MINISTRY OF HEALTH OF BULGARIA NATIONAL PROGRAM FOR PREVENTION AND CONTROL OF VECTOR BORNE TRANSMISSIVE DISEASES 2014-2018 Dr Sonia Jordanova, Chief expert, Ministry of health 22-23 April 2015, Razlog

MINISTRY OF HEALTH OF BULGARIA Solid results have been achieved due to: 1. The National Program for Prevention and Control of Tick Borne Transmissive Diseases (TBTD) 2008-2009 is an extension of the current functioning one, adopted by a Decree of the Council Of Ministers №18 from 16 January 2004 for the period 2004-2007

MINISTRY OF HEALTH OF BULGARIA Година 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Общо ККХТ Брой случаи (на 100 000) 18 0,23 14 0,18 7 0,09 2 0,03 13 0,17 6 0,08 4 0,05 8 0,11 90 Брой умрели (леталитет) 33,33 14,29 28,57 1 50,00 7,69 16,67 25,00 0,01 17 ХТБС (на 100000) 5 0,06 0,07 3 0,04 15 0,21 9 0,12 55 20,00 Марсилска треска 1282 16,34 807 10,4 406 5,26 640 8,29 655 8,57 656 8,62 451 5,96 405 5,4 349 4,76 400 5,49 343 4,73 6 394 1,01 10 1,24 0,25 0,63 1,07 0,91 1,11 1,72 0,5 64 Лаймска борелиоза 953 12,28 979 12,61 620 8,03 700 9,07 831 10,88 882 11,6 595 7,87 594 7,91 412 5,62 378 5,19 404 5,58 7 348 Ку треска 267 3,44 49 27 0,35 36 0,47 0,22 24 0,32 0,24 12 0,16 29 0,40 23 519 3,7 5,56 4,35 Туларемия (на 100 000) 16 0,20 0,13 60 0,00

Incidence rate, Crimean Congo haemorrhagic fever %, 2004-2014 г.

Incidence rate, Haemorrhagic fever with renal syndrome %, 2004-2014 г.

Incidence rate, Tularemia %, 2004-2014 г.

Incidence rate, Q-fever %, 2004-2014 г.

Incidence rate, Rickettsiosis marsiliensis % 2004-2014 г.

Incidence rate, Lyme Borreliosis %, 2004-2014 г.

CONCLUSIONS In spite of the good results we are still facing some problems: The climate changes cause biotope mutations of the reservoirs and vectors and lead to increased populations The increased human out of door activities lead to growth of contacts with vectors and increased risk of vector borne diseases Epidemiological data show that recently the urban population also develops illness because of unlimited access to roaming animals (dogs), adverse and unhealthy field work, and limited application of DD measures The contamination risk in humans is dependent to a high degree on the density of tick population, the presence of competent hosts and reservoirs which vary geographically Still the percentage of undiagnosed cases is high. The etiological diagnosis of tick borne transmissive diseases and the implementation of effective measures in settlements as well as destroying the biotopes are of utmost importance

MINISTRY OF HEALTH OF BULGARIA PREREQUISITES FOR DEVELOPMENT OF THE NATIONAL PROGRAM 1. The climate changes globally and their influence over the reservoirs and vectors - morbidity dynamics 2. New emerging vector borne transmissive diseases 3. Conducting of focused preventive epidemiological and epizootic measures aiming at decrease of vectors population in settlements 4. Maintenance of integrated epidemiological, veterinary and entomological surveillance of vector borne transmissive diseases 5. Full detection of human and animal cases

MINISTRY OF HEALTH OF BULGARIA PROGRAM GOALS Strategic goal Decrease of morbidity and mortality rates due to vector borne transmissive diseases and bringing them to sporadic cases. Reducing the lethality within the country Operational goal Achievement of integrated epidemiological, veterinary and biological surveillance of vector borne transmissive diseases Conducting focused preventive epidemiological and epizootic measures aiming at decrease of vector populations in settlements. Establishing a stable trend of reducing morbidity and mortality and progressive decrease of people having vector bite (ticks and mosquitos)

MINISTRY OF HEALTH OF BULGARIA Crimean Congo haemorrhagic fever Haemorrhagic fever with renal syndrome Tularemia Q-fever Lyme Borreliosis Rickettsiosis marsiliensis West Nile fever Encephalitis ixodica Leischmaniosis visceralis Malaria

National Coordination Council PROGRAM MANAGEMENT National Coordinator National Coordination Council 28 Regional Coordinators Members

PROGRAM EXECUTORS MINISTRY OF HEALTH NATIONAL CENTER OF INFECTIOUS AND PARASITIC DISEASES REGIONAL HEALTH INSPECTIONS HEALTH CARE ESTABLISHMENTS FOR CURATIVE AND PREVENTIVE CARE BULGARIAN FOOD SAFETY AGENCY National Research Veterinary Institute of the name of Prof. Pavlov and its Department on the health and human attitude towards animals and feed control Research virological laboratory at the Military Health Academy Plovdiv University of the name Paisii Hilendarski and its chair of Zoology Municipalities endemic for vector borne transmissive diseases

MINISTRY OF HEALTH OF BULGARIA TASKS; Strengthening the structures for laboratory diagnosis of VBTD on national and regional level Improving the diagnosis by means of contemporary methods and resources. Development , assessment and implementation of new diagnostic methods Full detection, registration and analysis of people and animals morbidity Timely hospitalization of sick people and implementation of relevant preventive and epidemiological measures Revealing new natural foci and tracing out the epidemiological activity of already existing ones Carrying out representative studies of vectors from active natural foci aiming at determining the contamination rate and people`s risk

MINISTRY OF HEALTH OF BULGARIA 7. Conducting species diagnosis, assessing the contamination rate and/or vermination of reservoirs and vectors populations and its influence on the population dynamics 8. Undertaking measures aiming at decrease of vector populations in settlements together with the possibility of transmitting this type of infection through monitoring of basic population parameters and assessing their influence over population growth 9. Conducting representative studies of human and domestic animal`s serum 10. Modernizing instruction documents, producing a manual for health professionals as well as for biologists and ecologists 11. Health education of the population oriented to risk reduction

MINISTRY OF HEALTH OF BULGARIA AWAITED RESULTS: Ensuring reliable, high quality laboratory diagnosis of VBTD through implementing contemporary diagnostic methods and resources Full detection and real registration of all sick people Improving the quality of epidemiological surveillance and control Timely hospitalization and treatment of patients 5. Reduction of vectors` population in settlements and thus the possibility of transmission Modernizing the control measures to fight the vector host plants Intensive cooperation between the health and veterinary professionals

МИНИСТЕРСТВО НА ЗДРАВЕОПАЗВАНЕТО 8. Clarifying the localization of natural foci and their activity. Development of a cadaster of natural foci in Bulgaria 9. Raising the health information of the population The Program implementation will meet the European standards in compliance with the strategy of the ECDC and WHO

MINISTRY OF HEALTH OF BULGARIA A working program based on the goals, priorities and activities as well as a financial plan have been developed