Arboviral disease surveillance staff perceptions

Surveillance staff perceptions of factors contributing to success or barriers/challenges in human arboviral disease surveillance (ref Q14)

Country	Successes	Barriers
Albania
Armenia	Ongoing entomological surveillance throughout Armenia	Lack of the knowledge on Arboviral diseases
Bosnia and Herzegovina
Bulgaria
Croatia	Interdisciplinary and multisectoral "One Health" approach
France	Diseases are notifiable.	Many cases are pauci-symptomatic. Information for travelers returning from exposed areas must be reinforced.
Georgia	Monitoring of vectors, geographical distribution mapping, IRS of black sea coastal line (touristic destinations) as a success.	Geographical spread of the area of vectors, as a main barrier/challenge.
Germany	Germany is climatically only marginally suitable for ongoing transmission of for Aedes-transmitted arboviruses)(- capable Aedes vectors are only present in smaller parts of the country, yet) - there are no financial barriers for diagnosis of human arbovirus infections (near universal health care coverage, lab diagnoses without co-pay) - wide availability of laboratories able to diagnosed arboviral infections	(Potential) transmission of arboviruses in Germany is a relatively new threat (Aedes vectors not present until recently, WNV not present until recently) and thus local authorities and diagnosing physicians are unfamiliar with the topic, yet. - Local authorities frequently have no recent experience, structures, personnel, budgets for vector surveillance and control. - Physicians may fail to include arboviral infections in differential diagnoses.
Greece	Enhancement of passive surveillance - Regular awareness raising of health-care workers for testing suspected cases. Active surveillance (for West Nile virus infections: active laboratory-based surveillance for human cases, active surveillance in equids, and active vector surveillance are implemented in Greece) - Animal and vector surveillance data are used as early warnings/ alerts for the WNV circulation, for raising awareness of local health-care workers (for the diagnosis of human cases). Enhancement of the laboratory capacity – Support of Reference and specialised laboratories - laboratory expertise and free-of-charge testing of suspect cases. Multi-sectoral collaboration (national, regional and local level): - intersectoral National Committee/ advisory working groups - networks at national and local level, information flow - good interpersonal communication. Action plans, established procedures, experience. Free access to healthcare facilities (diagnosis, management). Strong commitment of involved stakeholders and public health staff in their work and service. Timeliness of communication, real-time information sharing. Communication to health-care workers on the rationale of enhanced surveillance and the real-time use/ impact of surveillance data on the PH measures implemented (published surveillance outputs/ reports, timely implementation of response measures).	Human resources/ public health workforce at national and local level (high workload), Advocacy. Coordination of One Health strategy for preparedness and response, at the policy level - integrated plan and coordination among sectors (public health + animal health + vector control). Vector surveillance at national level (guidance, legislation, resources allocation, quality assessment). Awareness of health-care workers for Arboviral diseases which have a very low incidence in the country or for imported cases of non-endemic diseases (regular awareness is needed).
Hungary	The Hungarian National Reference Laboratory (NRL) for Viral Zoonoses is in close cooperation with the Hungarian NRL for Viral Exanthematous Diseases at the National Public Health Center (NPHC). The standard panel for investigating the aetiology of exanthematous illnesses includes screening for measles, rubella and/or parvovirus B19 viruses, while testing for WNV is in many cases not requested by the clinicians. As a result of the collaboration between the two reference laboratories, samples obtained from patients with exanthema, fever, myalgia and/or arthralgia are also involved in WNV screening during the transmission period.
Italy	Several factors contributes to arboviral diseases, for instance West Nile virus has a complex biological cycle and needs an integrated approach. In Italy we have a national coordination group to support the integration of policies.
Malta	Receive timely result from public and private laboratories on the island	Language barriers if foreigners, delay in reporting by general practitioners, patients with vague symptoms may not seek health care
Monaco	No cases.
Portugal
Romania	The experience - we have implemented a surveillance system for neuro-infection with West Nile virus from 1997	Deficient inter-ministerial collaboration (MoH – National Sanitary Veterinary Authority, MoH-Ministry of Public Administration, MoH-Ministry of the Environment )to receive early information about the circulation of the virus, to develop an operational manual with standard operating procedures to be respected, to develop a plan of control measures for vectors
San Marino
Slovenia		Main barrier is under ascertainment of cases (not all TBE cases are tested with appropriate confirmatory laboratory test, especially those who do not develop meningo-encephalitis phase of the disease). We estimate that there are too few individuals tested for West Nile virus infection, which is probably due to the uncharacteristic clinical picture and insufficient knowledge of this emerging infectious disease.
Spain		Difficulty for clinical suspicion. Need for more training on the subject. Not always local laboratory capacity
Switzerland	One health concept	Multidisciplinary working
Turkey	Arboviral diseases of concerned are notifiable diseases in Turkey. There is no local tranmission of these diseases except WNV, which is also not endemic. That's why there is a very strong surveillance for arboviral diseases as they are very uncommon. When one of the these diseases are diagnosed, Zoonotic and Vector-borne Diseases Department informed immediately. All the process is conducted under the supervision of the Department.