Enclosure 1.
PROPOSAL
of the network of managing, activities and regulations in implementation of the Activities Plan and of the needs of the Republic of
Montenegro before and in the course of the potential occurrence and pandemic of avian influenza.
Managing
Coordination
Activities
Regulations
Republican Coordination
Headquarters – Vice-President
presiding. Members: Ministers
of Health, Agriculture, Interior,
Traffic, Economy, Finance
Authorized competent Ministries,
based on the needs
Adopts the amendments and changes to the Plan
and proposes to the Government the introduction
of the following phases of the Plan; Proposes to
the Government the introduction and dismissal of
the state of the emergency at the proposal of the
Ministry of Health; Proposes to the Government
the activation of the budgetary reserves and
requests from the Government additional
resources; Proposes to the Government the
requests for international assistance.
The Law on the Protection of the Citizens
from the Influential Diseases (Official
Gazette of the Republic of Montenegro, no.
32/2005); the Law on Veterinary (Official
Gazette of the Republic of Montenegro, no.
11/2004); the Constitution of the Republic
of Montenegro (Official Gazette of the
Republic of Montenegro, no. 48/92).
Coordination body for the
issues of veterinary and health
– Managed by the Ministers of
Agriculture and Health
Ministry of Health; Ministry of
Agriculture, Forestry and Water
Industry; Republican Commission
for the Protection of Citizens from
the Infective Diseases; Veterinary
Administration; Institute for Public
Health; Clinical center of the
republic
of
Montenegro;
Specialized Hospital for Lungs
Diseases; Specialized Veterinary
Laboratory; Montefarm; Red Cross
of Montenegro; Doctors Chamber
of Montenegro; World Health
Organization representative in
Podgorica
Monitors the epizootic and epidemiologic situation
on domestic and international level; Proposes the
Plan and changes to the Plan; Continuously
estimates the risk from the avian influenza and
pandemic influenza occurrence; Evaluates the
effectiveness of the proposed measures;
Performs the control over the implementation of
the plan through the inspection services as well
as availability of medicines, vaccines; Performs
the control over the reference health institutions;
Exchanges information with the OEI and WHO.
The Law on the Protection of the Citizens
from the Influential Diseases (Official
Gazette of the Republic of Montenegro, no.
32/2005); the Law on Veterinary (Official
Gazette of the Republic of Montenegro, no.
11/2004);
Municipal
Coordination
Headquarters – Managed by
the President of the Municipality
(Mayor)
Health Centers; General Hospitals;
Veterinary ambulances; Municipal
utility services; Ministry of interior;
Firefighting services; Local grocery
suppliers etc.
Proposes and enacts Plans for the territories of its The Law on Local Self-Governments
competency; Performs the control over the (Official Gazette of the Republic of
application of the municipal plan; Estimates the Montenegro, no. 42/2003 and no. 28/2004)
efficiency of the measures applied and reports on
it to the Republican Coordination Headquarters
and coordination headquarters in charge for the
issues of health and veterinary.
Enclosure 2. List of the priorities for the immunization by mono-valence vaccine, chemo profilax by anti-virus medicines
Bearing in mind the general sensitivity of the population at the new influenza virus sub-type, ideal prevention would be the vaccination of the whole population. Vaccinating I and II
groups of priorities provides the medical treatment of diseased and functioning of the vital functions of the state, and expending the list for the III and IV group of priorities decreases the
number of heavy complications and dying. Vaccination is performed with the 2 doses of the vaccine. Chemo profilax with anti-virus medicines is performed in the later phases of the
Plan, at the confirmed exposure to the new influenza virus sub-type and under condition that vaccination has not been undertaken. Therapy with the anti-virus medicines is efficient only
within the first 36-48 hours from the beginning of the disease. The WHO recommends zanamivir and oseltamivir (Tamiflu).
Groups of Priorities
Targeted population
Group 1.
Health and veterinary
workers exposed to risk
Health and veterinary workers and staff involved in medical checkups and
treatments of diseased and services (priority: Infective Diseases Ward; Health
Centers; Retirement Homes; HES; Micro-Biological and other Terrain Services;
Veterinary Ambulances; Sanitary, Health and veterinary Inspectors).
