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ECDC Country Visit to Moldova: Summary on Communicable Disease Surveillance

Core Content Overview

The European Centre for Disease Prevention and Control (ECDC) conducted a technical visit to Moldova in April 2025 to assess the national communicable disease surveillance system. This visit was part of the EU Initiative on Health Security, aiming to support Moldova's progressive integration into ECDC's work as a new EU candidate country.

Main Objectives of the Visit

• To evaluate the existing structures, systems, and processes for communicable disease surveillance.
• To identify strengths, weaknesses, needs, and potential areas for improvement.
• To document the current situation and outline possible action plans.
• To discuss next steps and set priorities for further surveillance activities with ECDC support.

Surveillance System Description

• Legislative Framework: Moldova's surveillance system is governed by several laws and regulations, including Law No. 10/2009 on Public Health, Government Decision No. 885/2022 establishing the SI SBTESP platform, and Order No. 533/2023 defining notifiable diseases.
• Central Authority: The National Public Health Agency (ANSP) is responsible for national communicable disease surveillance.
• Surveillance Platforms:
  • SI SBTESP (since 2023) is the main electronic surveillance platform, supporting both case-based and event-based reporting.
  • Sentinel surveillance systems for ILI, ARI, SARI, and acute diarrhoeal diseases have been in place since 2009 and 2023, respectively.
  • Moldova participates in international surveillance networks like the Global Antimicrobial Resistance Surveillance System and the Central Asia and Europe Antimicrobial Resistance Surveillance Network.

Data Collection

• Primary Tool: SI SBTESP is used for electronic reporting, with a gradual increase in adoption (from 20% to 50% of prior paper-based levels).
• Manual Reporting: Some primary care facilities still use paper-based reporting, which is later transcribed into the system.
• Sentinel Systems:
  • Sentinel sites for respiratory viruses and acute diarrhoea collect data weekly using Excel templates.
  • Event-based surveillance reports approximately 100–300 public health events monthly.

Data Quality

• SI SBTESP Architecture: Standardised case reporting forms with mandatory fields and automated coding improve data uniformity.
• Coverage and Gaps:
  • SI SBTESP has nationwide coverage, but the Transnistria region only reports aggregated data.
  • No formal framework exists for tracking data quality metrics like completeness or timeliness.
  • Underreporting and under-ascertainment are not quantified, and the proportion of laboratory-confirmed cases is not formally assessed.

Data Management

• Platform Features: SI SBTESP is a modular, standalone, web-based platform hosted on secure government servers.
• Interoperability:
  • Laboratory data are not integrated with SI SBTESP, requiring manual uploads.
  • Data can be manually exported, but no automated pipelines or interfaces exist for external data transfer.

Data Analysis

• Routine Use: Data are used for descriptive epidemiological analyses, including case counts and incidence rates.
• Tools and Methods:
  • SI SBTESP provides basic analytical functions, but most analysis is done using spreadsheet software.
  • Syndromic surveillance for respiratory viruses includes epidemic threshold charts.
  • Data for broader reports are manually extracted and processed using standard office tools.

Dissemination of Surveillance Data

• Internal Sharing: Surveillance outputs are shared internally with the Ministry of Health and other stakeholders.
• Public Access:
  • Weekly reports on respiratory virus circulation, ad-hoc reports on measles, and annual reports on HIV are available on the ANSP website.
  • A comprehensive 'Public health surveillance in the Republic of Moldova' report is also published.

Outbreak Detection

• Guidelines and SOPs: Outbreak investigation guidelines are developed in collaboration with the Norwegian Institute of Public Health.
• Notification Process: Physicians and healthcare providers are required to notify authorities immediately upon suspicion of outbreaks.
• SI SBTESP Role: The outbreak/cluster module supports epidemiological linking and alert generation.
• Foodborne Outbreaks: Moldova records several foodborne disease outbreaks annually, with limited molecular characterisation capacity.

Capacity Assessment

• Laboratories: Moldova has a network of public health laboratories with BSL-3 capability and strategic reserves for highly contagious diseases.
• Workforce:
  • Training on SI SBTESP is provided by ANSP.
  • Human resource gaps persist, especially in epidemiologists and medical assistants at local levels.
  • Limited bioinformaticians hinder molecular surveillance and genomic analysis.

Key Recommendations

• Integrate Laboratory Data with SI SBTESP to enable automatic importation of test results and reduce administrative burden.
• Review and Streamline Data Collection to reduce duplication and align with international metadata standards like TESSy/EpiPulse.
• Implement Data Quality Monitoring by establishing KPIs and regular assessments for completeness, timeliness, and laboratory confirmation rates.
• Enhance Analytical Capacity through the use of statistical software and training in advanced methods.
• Strengthen Communication and Dissemination by creating regular bulletins, visual dashboards, and automated summaries for different audiences.
• Estimate Under-ascertainment and Under-reporting using methods such as capture-recapture analysis and seroprevalence surveys.
• Operationalise Public Health Functions at all levels of the healthcare system to ensure continuity and effectiveness of surveillance and response.

Conclusion

Moldova's communicable disease surveillance system has made significant progress since the introduction of SI SBTESP in 2023, aligning more closely with EU frameworks. However, challenges remain in system integration, data quality, and workforce capacity. ECDC recommends targeted improvements to ensure the system's full potential is realised.