Prevention and Control of Communicable Diseases – Road to the European Union

Prevention and Control of Communicable Diseases – Road to the European Union

The Association Agreement between the EU and Georgia envisages the modernization of the Georgian healthcare system and the gradual introduction of European standards. Reforms will continue in the healthcare sector and joint programmes between the EU and Georgia will be established with the aim of ensuring high quality healthcare for all Georgian citizens.

Georgia has undertaken the obligation to bring its healthcare legislation into line with that of the EU, a process known as approximation. Legislative approximation to the EU will cover areas like the development of human resources for health, improving the governance and financing of the healthcare system, improving epidemiological surveillance and the control of communicable diseases, increasing preparedness for public health threats and emergencies, quality and safety of substances of human origin and the prevention and control of non-communicable diseases.[1]

Microorganisms do not recognize borders and epidemics can spread very quickly if countermeasures are not taken in a timely manner. When it comes to communicable diseases, the EU response aims to be prompt and coordinated. The EU has three decisions on communicable diseases, which are binding on Georgia from 2017. The protection of public health represents a set of measures designed to improve public health, prevent and control diseases. Europe pays a great deal of attention to public health as the prevention and control of diseases is more cost-effective than their treatment.

The first decision is “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”.

This decision sets up a Community network to promote cooperation and coordination between European countries with a view to improving the prevention and control of communicable diseases. This network conducts epidemiological surveillance and established an early warning and response system, aiming to prevent and control the spread of diseases.

What are communicable diseases and why are they dangerous for society?

Communicable or infectious diseases are diseases caused by pathogenic biological agents, sometimes known as germs. The definition derives from the term “infection” which means the invasion and multiplication or activity of disease-causing microorganisms (bacteria, viruses, parasites, prions, fungi) in a host body. Infectious disease may progress with or without clinical symptoms, or manifest itself in the form of carrier of causing pathogen.[2]  The human body has natural immune system to fight infections. The body develops antibodies, which protect us from and fight against infections. Nevertheless, there are communicable diseases which the body cannot overcome naturally. In case of aggravation, these diseases can be dangerous to life. To avoid these diseases and their aggravation, immunization (the strengthening of immunity through vaccination) is carried out. Communicable diseases include diseases subject to vaccination (diphtheria, measles, German measles, mumps, whooping cough, poliomyelitis, and so on), sexually transmitted diseases (gonorrhea, chlamydia, HIV, viral hepatitis), waterborne and foodborne diseases (botulism, leptospirosis, salmonellosis, shigellosis), airborne diseases (legionella, meningococcal infection, pneumococcal infection, tuberculosis, zoonoses (brucellosis, rabies), nosocomial infections and others.

The decision directive is the “Commission Decision 2000/96/EC of 22 December 1999 on the communicable diseases to be progressively covered by the Community network under Decision No 2119/98/EC of the European Parliament and of the Council”.

Epidemiological surveillance is a permanent system of collecting, analyzing and spreading information about public health. The prevention and control of communicable diseases involves various activities, including epidemiological research by public health centers, designed to avoid the spread of communicable diseases and to prevent them. The Community network set up by these directives collects information on communicable diseases and sends that information to relevant bodies, such as public health authorities, researches and so on, passing information between countries. The list of diseases covered by the network changes in accordance with how prevalent they are among the population.

The third decision concerns the reporting of communicable diseases. It is called the “Commission Decision 2002/253/EC of 19 March 2002 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”.

Through the Community network, EU member states must communicate information on epidemiological developments and the emergence of public health threats from communicable diseases. For data in the epidemiological surveillance to be useful, it must be uniform across the countries, and be presented in a timely manner. In order to ensure that information can be passes efficiently from country to country, common case definitions were set up. Definitions of infectious diseases and conditions are uniform criteria for their confirmation and classification. The definitions of cases was based on the following principles:

Confirmed case – a case with typical a clinical picture associated with a specific disease and positive laboratory tests confirming the disease.

Probable case – a case characterized by a clinical picture associated with a disease and linked epidemiologically to a confirmed case.

