Ohkusa Yasushi

In 2011, March 11th, the big earthquake attacked eastern Japan, and forced a lot of people to live in evacuation sites. Since those evaluation sites have high density of population and sanitary condition was poor in these sites, outbreaks of influenza, noro virus or other infectious diseases were concerned.

Objective

For an early detection and control of an infectious disease outbreak, we developed and have been operating syndromic surveillance for evacuation sites, "evacuation site surveillance."

In 2011, March 11th, the big earthquake attacked eastern Japan followed by huge tsunami and nuclear plant accident. Consequently a lot of people could not help living in evacuation sites. Since those evaluation sites have high density of population and were not necessarily good in sanitary condition, outbreaks of influenza, norovirus or other infectious diseases were concerned.

Objective

For an early detection and control of an infectious disease outbreak, we developed and have been operating syndromic surveillance for evacuation sites, "evacuation site surveillance."

Infection Control Law in Japan has asked doctors to cooperate in syndromic surveillance for pandemic flu and smallpox since 2007. However, doctors have to report by typing the number of patients on the web site, or by sending a fax to local public health centers. It imposes the heavy burden of reporting, and thus it has not worked well yet. Therefore, we need an automatic system for routine syndromic surveillance.

Objective

We performed some syndromic surveillance system for the Hokkaido Toyako G8 summit meeting in July 2008 in Japan as a counter-measure to bioterrorism attack or other health emergency. This presentation shows the workable syndromic surveillance systems in Japan.

To evaluate the potential of using the sales of Over the Counter (OTC) medicines for early detection of infections of public health concern, retrospective analysis of the sales of OTC common cold medications used for influenza-like illness (ILI) has been carried out in Japan since 2003. This presentation assess correlations and predictability of OTC sales to ILI for 2004-05 influenza season and compares with the results from 2003-04 season to discuss on robustness and versatility of OTC sales surveillance.

I Medical services for outpatients are well developed due to universal public health insurance. Even patients who have mild symptoms can visit a clinic freely in Japan. Thus the monitoring of outpatients provides very timely information to detect unusual events. On the other hand, EMRs haven't had much penetration, less than 10% at clinics and 20% at hospitals. Moreover, almost nobody uses HL7 or other standards for EMRs. Therefore, it is very difficult to develop a syndromic surveillance system using EMRs like the U.S. We have to develop a system for each EMR and it has a heavy cost. In Japan, there are about 40 thousand pharmaciesand almost half of drugs prescribed are delivered through pharmacies. Almost all pharmacies record prescriptions electronically. Objective: So that full automatic syndromic surveillance cover the whole of nation, we construct the system using the information of prescription.

We started an experimental syndromic surveillance using 1)OTC and 2)outpatients visits, in the last year and included 3)ambulance transfer from this year so as to early detect bioterrorism attack (BTA). 

Since we donít know when such a disaster may occur, we have to perform this syndromic surveillance routinely, and thus the system should be automatic. Namely, information is drawn from electronic medical records (EMR), and is statistical analyzed, aberrations are detected and then Results are reported by e-mail or HP. It is preferable that this system be fully automatic. Though many systems of this type have been developed in the US, they have not been well developed in Japan. So as to develop such a system, we made a prototype system and have been performing prospectively and evaluating the system.

So as to be able to detect nosocomial outbreaks at an early stage, we examine the construction of a syndromic surveillance system for inpatients who have fever, respiratory symptoms, diarrhea, vomiting or rash and evaluate its statistical properties.