Staff engaged in distribution and production of medicines, food, water, electrical
energy, members of the operational police services, fire-departments, public
transportation, telecommunication, utility services, customs, members of
judiciary, teams on duty for electronic and printed media, members of the
Parliament and Government and of foreign consular missions.
Retirement homes, homes for pupils and students, social institutions or children
and youth at the permanent custody, collective centers.
Group 2.
Persons engaged in
general functions of the
state
Group 3.
Persons in permanent
collective lodgings
Group 4.
Persons with
chronically diseases
Group 5.
Persons older than the
age of 65.
Group 6. Kindergarten
age of children (6
months of age to 6
years).
Group 7. Schooling age
children (7 to 14 years
of age)
Total for all
Heavy disturbances of respiratory functions, chronically cardio-vascular
diseases, chronically kidney diseases, patients on chemo-dialyze, diabetic
disease, immune-deficiency.
Number of
doses (two
doses per
person)*
10 000 x 2
Chemo profilax and
medical tratament
with anti-virus
medicines**
Pre-exposed profilax of
professional risk
Number of
doses for
shortterm/longterm
profilax***
500 – 10 000
doses
Post-expositional profilax
of exposed to animal
virus of avian influenza
100 – 2000 doses
Post-expositional profilax
100 – 500
doses
Post-expositional profilax
of the exposed
chronically patients
500- 2 000 doses
75 000 x 2
Post-expositional profilax
of the exposed persons
1 000- 5 000
doses
60 000 x 2
Post-expositional profilax
of the exposed persons
1 000- 5 000
doses
72 000 x 2
Post-expositional profilax
of the exposed persons
1 000- 5 000
doses
36 500 x 2
6 500 x 2
20 000 x 2
280 000 x 2
4 200- 29 500
doses
*in the event that the vaccine is not available at all or that it doesn’t come on time, in order to provide for enough time to receive two doses of the vaccine
**for the needs of vaccination it is necessary to provide approximately 600 000 sterile needles and syringes for single use, 300 l of alcohol and 500 kg of absorbent
cotton, 300 ampoules of adrenaline and 300 ampoules of metileprednisolon
*** putting an effort in trying to provide larger quantities of vaccine for the following influenza season of 2006/2007 (requesting as soon as possible since its production
capacities world vide are very limited)
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Enclosure 3.
Plan of the available health workers and beds fund
Health service
Health institution
Treatment of the nonhospital patients and
vaccination
Supervision and
suppression of the
disease and
vaccination
Isolation of the first
cases and serious
cases
Hospital treatment of
the influenza
complications
Hospital treatment for
complications of
influenza
Hospital treatment for
complications of
influenza with children
Hospital treatment for
complications of
influenza – extended
list
Total
Number of
doctors
Number of Beds fund
technicians
medium +
higher
Health centers
515
1 650
80
36
-
14 + 20
35 + 40
59 + 23
75
180
414
18 (7) **
51 (20) **
141 (60) **
56 **
150 **
296
3
10
19
713
2 121
951
Institute for Public Health
23
Wards for infective diseases and particularly isolated parts of units
of intensive care (with monitoring and mechanical ventilation
provided)
Internal wards of all the general hospitals and of the Clinical
Center of the Republic of Montenegro
Part of the beds fund of the Specialized hospital for lungs diseases
in Brezovik
Pediatric wards of all the general hospitals and of the Clinical
Center of the Republic of Montenegro (institute for the diseases of
children)
Dermatologic-veneorology and certain chirurgical wards in
accordance with the needs
*In the event of the need for increased number of health workers, for the works of triage, treatment of easier cases and vaccination, additional staff
would be engaged. If the number of the diseased would increase in a short period of time, the number of health workers could be increased
alternatively with the retired doctors, final exams students and students of the final year of medicine, as well as with students of the final schooling
years of the secondary and high medical schools. Bed funds could be increased with hotel capacities, beds in the students homes and boarding
schools.
