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Dr. Zhen XU Branch of Respiratory Disease Prevention and Control Division for Disease Control and Emergency Response Chinese Center for Disease Control and Prevention June, 2011 ILI surveillance in outpatients of sentinel hospitals • 556 sentinel hospitals, 411 labs SARI surveillance in inpatients • Sentinel-based: 10 hospitals • Population-based: Jingzhou city in Middle China ILI/ARI outbreak report • Events reporting, virus detection National notifiable communicable disease reporting • H5N1, pdm H1N1: Class B; seasonal flu: Class C • No virological info Etiology-unknown pneumonia surveillance Integration of ILI sentinel surveillance system and ILI outbreak event report system Data input, query and auto analysis Lab info management Surveillance quality monitoring Epidemiology Surveillance Diagnosis and Registry: daily Reporting of ILI case: weekly Collect and analyze the surveillance data Laboratory Surveillance Specimen collection: 5-15 nose & throat swabs from ILI cases per week per hospital Lab detection: PCR test or virus isolation, antigenic and genetic analysis, antiviral resistance 5 ILI surveillance information reporting ILI reporting ILI sentinel hospitals Specimens collection Send specimens to labs Network laboratories Specimens info & results Detection Isolates to CCDC Reidentification CCDC Input data of ILI counts and ILI% by week and age group; Data query by date, by week, by age group, by hospital and by area ; Input data of PCR and virus isolation results by specimen within 48h; Data query by patient, by date, by week, by hospital and by area ; event-based report basic info of ILI outbreak: major symptoms, case number, lab results, duration and location of the outbreak progress report of outbreak response; ILI analysis 300 10 250 暴 8 发 6 200 起 4 数 2 报 告 暴 发 150 疫 情 100 起 数 50 Surveillance quality monitoring 4000 Virus typing 阳 性 3500 甲型H1N1流感暴发疫情 数 3000 无实验室结果的ILI暴发疫情 2500 Untyped Yamagata Victoria B(lineage not determined) A(unsubtyped) A(unsubtyped excluded H1N1pdm) H1N1 H3N2 H1N1pdm Influenza Positive(%) 季节性流感暴发疫情 70 阳 60 性 50 率 ( % ) 40 2000 0 14 19 24 29 34 39 44 49 2 7 12 17 周次 2010-2011 30 1500 20 1000 10 500 0 周次 15 21 27 33 39 45 51 4 10 16 22 28 34 40 46 52 5 11 17 23 29 35 410 47 1 7 13 19 2008-2009 2009-2010 0 14 21 28 35 42 49 2010-2011 2009 3 10 17 24 31 38 45 52 2010 7 14 21 28 35 42 49 2011 周次 environment surveillance data Serological surveillance data Information dissemination: Weekly Report Influenza Weekly Report www.cnic.org.cn/eng www.cnic.org.cn Information Sharing FluID To monitor the severity of Pandemic H1N1 and understand the characteristics of SARI cases caused by pdm H1N1 Following WHO case definition Support by MOH and EID program Data source: ◦ Epi data by case: Respiratory, Internal ICU, and Infectious Departments from 10 hospitals ◦ Lab data: 10 network Labs where the hospitals located Data report: EPI Database weekly sent from hospitals and labs by email Data sharing: Brief report sent to hospitals and labs regularly •Most are clinical cases; •No virological info; •Limited use for flu surveillance Case patients hospitalized with 2009 pandemic influenza A (H1N1) virus infection, by date of onset, China, Sep 2009–Feb 2010. ICU, Still lack of a comprehensive surveillance system to oversee the virus and diseases caused by flu virus ◦ Characteristics and burden of mild, severe and fatal case Maintain the current giant ILI network—cost, willingness and enthusiasm Translating data into practice is much more important than collecting data ◦ Surveillance data, research data Risk assessment of surveillance data Quality monitoring didn’t followed by in time quality improvement action SARI surveillance info is independent from ILI system. Mild and severe case caused by flu virus cannot be linked well Vaccine gap ◦ Supply: 30m doses VS 570m population ◦ Capacity: 126m doses VS 570m population Vaccination strategy ◦ Annual technical recommendations for target population only ◦ Flu vaccination not covered by national government or medical insurance ◦ Beijing is the only city to provide the free vaccination service to local population: ﹥65yrs, primary and middle school students Improve the sentinel SARI surveillance ◦ Internet-based reporting of epi and lab data ◦ Integration with HIS and LIS in hospitals ◦ Publication and sharing of SARI findings Modeling the ILI seasonal pattern Application of early warning based on long-term and good-quality flu data in pilot areas Describe the burden of severe and fatal cases caused by flu virus ◦ Population-based inpatients surveillance ◦ DSP site: ICD code-based deaths analysis Use the data for vaccination policy making Integrated information system Submission Data Entry Search Download Sequence Database Surveillance Information System Result feedback Analysis&Report Share Information Platform Security check Receipt Take&Return Lab Data Management Website Public propaganda Technical support Result Entry New Security check