Download Surveillance for Pediatric infectious disease except Influenza

Surveillance
Surveillance for
for Pediatric
Pediatric infectious
infectious disease
disease
except
except Influenza
Influenza
July 5, ２００６
Yajima Children’s Clinic
Shigehiro Yajima, MD.
Japan
Japan and
and Gifu-city
Gifu-city
Hokkaido
Tokyo
Korea
Nagoya
Okinawa
Five
Five major
major hospitals
hospitals in
in Gifu
Gifu
University
University Hospital
Hospital
Children
’s Hospital
Children’s
Hospital
Red
Red Cross
Cross Hospital
Hospital
Nagara River
Mt.Kinka
Municipal
Municipal Hospital
Hospital
Prefectural
PrefecturalHospital
Hospital
Gifu Station
Population : Gifu-prefecture 2 million and Gifu-city 0.4 million
Surveillance
Surveillance for
for Pediatric
Pediatric infectious
infectious disease
disease
‹ Surveillance
¾
¾
in Japan
in Gifu-city
‹ Important
¾
¾
system
Pediatric disease
Measles
Rubella ( congenital Rubella syndrome : CRS )
‹ problems
Surveillance
Surveillance system
system in
in Japan
Japan
‹
Infectious Disease Surveillance Center (IDSC) was
established newly in 1997, expanding its responsibility
and replacing former Division of Infectious Disease
Epidemiology, and it has been designated as a National
Infectious Disease Surveillance Center.
‹In
local or district level, it is encouraged to designate
Local Infectious Disease Surveillance Centers. The
main targets of our surveillance are category 1-5
infectious diseases prescribed in the Law．
category
category 1-3
1-3 infectious
infectious diseases
diseases
category １
Crimean-Congo hemorrhagic fever
Ebola hemorrhagic fever
Lassa fever
Marburg disease
category 2
Cholera
Diphtheria
Paratyphoid fever
Plague
Poliomyelitis
ＳＡＲＳ
Shigellosis
Smallpox
Typhoid fever
category 3
Enterohemorrhagic Escherichia coli infection
notify the public health center of the disease immediately
category 4
Anthrax
Legionellosis
Nipah virus infection
Botulism
Leptospirosis
Tularemia
Brucellosis
Lyme disease
West Nile fever
B virus disease
Malaria
Avian influenza virus infection
Coccidioidomycosis
Monkeypox
Epidemic louse-borne typhus fever
Dengue fever
Scrub typhus
Hantavirus pulmonary syndrome
Echinococcosis
Psittacosis
Hemorrhagic fever with renal syndrome
Hepatitis A
Q fever
Japanese spotted fever
Hepatitis E
Rabies
Lyssavirus infection
Infant botulism
Relapsing fever
Japanese encephalitis
Yellow fever
notify the public health center of the disease immediately
Category
Category V
V
（（ Notifiable
Notifiable Diseases
Diseases ））
AIDS
Acute encephalitis (excluding Japanese encephalitis and West Nile encephalitis)
Acute viral hepatitis
Hepatitis B、Hepatitis C、Hepatitis D
Amebiasis
Congenital rubella syndrome （CRS)
Creutzfeldt-Jakob disease
Cryptosporidiosis
Fulminant group A streptococcal infection
Giardiasis
Meningococcal meningitis
Syphilis
Tetanus
Vancomycin-resistant Enterococcus infection
Vancomycin-resistant Staphylococcus aureus infection
notify the public health center within seven days
Category
Category V
V （（Sentinel-Reporting
Sentinel-Reporting Diseases)
Diseases)
Number of sentinel clinics in Japan
Influenza (excluding avian influenza ）
4,694
Pediatric diseases
3,046
Ophthalmic diseases
644
Sexually-transmitted diseases
919
Specially-designated sentinel clinics
weekly reporting
470
monthly reporting
469
Sentinel clinics have to notify the public health center within seven days
Pediatric
Pediatric infectious
infectious disease
disease
Measles
Pharyngoconjunctival fever
Rubella
Group A streptococcus infection
Chickenpox
Hand-Foot-Mouth disease
Mumps
Erythema infectiosum
Pertusis
Exanthem subitum
Herpangina
RS virus infection
Infectious gastroenteritis
Vaccine (＋)
vaccine (ー)
Pediatric
Pediatric Infectious
Infectious Disease
Disease Surveillance
Surveillance in
in Japan
Japan
‹ Sentinel
clinics and Hospitals
Every week ( not everyday )
‹ Public
Health Center
‹ Prefectural
governor
‹ Infectious
Disease Surveillance Center in
National Institute of Infectious Diseases (NIID)
two or three weeks later
‹ Weekly
report will be published.
