MISSION REPORT Surveillance and early detection and response systems in Latvia 26–30 September 2011 www.ecdc.europa.eu ECDC MISSION REPORT Surveillance and early detection and response systems in Latvia 26–30 September 2011 This report of the European Centre for Disease Prevention and Control (ECDC) was coordinated by Graham Fraser. Acknowledgements The ECDC team gratefully acknowledges the generous assistance and valuable information provided to them by officials from the Latvian Ministry of Health; experts at the Infectology Centre of Latvia; and public health staff at national, regional and local levels. The following reports: Country mission Latvia: antimicrobial resistance; Country mission Latvia: HIV, sexually transmitted infections and hepatitis B and C; and Tuberculosis in Latvia, are also available at www.ecdc.europa.eu/en/publications/ Suggested citation: European Centre for Disease Prevention and Control. Surveillance and early detection and response systems in Latvia. Stockholm: ECDC; 2013. Stockholm, November 2013 ISBN 978-92-9193-510-9 doi 10.2900/92471 Catalogue number TQ-02-13-499-EN-N © European Centre for Disease Prevention and Control, 2013 Reproduction is authorised, provided the source is acknowledged ii MISSION REPORT Surveillance and early detection and response systems in Latvia Contents Abbreviations ................................................................................................................................................ v Executive summary ........................................................................................................................................1 1 Introduction ...............................................................................................................................................2 1.1 Background ........................................................................................................................................2 1.2 Scope and purpose ..............................................................................................................................2 1.3 Organisation .......................................................................................................................................2 2 Background ................................................................................................................................................4 2.1 Public health system overview ..............................................................................................................4 2.2 Restructuring under economic stringency ..............................................................................................4 2.3 Communicable disease and control infrastructure ...................................................................................4 2.4 Diagnostic laboratory infrastructure ......................................................................................................6 3 Surveillance system .....................................................................................................................................7 3.1 System objectives ...............................................................................................................................7 3.2 Current basis: legislative, regulatory, administrative ............................................................................... 7 3.3 System overview ................................................................................................................................. 7 3.4 Major additional disease-specific surveillance systems .......................................................................... 10 3.5 Sentinel surveillance systems ............................................................................................................. 10 3.6 Syndromic surveillance systems .......................................................................................................... 11 3.7 Personal data protection .................................................................................................................... 11 4 Surveillance system assessment ................................................................................................................. 12 4. 1 Evaluation and monitoring of the surveillance system .......................................................................... 12 4.2 System attributes .............................................................................................................................. 12 4. 3 System coordination and integration .................................................................................................. 13 5 Early detection and response systems ......................................................................................................... 15 5. 1 Regional level .................................................................................................................................. 15 5.2 National level .................................................................................................................................... 16 6 Summary and conclusions .......................................................................................................................... 18 6.1 The surveillance system (VISUMS) ...................................................................................................... 18 6.2 Wider system and primary diagnostic laboratory system issues resulting in apparent under-diagnosis of certain diseases of public health importance .............................................................................................. 18 6.3 Outbreak detection and management ................................................................................................. 20 6.4 Wider system issues .......................................................................................................................... 21 6.5 Epidemiologist workforce: accession planning, training, continuing professional education ....................... 22 6.6 Feedback to data providers and stakeholders ....................................................................................... 23 6.7 Workload and efficiencies in workflow ................................................................................................. 23 6.8 Surveillance system case classification – from notifications to surveillance cases to ECDC reporting .......... 23 6.9 Data protection ................................................................................................................................. 23 7 Recommendations ..................................................................................................................................... 25 7.1 Incremental development of the VISUMS surveillance system................................................................ 25 7.2 Regulatory/laboratory primary diagnostic system issues for the underdiagnosis of certain diseases of public health importance ................................................................................................................................... 25 7.3 Increasing the effectiveness of outbreak response and evaluation ......................................................... 25 7.4 Communicable disease regulatory framework and priorities ................................................................... 26 7.5 The epidemiologist workforce ............................................................................................................. 26 7.6 Feedback to data providers and stakeholders ....................................................................................... 27 7.7 Workload, work routines .................................................................................................................... 27 7.8 National EU-compatible case classifications for surveillance ................................................................... 27 7.9 Data protection, patient confidentiality, deductive disclosure ................................................................. 27 7.10 Epidemic intelligence ....................................................................................................................... 28 7.11 Emergency preparedness (public health emergencies) ........................................................................ 28 Annex 1. Members of review team ................................................................................................................ 29 General surveillance and early detection systems review team .................................................................... 29 Annex 2. Respondents in Latvia ..................................................................................................................... 30 Annex 3. Draft itinerary ................................................................................................................................ 31 Annex 4. Specific questions from the ministry to be addressed in the course of the review ................................. 32 Annex 5. System description from the Latvian Ministry of Health, August 2011 .................................................. 33 1. EU and national legislation in the field of epidemiological surveillance ...................................................... 33 2. About accomplished reforms in the field of epidemiological surveillance ..................................................