Vaccine Preventable Diseases
HCDCP’s Newsletter devoted to Vaccine Preventable Diseases
Official Circulars on Vaccinations by the Ministry of Health
Immunization Program for Adults (2011)
New National Immunization Program for Children and Adolescents (2011)
Vaccination against tuberculosis (2012)
Vaccination for seasonal influenza (2012-2013)
AIMS OF THE OFFICE
The Office for Vaccine Preventable and Congenital Diseases aims at :
- the epidemiological surveillance of Vaccine Preventable Diseases (VPD) and Congenital Diseases (congenital syphilis, congenital rubella, congenital toxoplasmosis)
- the promotion of vaccination
- the prevention of VPD’s transmission
- the briefing of the public as well as healthcare professionals on VPD’s transmission and prevention.
OPERATIONS AND ACTIVITIES
A. Epidemiological surveillance of VPD’s
The Office for Vaccine Preventable and Congenital Diseases (VPD) of the Department of Epidemiological Surveillance and Intervention is responsible for the surveillance of the diseases: meningitis (bacterial and aseptic) and meningococcal disease, measles, rubella, mumps, pertussis, varicella with complications, tetanus / neonatal tetanus, diphtheria, poliomyelitis and congenital infections (rubella, syphilis, toxoplasmosis). Surveillance of these diseases is mainly performed through the Mandatory Notification System (MNS) while data are also collected through a Sentinel system in primary health care (sentinel). All the above-mentioned diseases are included in the Mandatory Notification System. Disease definitions, notification forms and instructions for their completion are available at the HCDCP site (eody.gov.gr).
Case definitions used are consistent with those set by the European Community legislation (2008/426/EC). Measles, rubella, mumps, pertussis and chickenpox are also monitored through the Sentinel system in primary health care (sentinel), which mainly has under surveillance diseases with wide significance for public health, relatively high frequency and mild clinical manifestations (thus usually not requiring hospitalization).
Specifically, the Office coordinates:
- reception, assessment and processing of VPDs notification forms
- surveillance and response process in reported VPDs cases · detection and investigation of single cases, clusters and outbreaks of VPDs, in cooperation with other public health bodies (such as the Regional Directorates of Public Health and Social Welfare)
- release of directives and coordination of interventions in public health events, caused by VPDs (measures to protect the cases environment and prevent the wider spread of the disease)
- assessment of VPDs’ incidence and time trends, for the country as well as for geographical areas and contribution of various risk factors on morbidity
- guidance and support on public health issues related to VPDs to doctors, healthcare professionals, public health officials and the public · preparation of protocols and procedures for VPD’s epidemiological surveillance
- reporting VPDs data to WHO (World Health Organization, Communicable Disease Annual Reporting Form), and ECDC.
A1. Poliomyelitis’ Surveillance
Among the Vaccine Preventable Diseases, poliomyelitis has a special significance as it has been a scourge in the past. After the implementation of systematic vaccination and close epidemiological surveillance, WHO declared the American Continent as polio free region in 1994, the Western Pacific in 2000 and Europe in 2002. In order to maintain Europe and the other regions as disease-free, WHO launched the surveillance of Acute Flaccid Paralysis (AFP) in all children aged less than 15 years old but also to adults of any age when polio is suspected. The monitoring and investigating of all AFP cases increases the system’s sensitivity to early detect of even rare cases, to detect the introduction of wild polio virus from endemic countries and to determine the incidence of vaccine-related cases. In our country, AFP surveillance is crucial due to country’s characteristics such as the immigration and entrance of refugees from endemic areas, the existence of special population groups with low vaccination coverage (eg Romas) and the proximity to countries, either until recently endemic or with collapsed health systems. Fifty-two (52) doctors from 24 hospitals in the country (neurologists, pediatricians and intensive care doctors) participate in the AFP clinical surveillance network.
Network’s main fields of actions are:
- weekly active monitoring of AFP incidence (telephone contact with the doctors), confirming compliance with the prescribed procedure (notification form, stool samples, case’s follow-up after 60 days)
- upload of a weekly cases’ report to WHO (or null statement) through a web-based specific database.
- cooperation with the National Reference Enteroviruses / Polioviruses Laboratory (Hellenic Pasteur Institute) for laboratory testing of stool samples
- participation, administrative and secretarial support to the meetings of the Scientific Committee «Committee of Experts» which monitors the polio eradication program.
- participation in the preparation of an annual report
- standardized by WHO – related to the country’s activities on the AFP – Polio surveillance and maintaining the disease-free country status (the report is drawn up by the National Certification Committee on polio eradication program)
- publication of AFP surveillance annual results and feedback to the AFP Network.