**Only available beds fund may be used
Estimated staff resources and hospital capacities would be revised after drafting the municipal plans
***In the event of need tourist facilities capacities would be used
3
Enclosure 4.
Plan of medicines and equipment needs for the period of pandemic
Based on the latest estimation of the WHO, projected for the population of the Republic of Montenegro, in the event of non-available vaccines, the
spreading of the disease is projected to be 5% and 35% of the total population of the Republic of Montenegro, that is from 33 000 to 228 000 persons.
Out of this number, it is estimated that the non-hospital health protection would be used by 5 000 to 21 800 diseased, while hospital treatment would
be used by 500 – 3 000 persons with heavy complications.
SHAPE OF MEDICINE
MEDICINE
Syrup (children up to 6
years of age) original
package about 65 000
children
Tablets/capsules (adults)
580 000 persons
Injections (ampoules)
erythromycin
5 000 – 10 000
20 000 - 58 000
benzyl penicillin
10 000
cephalosporin III generation
59 000
aminoglycozides
55 000
chloramphenincol
7 000
methronidazoe
10 000
24 000
imipenem
1 800
merepenem
450
vancomicine
500
clindamicine
300
ciprofloxacin
800
2 500
cortimoxazol
400
100
oseltamivir (TAMIFLU)*
5 000 – 16 500 *
25 000 -145 000 *
flukonazol
5 000
4 000
nesteroi anti-rheumatics
5 000 – 20 000
25 000 – 115 000
20 000
diuretics
10 000
20 000
*quantities of oseltamivir depend on whether the mono-valence vaccine would be available and on whether there would be enough time to apply two
doses of it
Beside medicines it is estimated that there would be needed 6 000 bottles of infusion solution, 310 000 of syringes and needles for single use, 500 l of
alcohol, 500 kg of gauze, 200 kg of chloral remedies for disinfection.
For the treatment of the most seriously diseased patients in the wards for isolation 10 fixed and 20 mobile respirators are needed, 30 monitors for vital
functions monitoring, 30 aspirators, 2 mobile RTG devices, 1 device for ultrasound diagnosis, 20 EKG devices, 20 devices for acid-base status, 20
devices for fast determination of glycolic, 100 devices for blood pressure measuring, 10 autoclaves
Enclosure 5.
4
Enclosure 5.
Needs estimates in resources and equipment for personal protection of health workers in the pandemic influenza
If we accept the estimates that the first couple of waves would last a few months (in average 5 months), for different levels of exposures of the health
workers, without the capacities extension in temporary facilities, there should be acquired the following:
Medical
activity
Number of usual
multi-layer masks
for single use –
chirurgical (pieces)
Number of specialized
masks N-95 and N-100
for health workers and
particularly exposed
(pieces)
Special
protective suits
(2 models –
standard and
PAPR)
5 000 000 *
-
-
Number of
protective
glasses
(pieces)
Number of
usual gloves
for single use
(pairs)
Number of
chirurgical
gloves (pairs)
for single use.
Number
of rubber
boots
(pairs)
Number
of paper
coats
(pieces)
100 000 *
-
-
-
5 000 *
-
400 *
1000 *
Citizens
-
Farmers
10 000 *
Health centers,
HES, inspection
services of local
community,
Institutes for
public health
Microbiological
and
biochemical
laboratories
Hospital wards
for adults
Children
hospital wards
1 000 *
?
1 000 *
320 000
35 000
250
3 000
330 000
2 000
800
60 000
-
2 000
100
200
30 000
500
50
8 000
800 000
300 000
25 000
10 000
350
150
2 700
500 000
200 000
5 000
3 000
300
200
54 000
16 000
1 750
139 200
800
Total
6 430 00
73 000
850
7 700
1 165 000
11 100
*quantities available for citizens in free sails (pharmacies)
** includes the needs for patients who need to wear mask in the scope of preventing the spreading of disease in the hospital
***protective caps (chirurgical) – 1 430 000 pieces (for health workers)
Estimated quantities are subject to revision based on further experiences
5
Enclosure 6.
