surveillance Data Sharing The European Surveillance System TESSy NIPH validates and corrects EpiDat data NIPH exports EpiDat national data on communicable diseases to TESSy (ECDC) on the basis of EU case definitions Data export is annually (all diseases), quarterly (salmonella), monthly (mumps, rubella)

22 RED REPORT Same data structure for all diseases

23 Laboratory tests Etiological agent Disease actively searched Diagnosis determined Character of illness Location supplied with water Disposal of waste water Source of infection confirmed Satisfies Name of source Date of birth Address Example of BR for Salmonellosis City Date of onset Route of transmission confirmed

24 VEHICULUM SPECIFICATION More detail specification Food produced Food purchased Suspected vehiculum tests Examined sample specification Date of sampling Result of the test sample Tests of animals Type of animal Type of material Date of biological material collection The result of biological material examination Example of BR for Salmonellosis

25 LABORATORY TESTS Date of sampling: Examination: Result: Material: Cultivation: Type of test: Titre: Serological: Agent: Note: Phagotype: Example of GR for Salmonellosis

26 Presentation of data collected 1. system generates incidence per tables for all notified diagnoses and all regions Overview by report week 19. week Diagnosis: N carrier A01 A01.0 A01.0N A01.1 A01.1N A01.2 A01.2N A01.3 A01.3N A01.4 A01.4N A02 A02.1 A02N A03 A04 A04.5 A05 A05.1 A05.2 A06 A06.0 A06.2 A06.4 A06.N A07.1 A07.8 A08 A09 A21 A26 A27 A32 A35 A36 A36N A37.0 A37.1 A38 A39.0 A39.2 A40 A41 A42 A46 A48.0 A48.1 A48.3 A59 A69.2 A74.0 A79 A81 A84.1 A86 A87.0 A87.8 A87.9 A88 A89 A90 A98.5 B00 B01 B02 B06 B08 B08.0 B15 B16 B17.1 B17.2 B18 B18.1 B18.2 B18.9 B25 B26 B27 B30 B33.0 B35 B36 B37 B45 B49 B50 B51 B58 B65.0 B67 B68.1 B76 B77 B79 B80 B83.0 B85 B85.0 B85.1 B85.2 B86 B96.3 G00 G51 J10 J17 W54 W55 B01 VARICELLA by week of report Total week per week per , ,6 69 5, ,1 71 6, , , , , ,6 14 4, ,8 44 5, , , , , ,9 39 7, ,3 39 7, , , ,4

27 Presentation of data collected 2. detailed description of diagnoses picked for current situation by clinical epidemiologist Every case report includes Main reasons for standardization: - different age structure of districts - comparable incidence not only within the Czech Republic date of report date of onset best for fast information best for analytic purpose European standard WHO

28 Morbidity per : Start of Routine HBV-Vaccination in Risk Groups Others Health Care Workers ,0 4,0 3,0 2,0 1, ,

29 No of Cases : Start of Special HAV+HBV Vaccination in Selected Staff of Integrated Rescue System 0 Year

30 Infectious Diseases Imported to the Czech Republic during , by destination of origin (N = 2663) CZECH TOURISTS FROM WORLD FROM EUROPE

31 Infectious Diseases Imported to the Czech Republic during , by destination of origin (N = 3735) FOREIGNERS

32 FLOODING - TOTAL PRECIPITATION with comparison of leptospirosis cases Leptospirosis cases associated with flooding in 1997 Leptospirosis cases associated with flooding in 2002

33 Outbreak Detection and Early Warning Notification Algorithm COM ECDC MS MoH NIPH MoA / SVA MedSSOCs RPHO HOs / LABs GPs

34 Outbreak Detection and Expert Communication Algorithm COM EPIS ECDC MS MoH NIPH MoA/SVA MedSSOCs RPHO HOs / LABs GPs

35 Surveillance and interdepartmental Cooperation - Working Group on Zoonoses Established under State Veterinary Administration gestion Active since 2010 Members: State Veterinary Administration, Ministry of Agriculture, Czech Agricultural and Food Inspection, Ministry of Health, National Public Health Institute, State Veterinary Institute Olomouc The main objective: regular exchange of information, risk analysis, coordination and evaluation of monitoring programs and coordination of procedures for the adoption of measures and public health awareness enhancement

36 SURVEILLANCE INTERACTIONS National Focal Points according EU / ECDC requirements NFP - Public Health Function Communication Microbiology Preparedness and Response Public Health Training Scientific Advice Coordination Surveillance Threat detection EWRS (Early Warning and Response System), IHR (International Health Regulations) NFP - Disease Specific Antimicrobial Resistance ARHAI Antimicrobial Consumption Health-care Associated Infections Emerging and Vector-borne dis. Influenza Food/Water-borne - Zoonosis Legionellosis TSE HIV/AIDS-STI-Hepatitis Tuberculosis Vaccine Preventable Diseases

37 Surveillance System for ARI (1) Starting from the season 2001/2002 ARI acute respiratory illness ILI influenza like illness Each RPHA enters the data from collaborating general practitioners and paediatricians into the central database, using an encrypted Web transfer with name and password controlled access Five age groups: 0-5, 6-14, 15-24, 25-59, 60+ In each district was sampled physicians covering approximately 20% of population The entered data consists of numbers of ARI, numbers of complications of ARI and the population registered with the GPs and paediatricians that reported, all separately in monitored age groups (0-5, 6-14, 15-24, 25-59, 60+ years). There is also space for comments The system now includes approx GPs and 1240 paediatricians; approximately 5 million population (half of the Czech population) is in their care

38 Surveillance System for ARI (2) ARI for reporting purposes is defined as every GP s clinical diagnosis of acute upper respiratory tract infection (as defined by the International Classification of Diseases, Tenth Revision (ICD-10), codes J00, J02, J04, J05, J06) and influenza (ICD-10 codes J10.1, J10.8, J11.1, J11.8) ILI is defined as clinical picture compatible with influenza, e.g. sudden onset of disease, cough, fever > 38 ºC, muscular pain and/or headache, in accordance with the EU case definition for influenza. (Commission Decision of 19 March 2002 laying down case definitions (Decision No. 253/2002/EC) for reporting communicable diseases to the Community network

39 Surveillance System for ARI (3) Tools for public health specialists For construction of tables, maps or graphs is possible to use filters for: - ARI or ILI -region or district - age group - week and year

40 Uniform criteria set by the Chief Public Health Officer i. a. selection of children by annually chosen first letter of their family name Sentinel estimates are under responsibility of Regional PHAs in close collaboration with practicing pediatricians Regular mandatory vaccination against nine infectious diseases is included (Measles, Mumps, Rubella, Diphtheria,Tetanus, Pertussis, Poliomyelitis, Invasive diseases due to Haemophilus influenzae type b, Hepatitis B) Results confirm that the vaccination coverage in the regions achieves levels suitable for inducing herd immunity against the selected infectious diseases

41 ACKNOWLEDGEMENTS Colleagues from NIPH Dr Barbora Mackova Dr Hana Orlikova Dr Bohumir Prochazka

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