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Planning for the future –
influenza pandemic preparation in Croatia
Vladimir Drazenovic, Spec. Virologist, Head of National Influenza Centre, Croatian National Institute Of Public Health
The role of the World Health Organization (WHO) in global
preparedness for future influenza pandemics has been
defined. Its activities are divided into stages of the
pandemic and interpandemic period. The national pandemic
influenza preparedness plan of Croatia equally takes account of
these stages and WHO recommendations in its activities.
Croatia has a National Committee on Intrapandemic Planning
(NCIP), which has few standing members who would enable the
continuity of its operation. Yet if necessary, the committee could
engage additional experts when there is need for their expertize.
Basing itself on the experiences of health organizations in crises,
the Ministry of Health and Social Welfare has established a Ministry
of Health Crisis Headquarters (MHCQ) by the health minister’s
decree. Structurally, the MHCQ has been shaped into a coordinat-
ing body to run the local self government units. For this purpose, it
has set up health headquarters in all its counties. The MHCQ is made
up of departments, one of which is in charge of preventive medical
care (PMCD) and has been set up for the precise task of running
epidemic control activities.
Organizationally, the MHCQ is a government administrative body
for managing crises and catastrophes. It acts as a link between the
existing governmental bodies, local self government and technical
organizations with the view of meeting the challenges that present
themselves. PMCD uses the Croatian National Institute of Public
Health, Epidemiology service and WHO National Influenza Centre
(NIC) as Croatia’s central public health body, and county
public health institutes (CPHIs) at local self-government
level. This constitutes a primary link between govern-
mental administrative authorities and local self
government bodies, as well as reaching out to other tech-
nical health organizations.
NIC has an important role and coordinates a number
of different activities for future influenza pandemic
preparation.
The basic presuppositions on which activities for
pandemic preparedness within the whole country are
based are the infrastructural organization for seasonal
influenza and the best preparation for a pandemic. In
this sense, epidemiological, virological and serological
surveillance of the dynamics of parameters related to
influenza have been set up. While epidemiological
surveillance encompasses the number of reported cases
according to age groups, serological surveillance is
oriented to the estimation of vaccine efficiency used that
year. Virological surveillance of circulating strains of the
influenza virus looks at the frequency of movement of
particular virus strains and their presence in the popu-
lation. It is also possible to conduct good monitoring of
the dynamics of the epidemic itself in the form of a
weekly real-time reporting scheme based on positive
confirmations of the number of influenza cases. By using
real-time polymerase chain reaction molecular diag-
nostics it is also possible to process a large number of
samples in one day, which is a basic requirement in viro-
logical surveillance in the case of a pandemic.
Certainly one of the most important roles of NIC is
in the collection of representative numbers of circulat-
ing influenza viruses and sending them to the
Collaborative Centre in London to participate in vaccine
strain selection. As long as vaccine production contin-
ues to be based on embryonated chicken eggs, its goal
each year is to keep the virus isolated in that medium.
This classifies NIC among only ten recognized labora-
tories in Europe that still regularly carries out this very
important type of diagnostic.
Aside from surveillance of the above named parame-
ters and other activities, seasonal vaccination coverage
is of great importance in case of a pandemic. On average,
around 100,000 seasonal influenza cases are reported in
Croatia annually, even though the true number is actu-
ally larger. The cheapest and most efficient way to The public health web portal
Image: Vladimir Drazenovic