Weekly
Weekly report
report from
from IDSC
IDSC
decreased
Increased
Freequency of disease is reported weekly with comment and figure.
In this year, Pharyngoconjunctival fever( ) and Mycoplasma pnuemonia(
are widespread epidemic.
)
Weekly
Weekly report
report from
from IDSC
IDSC
2006
Pharyngoconjunctival fever is epidemic for last five years, especially in this year.
Infectious
Infectious Pediatric
Pediatric Disease
Disease Surveillance
Surveillance
‹ Category
5 (sentinel disease)
‹ National surveillance system is not real-time.
‹ This surveillance does not reflect low-frequency
disease such as Measles and Rubella, correctly.
‹ All the cases of Measles should be reported
immediately to prevent widespread epidemic.
Surveillance
Surveillance for
for pediatric
pediatric infectious
infectious
disease
in Gifu-city
Gifu-city
disease in
‹
System
same as the system for influenza in Gifu
‹
Registration
by Online-registration with internet or Fax
from 5 hospitals and some clinics in Gifu-city
‹
Disease for registration
Category V （Sentinel-Reporting Pediatric Diseases)
‹
Reports and comments
¾
¾
the number of the disease is counted automatically if registered from
internet
comments for surveillance is send to clinics once or twice a month by mail
( comment for Influenza is made by Dr.Kawai everyday ! )
Hospitals
Hospitals and
and clinics
clinics for
for children
children
summary
summary for
for pediatric
pediatric Infectious
Infectious disease
disease
Annual
Annual report
report (( 2005
2005 ))
Infectious gastroenteritis is common in Japan, children never die from gastroenteritis.
Mumps and chikenpox spread every year, because less than half of the children get
vaccine. Government does not support the vccination for these disease.
Measles was not epidemic for last 5 years, however, widely spreads in this year.
2003~2005
2003~2005 in
in Gifu-city
Gifu-city
RS virus infection
Pharyngoconjuncval fever
group A streptococcus
Infectious gastroenteritis
Chikenpox
Hand, foot and mouth disease
Erythema infectiosum
Exanthema subitum
Pertusis
Rubella
Herpangina
Measles
Mumps
total
2003
2004
2005
0
74
69
759
596
577
359
212
278
1538
1174
1492
561
710
554
763
88 ↓
91
46
68
494
456
433
29
26
1
7
6
2
663
733
4
4
89
329
897↑
5357
4454
7503
82↓
1043
2
Surveillance
Surveillance system
system in
in Gifu
Gifu
‹ Five
hospitals, sentinel clinics and other clinics
may notify about the disease in category 5 .
‹ The data is counted automatically if registered by
internet. So real-time counting is possible
‹ The data can be seen on the internet.
Important
Important pediatric
pediatric Infectious
Infectious disease
disease
Measles
Rubella
Measles
Measles is
is the
the most
most dangerous
dangerous disease
disease
‹ High-infectability
‹ Many
complications (pneumonia, otitis media,
encephalitis, SSPE)
‹ Mortality rate is about 0.1% in Japan.
‹ In 2001, measles was extensive epidemic in
Okinawa. The number of patient was over 2000,
9 children died from measles.
‹ Recently, adult patient is increasing.
Newspapers
Newspapers said
said the
the risk
risk of
of adult
adult measles
measles
Measles epidemic in university
Adult measles patient rapidly increasing
‹
2 years old girl
¾
¾
¾
¾
¾
¾
¾
‹
Admitted with measles
Lost right vision
Lost consciousness with
encephalitis for 1 week
Tracheostomy
Perforated to the aorta
Emergency operation
Admitted for 6 months
22 years old
¾
graduated from collage
Important
Important pediatric
pediatric Infectious
Infectious disease
disease
Measles
Rubella
Congenital Rubella syndrome ( CRS )
( deafness, Cataract, heart disease )
Measles
Measles and
and Rubella
Rubella can
can be
be eliminated
eliminated
by
by vaccine
vaccine
Problems
In
In 2006,
2006, Measles
Measles is
is epidemic
epidemic again.
again.
‹
Measles patients were reported from Ibaragi
and Chiba prefecture in April.
‹
Epidemic to high school and university.
‹
So, Infectious Surveillance Center in Japan
planed the registration system for all
measles cases.
‹
But ・・・・
Ibaragi
Nagoya
Chiba
Measles
Measles surveillance
surveillance system
system does
does not
not come
come out
out yet.
yet.
Measles
Measles
‹ should
be registered without exception
‹ can be eliminated, if all the children are
vaccinated twice against measles.
Elimination of measles depends on
not the surveillance system, but on the “ political will ”