Analysis of public health operations, services and activities in the Republic of Moldova

The public health system in the Republic of Moldova has undergone various reforms since 1992. The inherited sanitary–epidemiological services were transformed into a broader public health service. Reorganization of the public health system will continue in the coming years, both at national and regional levels, in order to strengthen the institutional framework, building a system that can address and respond to both communicable and noncommunicable diseases. To evaluate the current public health services and to make recommendations for strengthening their capacities, an overall assessment was carried out during 2011–2012, using the WHO European Region self-assessment tool. This report presents the results of the assessment, a joint effort of the WHO Regional Office for Europe, the WHO Country Office in the Republic of Moldova, the Ministry of Health, the National Centre of Public Health, and representatives of Centres of Public Health and health institutions within the country. It addresses the major challenges in the health sector, including demographics, the low level of public health service financing, and the significant burden of noncommunicable diseases and social and health inequalities. It also argues in favour of promoting public health governance and a “Health in All Policies” approach through multi- and intersectoral collaboration, including the coordination of public health activities within the health sector and beyond it. The main conclusions and recommendations will serve as a base for the development of the National Public Health Strategy 2013–2020, a policy document for effective interventions to reduce health inequalities and improve population health.

Mumps outbreak in the Republic of Moldova, 2007-2008.

BACKGROUND: Moldova experienced a nationwide mumps outbreak between 2007 and 2008. Single-dose monovalent mumps vaccination at 15 to 18 months was introduced in 1983, replaced by a 2-dose MMR schedule at age 1 and 6 to 7 years in 2002. We investigated the outbreak to quantify its extent, explore the role of primary and secondary vaccine failure, and provide control recommendations. METHODS: We analyzed national mumps surveillance and vaccination coverage data to estimate vaccine effectiveness (VE) using the screening method. A retrospective cohort study in 5 educational institutions was conducted to determine age-specific attack rates (ARs) and VE. We compared vaccine strain-specific ARs. Isolation and genotyping of mumps virus strains were performed. RESULTS: Of 31,142 cases reported during October 2007 and July 2008, 80% were in 15- to 24-year-olds. Of cases with information (66%), 92% were vaccinated once, 4% twice. One-dose mumps VE estimates based on surveillance data over 1997-2001 declined from 91% (95% CI: 88%-92%) in 2-year-olds to 72% (70%-74%) in 15- to 19-year-olds. In the cohort study (n = 1589), VE was -40% (-120% to 20%) for 1 dose. For 2 doses it was 62% (-43% to 90%) in 13- to 15-year-olds. ARs were higher in individuals vaccinated with Urabe strains (43%) than with Leningrad-Zagreb strains (14%, P < 0.001). Mumps virus genotype G5 was identified. CONCLUSIONS: Low effectiveness of single-dose mumps vaccination was the main cause of the outbreak. Waning immunity may have contributed to this. The risk of mumps in 2-dose vaccinees was low. Other countries in which large population groups have received <2 doses of mumps vaccine may face similar outbreaks.