Vastuskiri

Dear Jonas Žvirgždas,

Thank you for your inquiry regarding Estonia's national reference healthcare laboratory and Centre for Disease Prevention and Control. We appreciate the opportunity to share insights into the structure and functions of these institutions.

In Estonia, the primary institution responsible for communicable disease prevention and control is the Health Board (Terviseamet), operating under the Ministry of Social Affairs. The Health Board oversees disease surveillance, outbreak response, and coordination of public health measures. Its activities are governed by the Communicable Diseases Prevention and Control Act (Riigi Teataja), which establishes legal responsibilities for disease monitoring, prevention, and control at the national level:

§ 18.  Duties of Health Board upon prevention, surveillance and control of communicable diseases

 (1) The competent authority in the area of prevention, surveillance and control of communicable diseases shall be the Health Board which shall:
 1) conduct epidemiological investigations with the aim of ascertaining the circumstances under which persons suffering from a disease became infected and of determining the circumstances of the spread of the communicable disease, contact the persons suffering from a communicable disease and persons who have been in close contact therewith, and, in the event of clusters of disease, shall provide instructions for the application of disease control measures;
 2) inform the population through the media of the occurrence of a communicable disease and the measures taken to control the outbreak of the disease;
 3) make a proposal on the procurement and distribution of immunological preparations to the Estonian Health Insurance Fund if the risk of an epidemic spread of a communicable disease arises;
 4) collect, analyse and publish data concerning immunisations;
 5) organise the surveillance of communicable diseases, including the sentinel surveillance, according to the relevant legislation of the European Union and recommendations of the World Health Organisation.

 (2) The competent authority in the area of epidemiological risk analysis and risk assessment of communicable diseases shall be the Health Board who shall determine and assess:
 1) tendencies of spread of communicable diseases;
 2) immunisation coverage.

 (3) The authorised authority upon participation in the international control of communicable diseases shall be the Health Board who shall handle the early warning and response system of the European Centre for Disease Prevention and Control in Estonia.

 (4) The Health Board shall be the liaison body authorised by the World Health Organisation and European Commission concerning biological agents in connection with the application of international health regulations.

 (5) The Health Board shall participate as the competent authority in the disease-specific epidemiological activities of the World Health Organisation and the European Centre for Disease Prevention and Control, including in the international disease control programmes by performing the role of the national reference laboratory in the relevant testing areas of communicable diseases.

 (6) In performing the functions prescribed by this Act, the Health Board shall co-operate with local authorities for the prevention, surveillance of communicable diseases and to prevent and control the spread of communicable diseases.

 (7) When participating in the international control of communicable diseases, the Health Board is required to inform other states of the occurrence of a communicable disease and the measures taken to control the outbreak of the disease. The requirements and procedure for international co-operation in the control of communicable diseases and the provision of information related thereto shall be established by the Government of the Republic.

The Health Board’s Central Laboratory functions as Estonia’s national reference laboratory for various communicable diseases. Its key reference functions include:

• * Food and Waterborne Infections: Confirming species identification, conducting serotyping, and performing antimicrobial susceptibility testing (e.g., Salmonella spp., Campylobacter spp.).

• * Sexually Transmitted Infections: Participating in the European Gonococcal Antimicrobial Surveillance Programme, monitoring antimicrobial resistance in Neisseria gonorrhoeae.

• * Invasive Bacterial Infections: Overseeing reference functions for invasive pneumococcal infections, ensuring accurate identification and antimicrobial susceptibility testing.

• * Rare Bacterial and Viral Pathogens: Providing specialized diagnostics and reference services.

• * Antimicrobial Resistance (AMR) Monitoring: While designated as the national reference laboratory for AMR, the Health Board continues to develop its capabilities in this area, including molecular diagnostic advancements.

The interaction between institutions is structured through coordinated public health surveillance, laboratory diagnostics, and information exchange. The Health Board’s reference laboratory collaborates with regional and hospital laboratories, ensuring diagnostic quality assurance and validation. Additionally, it cooperates with international organizations such as the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) for epidemiological surveillance and response coordination.

Health Board also hosts a National Influenza Centre (NIC), which is part of the World Health Organization's Global Influenza Surveillance and Response System (GISRS). The NIC operates within the Laboratory for Communicable Diseases of the Health Board (Terviseamet)

The primary responsibilities of the National Influenza Centre include:​

• * Influenza Surveillance: Monitoring and analyzing influenza virus activity within Estonia to detect seasonal trends and potential outbreaks.​

• * Virus Isolation and Characterization: Performing primary virus isolation and preliminary antigenic characterization of circulating influenza strains.​

• * Data Sharing: Reporting findings to the World Health Organization (WHO) and contributing to global influenza data repositories, aiding in the formulation of vaccine compositions and public health strategies.​

The NIC collaborates closely with other national and international health institutions, such as The Estonian Society of Family Doctors , Estonian Society of infections Diseaseses, Estonian Health Insurance Fund, Ministry of Social Affairs, ECDC, WHO etc to ensure a coordinated approach to influenza surveillance, prevention, and control.​ This integrated network enhances Estonia's capacity to respond effectively to influenza-related public health challenges.

We hope this information provides useful insights for your evaluation.

Sincerely,

Dear Colleagues,

We are currently interested in understanding the work of our counterparts in neighboring countries. Our goal is to review and evaluate our own activities by examining international examples and to develop a vision for how institutions in our country should operate.

We would greatly appreciate it if you could share whether Estonia has a national reference healthcare laboratory and a Centre for Disease Prevention and Control.

If so, what are the functions of these institutions? Additionally, how do these institutions interact, and what are their respective areas of responsibility?

Thank you in advance for your time and insights!

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Sincerely

Jonas Žvirgždas