Within the intensification of polio surveillance in our country, the Office coordinates:
- The organization and operation of supplementary enteroviruses surveillance (Nov 2010 – present), in accordance with the instructions of the Scientific Committee «Committee of Experts» to monitor the polio eradication program, with the participation of 9 Social Centers and Reception Centre for Asylum Seekers Lavrion (collection of stool samples from healthy children belonging to high risk groups), following the pilot program conducted in 2008.
- The coordination of supplementary polio sewages surveillance
- The reorganization and expansion of AFP surveillance network surveillance, adding and other medical-associates
- The preparation of a proposal for the National Action Plan for Polio (according to WHO guidelines), at the request of the Scientific Committee «Committee of Experts» to monitor the polio eradication program.
A2.Surveillance of Meningitis
One of the diseases that are of particular interest to the general public is meningitis. Greece is one of the few countries in the world that has under surveillance meningitis as a whole, collecting data on meningococcal disease (which is usually the main target of surveillance), as well as for bacterial and aseptic meningitis. The Office of Vaccine Preventable Diseases collects data through the mandatory notification form for meningitis cases, which are hospitalized throughout the country and through the daily communication with the National Reference Center for Meningitis (NRMC) of the National School of Public Health. Follow up of hospitalized patients is performed in order to obtain additional information on the clinical status and laboratory findings of the patient and the notification form statement is sent by fax to the Regional Directorates of Public Health and Social Welfare. Crucial is the causal classification of the case in order to take all necessary measures (chemoprophylaxis and / or vaccination when needed) in cooperation with the Directorate of Public Health to prevent the spread of the disease in all persons who came in close contact with the case.
In particular, surveillance of meningitis include the following actions by the Office of Vaccine Preventable Diseases:
- Investigation of meningitis cases, coordination of interventions and guidance for the public health safety (communication with doctors and Regional Directorates of Public Health)
- Checking of the notification forms for completeness of data and recording them in a special database for meningitis
- Exchange of data with the National Reference Center for Meningitis via a daily telephone contact and active search meningitis cases that have not been notified. NRCM identifies some of the causal factors that cause meningitis (bacterial or viral) as: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, Listeria monocytogenes, Streptococcus spp, Pseudomonas aeruginosa, Haemophilus spp (non b,) Staphylococcus aureus, Enteroviruses and Herpes viruses (HSV-1, HSV-2). The identification is made with conventional (cultivation, serotype) and molecular techniques.
- Strengthening the collection of samples and dispatch for laboratory confirmation and strain identification from bacterial meningitis cases.
A3. Surveillance of Measles
Measles is the next targeted disease for eradication by WHO, just after polio. For its global achievement, it seems that more than 10 years are required but for the European zone of WHO, the measles strategic plan for 2010-2015 aims to achieve and maintain vaccination coverage of 95%, reduction of cases in less than 5 per one million population and reduction of mortality by 95% compared to 2000. Measles is a highly contagious acute viral disease that can lead to serious complications and even death. Despite the implementation of effective and safe vaccine, the goal of WHO for measles eradication from Europe by 2010 has not been attained. On the contrary, in 2010, 30.367 measles cases were reported in Europe, of which 22.005 (25 deaths) were reported in Bulgaria and several in France, Italy, Germany, Ireland, the United Kingdom and Spain. In Greece, measles outbreaks were reported in 2005, 2006 and in 2010 – 2011 with 149 cases in 2010 and 40 cases by the end of 2011.
More specifically, the Office for Vaccine Preventable Diseases in order to take care of outbreaks carries out :
- Enhanced surveillance of measles in collaboration with the National Reference Centre for Measles-Rubella (Hellenic Pasteur Institute), with weekly telephone contact and active search of measles cases that have not been declared. In this context, instructions are given to healthcare professionals for timely samples collection and sending them for laboratory confirmation and standardization of virus in all clinical cases of measles.
B. Informing the public and healthcare professionals on VPDs transmission and prevention
- Reply to queries via telephone
- Send detailed answers to questions by bodies, organizations, institutions, etc.
C. Vaccination coverage study
Perform a vaccination coverage study in order to make a systematic record of children’s vaccination status and draw conclusions on potential need for periodic updating of national vaccination strategies.
D. Scientific support and written instructions in case of interventions in VPD’s outbreaks or individual cases
E. Convergence of poliomyelitis’ Scientific committees
F. Representation in international organizations
Representation of Greece to WHO and the European Centre for Disease Prevention and Control (ECDC) on issues related to VPD by communicating data, reply to questionnaires etc.
G. Participation in the HCDCP’s website and Newsletter
||Administrative personnel (BSc, MSc)