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

2. 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) 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

3. MINISTRY OF HEALTH OF BULGARIA
Година
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Общо
ККХТ
Брой случаи
(на ) 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 ) 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

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

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

6. Incidence rate, Tularemia %, 2004-2014 г.

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

8. Incidence rate, Rickettsiosis marsiliensis % 2004-2014 г.

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

10. 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

11. 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

12. 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)

13. 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

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

15. 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

16. 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

17. 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

18. 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

19. 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

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