Possible case – any case with clinical symptoms compatible with the description of a disease subject to reporting, i.e. a case with typical a clinical picture associated with a disease. In a possible case, the epidemiological link is not established with a confirmed or probable case. Let us discuss a case of diphtheria.

Clinical picture

The clinical picture is compatible with diphtheria, in particular, intoxication, inflammation of the mucous membrane of the respiratory tract, characterized by acute sore throat, fever, tonsillitis, and pharyngitis.

Laboratory criteria for diagnosis

  • Isolation of Corynebacterium diphtheria from a specimen
  • Histopathologic diagnosis of diphtheria.

Case classification

  • Probable case – not compatible
  • Possible case clinically compatible with diphtheria but not confirmed by laboratory analysis and not linked epidemiologically to a confirmed case
  • Confirmed case clinically compatible with diphtheria, confirmed by laboratory analysis and linked epidemiologically to other confirmed cases.

This is the principle applied in EU countries for the classification of all communicable diseases and their reporting to the relevant accredited structures.

In Georgia, the L. Sakvarelidze National Center for Disease Control and Public Health, part of the Ministry of Labour, Health and Social Affairs, is responsible for the implementation of these directives. However, placing the responsibility on only this entity is incorrect  However, epidemiological surveillance and the control of communicable diseases requires intensive coordination of other entities, including the Ministry of Agriculture of Georgia, the Ministry of Environmental Protection and others. The prevention of communicable diseases and the timely exchange of information in Georgia is regulated by the Law on Public Health, which was adopted in 2007. The aim of the law is to promote public health and healthy lifestyle practices, ensure environmental health, promote family reproductive health and prevent the spread of communicable and non-communicable diseases.[3] Apart from this law, two legal acts concern communicable diseases and the prevention thereof.

On 9 July 2015, the government of Georgia adopted the Ordinance #336 “On the Approval of the Rule of Operation of the Integrated National System of Epidemiological Surveillance of Infectious Diseases, including, Diseases Caused by especially Dangerous Pathogens” which concerns the smooth functioning of an integrated national system for the epidemiological surveillance of infectious diseases, including, diseases caused by especially dangerous pathogens.

The Decree #01-2/n, dated 18 January 2016, of the Minister of Labor, Health and Social Affairs, “On the Rule of Recording and Supplying Statistical Information” regulates the proper record-keeping of statistical data and supplying it to the relevant structures.

At present, the National Center for Disease Control and Public Health regularly supplies information to the World Health Organization about issues of epidemiological surveillance and the control of communicable diseases. Also, a regular exchange of information takes place with the European Centre for Disease Prevention and Control, the ECDC, especially on diseases such as flu, AIDS, and tuberculosis. It should be noted, however, that the supply of information on cases of tuberculosis is ensured by the National Center of Tuberculosis and Lung Diseases.

An integrated electronic system of epidemiological surveillance operates in Georgia. Entities falling within the integrated national system of epidemiological surveillance exchange information in a timely manner and this information is used for the prompt reporting, monitoring and analysis of cases of disease. Entities falling within the integrated national system of epidemiological surveillance (the National Center for Disease Control and Public Health, the Laboratory of the Ministry of Agriculture of Georgia, the National Food Agency, the Revenue Service, Public Health Center) have the obligation to register, notify and update existing cases within the scope of their competence.[4] This is a step forward, as the electronic exchange of information has already been successfully performed in Georgia. One issue remains to be solved – this information should be exchanged with, and reported in a corresponding format to, the European Community network.

How will the fulfillment the EU directives benefit the ordinary citizens of Georgia?

The answer is obvious – improved healthcare which includes the timely prevention of communicable and non-communicable diseases, and the provision of quality medical services in case of treatment. Approximation with Europe and the Association Agreement will benefit all citizens of Georgia because epidemiological surveillance and the control of communicable diseases, as well as the timely exchange of information with the European Community network, will help us avoid epidemics. It is therefore in the country’s interest to fulfill the agreement and to further approximate to Europe, as this will help to ensure a safe and bright future of Georgia.