Estimates of needs in resources for biochemical, microbiological laboratory equipment and reagents and radiological service
Based on the estimated number of the hospitalized cases and the price of the analysis of basic biochemical parameters, estimated
expenses amount from 12 500 to 90 000 €.
Based on the estimated number of hospitalized cases and the price of the analysis of general microbiological parameters, estimated
expenses amount from 12 500 to 90 000 + 3 laminar chambers for bio-safety of levels 2/3 20 000 – 40 000
Based on the estimated number of the hospitalized cases and the price of radiological services (RTG of lungs) estimated expenses
amount from 50 000 to 100 000 €
Total : ...........................................................................................................................................................................................95 000 – 320 000 eura
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ESTIMATION OF THE ADDITIONAL NEEDS OF BUDGETARY RESOURCES
FOR THE NEEDS OF THE PREVENTION AND SUPRESSION OF PANDEMIC INFLUENZA
(IN THE EVENT OF VIRUS TRANSMISSION FROM ONE HUMAN TO ANOTHER)
I Vaccines, anti-microb medicines and nesteroid anti-rheumatics
1. Mono-valence vaccine A (H5N1) – 560 000 doses
2. Oseltamivir capsules a 75 mg (original package of 10 capsules) – 25 000 to 145 000
3. Oseltamivir syrup a 12 mg/5 ml (original package of 120 ml) – 5 000 – 16 500
4. Erythromycin syrup 5 000 – 10 000
5. Erythromycin tablets a 500 mg – 20 000 – 58 000
6. Benzyl penicillin ampoules a 1 000 000 – 10 000
7. Cephalosporin III generation Ceftriaxon, ampoules 59 000 (10 ampoules)
8. Aminoglykozid (amikacin), ampoules a 500 mg – 25 000 (10 ampoules)
9. Aminoglykozid (gentamicin), ampoules a 80 mg – 30 000 (10 ampoules)
10. Chloramphenincol, ampoules – a 1 g – 7 000
11. Metronidazol, tablets a 250 mg (original package 20 tablets) – 10 000
12. Metronidazol, ampoules a 500 mg/100 ml – 24 000
13. Imipenem, ampoules a 500 mg – 1 800 (5 bottles)
14. Meropenem, ampoules a 1 g – 450 (10 ampoules)
15. Vancomicin, ampoules a 500 mh
16. Clindamicine, ampoules a 300 mg – 300 (10 ampoules)
17. Cyprofloksacin, capsules a 250 mg – 800
18. Cyprofloksacin, ampoules a 100 mg – 2 500
19. Kotrimokasazol, tablets a 480 mg – 400
20. Kotrimoksazol, ampoules a 5 ml – 100 (50 ampoules)
21. Fluconazol, tablets a 50 mg – 5 000
22. Fluconazol, sol. A – 4 000
23. Nesteroid anti-rheumatics, ibuprofen, tablets a 400 mg – 5 000 to 20 000
24. Nesteroid anti-rheumatics, paracetamol, syrup – 5 000 to 20 000
25. Nesteroid anti-rheumatics, paracetamol, tablets – 20 000 to 95 000
26. Nesteroid anti-rheumatics, diclophen, ampoules a 3 ml – 20 000 (5 ampoules)
27. Diuretics (Lasix, Yurinex, Lometazid), tablets – 10 000
28. Diuretics (Lasix, Yurinex), ampoules – 20 000 (ampoules)
29. Infusion solution, bottles 500 ml – 6 000
30. TOTAL ………………………………………………………………………………………………………………. 6 798 706 – 10 253 636 €
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II Personal protection equipment
1. Basic multi-layer masks for single use – chirurgical - 6 430 pieces
2. Special masks N-95 or N -100 for health workers and other particularly exposed staff – 73 000 pieces
3. Special protective suits – standard model – 700 sets
4. Special protective suits – PAPR model – 150 sets
5. Protective glasses – 7 700 pieces
6. Usual gloves non-sterile for single use – 11 650 pairs (50 pieces)
7. Chirurgical gloves sterile for single use – 11 100 pairs
8. Protective rubber boots – 1 750 pairs
9. Protective coat – 139 000 pieces
10. Protective caps – chirurgical – 11 430 000 pieces
TOTAL ...................................................................................................................................................................521 920 eura +
...................................................................................................................................455 150 US $ x 0,83..... 377 774 €
*5 000 000 of basic masks for citizens who would be buying them in free sails, but the resources for their acquisition need to be acquired
250 000 €
8
III Means for disinfection
1. Sodium dychlorizocijanurat a 1 kg – 200 kg
