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Health systems in transition Latvia event of violation of this Law. Epidemiological safety includes control of environmental sanitary and hygiene conditions and epidemiological surveillance of infectious diseases. • “Procedure of Notification of Infectious Diseases” (Regulations of the Cabinet of Ministers, 1999), which specifies notification procedures in the event of an outbreak of an infectious disease. • “Procedure of Epidemiological Surveillance of Infectious Diseases” (Order of the Ministry of Welfare, 2001), including documents of a technical character specifying details of epidemiological surveillance of infectious diseases. Communicable disease surveillance has been adapted to the requirements of the EU, and notification of infectious diseases is required to the European Centre of Disease Control in Stockholm. PHC services are key elements for the notification of communicable diseases. The notification flowchart in Fig. 6.1 shows that cases are reported to the Public Health Agency by health care service providers. AIDS patients and HIV-positive individuals, as well as patients with TB and STI are first reported to the institutions responsible for the control of these diseases. The Epidemiological bulletin is prepared by the Public Health Agency. Legislation obliges immediate notification of: • a single suspected case of a dangerous infectious disease (cholera, anthrax, plague, yellow fever, Ebola, Lassa, Marburg and other haemorrhagic fevers, Fig. 6.1 Notification system for communicable diseases Case detection (health care worker) Case notification within 12 hours by phone or fax PHA territorial branch AIDS, TB, STI centres Statistical reports State Agency of Statistics and Medical Technologies PHA Ministry of Health Epidemiological bulletin (PHA) Summarized data, monthly Other ministries, institutions and the mass media Source: Authors’ own compilation. Notes: PHA: Public Health Agency; AIDS: Acquired immune deficiency syndrome; TB: Tuberculosis; STI: Sexually transmitted infection. 165
Health systems in transition Latvia • • • • epidemic louse-borne typhus fever/Brill-Zinsser disease, relapsing fever, SARS and other dangerous infections, rabies); three or more cases of botulism, brucellosis, diphtheria, tick-borne encephalitis, E. coli 157, haemorrhagic fever with renal syndrome, legionellosis, leptospirosis, malaria, meningococcal infection, ornithosis, paratyphoid fever, Q-fever, nosocomial infection, trichinellosis, tularaemia, typhoid fever; five or more cases of hepatitis A, yersiniosis, salmonellosis, shigellosis, food intoxications, measles, mumps, rubella, pertussis, influenza (during non-epidemic season), viral meningitis, encephalitis; serious (hospitalized) cases without clear aetiology of the disease; suspicion of quarantine diseases at state borders; two or more cases of adverse events following immunization. Another task of the Public Health Agency is surveillance of immunization. The state Programme of Immunization is based on WHO guidelines. Vaccinations provided free of charge in Latvia include those: • for children – against TB, diphtheria, tetanus, pertussis, poliomyelitis, measles, rubella, mumps, infection of Haemophilus influenza, hepatitis B, tick-borne encephalitis (in selected regions); • for adults – diphtheria, tetanus (with specific indications), influenza (specific age and high-risk groups). The immunization level for children is on average approximately 95–98%. Vaccinations are provided by family doctors, paediatricians and doctor’s assistants at the PHC level. There are two special, population-based screening programmes: one is for neonates, to detect congenital phenylketonuria and hypothyroidism, and the other is a screening programme for pregnant women. These are financed by the SCHIA, and positive findings are reported to the Children’s Hospital. This hospital used to run the relevant registry, but at present all the registries are under the management and financing of the State Medical Statistics Agency. Oncology screening results are reported to state Oncology Centre (at the Riga East Hospital, which formerly used to run the onco-register). The rest of the population undertakes opportunistic screening. Public financing covers several cancer screening tests depending on one’s sex and age group, including: oncologic-cytologic smears, mammography, examination of feces for hidden blood, prostatic specific antigen, etc. Unfortunately, this opportunistic cancer screening does not appear to be effective, as the number of patients with cancer diagnosis at a late stage is growing in the country. 166
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