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Okabe Nobuhiko

Unfortunately, confirmation and notification of all A/H1N1 (2009) patients in Japan was ceased on 24 July when the cumulative number of patients was about 5000. After that, as all suspected patients are not necessarily confirmed or reported, the only official surveillance was the sentinel surveillance for influenza-like-illness (ILI) patients from 5000 clinics accounting for almost 10% of all clinics and hospitals in Japan. However, because the surveillance results are reported weekly, it tends to lack timeliness. To collect and analyze the information in more timely manner, we, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, developed a full automatic daily reporting system of ILI patients. Using this information, we had estimated Rv and predict its course in every week.

Objective

This paper summarized our effort for real-time estimation of pandemic influenza A/H1N1pdm in Japan.

Referenced File
Submitted by uysz on

The first prototype syndromic surveillance in Japan was used during the G8 summit meeting in 2000 with two local prefectures involved. The second trial syndromic surveillance and the first internet-based surveillance used in 2002 for the Japan-Korea 2002 World Cup soccer games. Since 2002, surveillances on over-the-counter medications, ambulance call, and outpatient visits were explored as syndromic approach candidates for early detection. Internet-based events and case reporting frame work has been reviewed for outpatient visits daily reporting concurrently. Limited spread of electrical patient record and vast range of commercialized medical record formats posed obstacles to nationwide syndromic surveillance implementation.

Recent threats from bioterrorism and influenza pandemic empowered Japanese government introducing surveillance of rapid detection mechanism. In line with the revision of the Infection Control Law took place in 2007 April, national syndromic surveillance system was implemented.

 

Objective

This paper describes recent establishment of national surveillance system for early detection of infectious diseases in Japan. With diagnostic data fed from existed routine surveillance, newly introduced system is expected to provide timely information for control response. We aim to facilitate cross-informative regional surveillance by sharing our experience and system frame work.

Referenced File
Submitted by elamb on

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.

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Submitted by elamb on

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.

Referenced File
Submitted by elamb on

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). 

Referenced File
Submitted by elamb on

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.

Submitted by elamb on

So as to develop more effective countermeasures against influenza, timely and precise information about influenza activity at schools, kindergartens, and nursery schools may be helpful. At the Infectious Diseases Surveillance Center of the National Institute of Infectious Diseases, a School Absenteeism Surveillance System (SASSy) has been in operation since 2009. SASSy monitors the activity of varicella, mumps, mycoplasma pneumonia, pharyngoconjunctival fever, hand-foot-mouth disease, influenza, and many other infectious diseases in schools. In 2010, SASSy was extended to the Nursery School Absenteeism Surveillance System (NSASSy). These systems record the number of absentees due to infectious diseases in each class of all grades of schools every day. As a powerful countermeasure to the pandemic flu of 2009, SASSy was activated in 9 prefectures, in which included more than 6000 schools, and it is gradually being adopted in other prefectures. As of February 2012, 18 prefectures and 4 big cities, which together comprised 15,700 schools (about 35% of all schools in Japan), utilized SASSy. NSASSy is used in more than 4100 nursery schools, which is about 18% of all nursery schools in Japan. Some studies of similar systems were performed in the UK (1), Hong Kong (2), and the USA (3,4), examined surveillance systems for monitoring infectious disease incidence, but the systems to construct in those studies do not operate nationwide like SASSy or NSASSy, and they cannot provide influenza incidence rates in children.

Objective: 

So far, it is difficult to show the incidence rate of influenza in the official sentinel surveillance in Japan. Hence we construct the system which record infectious diseases at schools, kindergartens, and nursery schools, and then can show the accurate incidence rate of influenza in children by age/grade.



 

Submitted by Magou on
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