2. Manual pumps for sprinkling a 10 l, 50 pieces
3. Motor pumps for sprinkling 3 pieces
4. Formal dechide 100 l
TOTAL:..........................................................................................................................................................................................................15 200 €
IV Disposable means
1. Syringes plastic sterile for single use – 910 000 pieces
2. Needles sterile for single use – 910 000 pieces
3. Alcohol 70% or 96% a 1 l – 800 l
4. Absorbent cotton – 1 000 kg
TOTAL ........................................................................................................................................................................................................ 32 840 €
V Equipment
1. Fixed respirator – 10 pieces
2. Mobile respirator with concentrator of oxygen – 20 pieces
3. Monitor for vital functions tracking – 30 pieces
4. Aspirator – 30 pieces
5. Mobile RTG device – 2 pieces
6. Device for ultrasound diagnosis – 1 piece
7. EKG device – 20 pieces
8. Device for acid-base status – 20 pieces
9. Device for quick determination of glikemia – 20 pieces
10. Blood preasure measuring device – 100 pieces
11. Autoclave – 10 pieces
TOTAL .......................................................................................................................................................................................625 000 €
VI Overtime and terrain work of the health workers and inspectors
1. Terrain work for 60 sanitary – health inspectors MZ x 60 days
2. Mobile teams work – 5 teams (1 team – 10 people) – 50x60 days
3. Overtime work of health workers in Health centers, Hospitals, laboratories – 5 000 persons x 60 days
TOTAL .........................................................................................................................................................................................................4 599 000 €
TOTAL ...............................................................................................................................................................................13 064 444 - 16 744 374 € +
250 000 € for citizens masks – Montefarm and private pharamacies + 105 000 doses of three valence vaccine against influenza 336 000 €
9
Resources needed for urgent acquisition of required medicines and equipment for the initial response with
occurrence of avian influenza and/or pandemic influenza
1. Oseltamivir capsules a 75 mg (original package of 10 capsules) – 10 000
2. Oseltamivir syrup a 12 mg/5 ml (original package of 120 ml) – 2 000
3. Basic multi-layer masks for single use – chirurgical - 10 000 pieces
4. Special masks N-95 or N -100 for health workers and other particularly exposed staff – 20 000 pieces
5. Special protective suits – standard model – 100 sets
6. Special protective suits – PAPR model – 50 sets
7. Protective glasses – 500 pieces
8. Usual gloves non-sterile for single use – 100 000 pairs (50 pieces)
9. Chirurgical gloves sterile for single use – 2 000 pairs
10. Protective rubber boots –200 pairs
11. Protective coat – paper -10 000 pieces
12. Protective caps – chirurgical – 10 000 pieces
13. Sodium dychlorizocijanurat a 1 kg – 50 kg
14. Manual pumps for sprinkling a 10 l, 10 pieces
15. Motor pumps for sprinkling 2 pieces
16. Formal dechide 20 l
17. Fixed respirator – 3 pieces
18. Mobile respirator with concentrator of oxygen – 5 pieces
19. Monitor for vital functions tracking – 8 pieces
20. Aspirator – 8 pieces
21. Mobile RTG device – 2 pieces
22. Device for ultrasound diagnosis – 1 piece
23. EKG device – 10 pieces
24. Device for acid-base status – 5 pieces
25. Device for quick determination of glikemia – 5 pieces
26. Autoclave – 10 pieces
27. Re-agents for biochemical analysis
28. Re-agents for microbiological analysis
29. Laminar chambers bio-safety 2 – 2 pieces
30. Re-agents and films for radiological services (RTG of lungs etc.)
TOTAL : .......................................................................................................................................................................................................727 887 €
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