Transcript On 23 July 2009, novel influenza (A/H1N1pdm) surveillance as

The 3rd meeting of National Influenza Centres in WP and SEA regions
Beijing, China
19 August 2009
Response to pandemic
(H1N1)2009
- Country experience - Japan
Tomimasa Sunagawa
[email protected]
Infectious Disease Surveillance Center
National Institute of Infectious Diseases, Japan
Case-based surveillance as of 23
July 2009（n=4,496*）
(*case with information of date of onset)
Accumulated number
累積報告数
報告数
Case
of cases
300
5000
4500
250
4000
Enhanced entry-screening at int. port and airport
200
3500
3000
150
2500
More than 3000 schools closed
in Hyogo and Osaka
2000
100
1500
1000
50
500
Date of onset
7/22
7/20
7/18
7/16
7/14
7/12
7/10
7/8
7/6
7/4
7/2
6/30
6/28
6/26
6/24
6/22
6/20
6/18
6/16
6/14
6/12
6/10
6/8
6/6
6/4
6/2
5/31
5/29
5/27
5/25
5/23
5/21
5/19
5/17
5/15
5/13
5/11
5/9
5/7
0
5/5
0
Case-based surveillance as of 10
July 2009（n=2,064*）
(*case with information of date of onset)
History to go overseas country within past 1 wk
YES linkage with traveler from overseas country
NO linkage with travelers from overseas country
Unknown
Source: MHLW
Overview of surveillance system for novel influenza (A/H1N1ｐｄｍ）
Strategy
Prevention against disease spreading
Prevention against severe disease
#5
Evaluation and preparedness
Epidemic trend
Current status?
Sporadic cases or clusters imported
from oversease countries
Objectives
1. Early detection of outbreak
2. Monitoring of trend
PCR positive
Notification of cases by law (cluster)
For early
Cluster surveillance
detection
of outbreak Schools, nursery, nursing homes, etc
→confirmed case
No PCR test/ Yes symptom →probable case
PCR tests for representative cases for all the
clusters
Surveillance of absentee (nursery, elementary/junior high/ high school)
Surveillance
For monitoring
of viral mutation
and disease
severity
(No lab tests)
Virus surveillance (sentinel/ outpatients) (lab tests) *including identification of drug resistance
(Lab tests initially for all the cases but for partial cases when pandemic)
(Lab tests initially for all the cases in all the hospitals)
Hospitalization surveillance (inpatients)
(the number of cases only reported from sentinel hospitals when pandemic)
For monitoring
Epidemic
trend
ILI surveillance (sentinels/ outpatients) (No lab tests)
Hospital surveillance as of
11 August 2009 – result (1)
Admitted # of
cases from 5 to
11 August
Accumulated
# of cases as
of 11 August
48
119
7
20
5-19
30
77
20-39
4
9
40-59
0
3
60 and <
7
10
Male
29
73
Female
19
46
Number of admission
Age distribution
< 5 (y.o.)
Sex
Source: MHLW (press release)
Hospital surveillance as of
11 August 2009 – result (2)
Admitted # of
cases from 5 to
11 August
Underlying diseases
(partially overlapped)
Accumulated #
of admitted cases
as of 11 August
(Total)
18
(Total)
50
0
1
12
31
CHD
1
2
Metabolic diseases
1
2
Renal disease
1
2
Immune deficiency
(e.g., steroid use)
1
3
Others
4
13
Pregnancy
COPD (e.g., asthma)
Source: MHLW (press release)
Hospital surveillance as of
11 August 2009Admitted
– result Accumulate
(3)
Severe cases
(partially overlapped)
number of
cases from 5
to 11 August
d number of
cases as of
11 August
Acute encephalopathy
due to influenza
1
3
Mechanical ventilation
1
4
1
2
Condition of patients as of 11 August
In hospital, with
mechanical ventilation
In hospital, with no
mechanical ventilation
Discharged
Died
No detailed information
Fatal cases 23
reported
on 15, 18 and 19
23
August (total: 3)
27
87
0
0
1
3
Source: MHLW (press release)
ILI surveillance in Japan,
from April 1999 to 2 August 2009
60.00
Reported number of cases per sentinel clinic
50.00
99
0
1
2
3
4
5
6
7
8
9
40.00
30.00
20.00
0.56
10.00
0.00
1
3
5
7
9
11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53
Source: Dr. Y. Yasui (IDSC/NIID)
ILI surveillance in Japan,
from April 1999 to 2 August 2009
(enlarged image)
2.00
1.80
1.60
0.9 in 32nd
week
(60,000 cases
estimated)
1.40
1.20
1.00
0.80
0.60
99
0
1
2
3
4
5
6
7
8
9
0.40
0.20
0.00
1
3
5
7
9
11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53
Source: Dr. Y. Yasui (IDSC/NIID)
Reported number of ILI cases per sentinel
clinic in each prefecture during 31st epi
week in 2009 (from 27 July to 2 Aug 2009)
2009年第31週インフルエンザ定点当たり報告数県別グラフ
Okinawa
14.00
12.00
10.00
8.00
Fatal cases as of 19 August 2009 (n=3) *Media information included
-A 50s male in Okinawa with underlying disease (dialysis)
-A 70s male in Hyogo with underlying disease (dialysis, COPD)*
-A 80s female in Aichi with underlying disease (detail unknown)*
6.00
4.00
Average
Tokyo
Aichi
Hyogo
2.00
0.00
全 北 青 岩 宮 秋 山 福 茨 栃 群 埼 千 東 神 新 富 石 福 山 長 岐 静 愛 三 滋 京 大 兵 奈 和 鳥 島 岡 広 山 徳 香 愛 高 福 佐 長 熊 大 宮 鹿 沖
国 海 森 手 城 田 形 島 城 木 馬 玉 葉 京 奈 潟 山 川 井 梨 野 阜 岡 知 重 賀 都 阪 庫 良 歌 取 根 山 島 口 島 川 媛 知 岡 賀 崎 本 分 崎 児 縄
平 道 県 県 県 県 県 県 県 県 県 県 県 都 川 県 県 県 県 県 県 県 県 県 県 県 府 府 県 県 山 県 県 県 県 県 県 県 県 県 県 県 県 県 県 県 島 県
均
県
県
県
Source: IDSC/NIID, amended
Summary
• Novel influenza (A/H1N1pdm) is spreading
nationwide in Japan in spite of summer season
– More than 1000 outbreaks in the past 2 weeks as of 15
August
• 60,000 cases estimated in 32nd epi week – preliminary data
• Median age: still in teenagers?
– Severe cases are increasing
• Approximately 100 hospitalizations; 3 acute encephalopathy
(<10 y.o.) and 4 mechanical ventilations (probably more)
• Three deaths reported (>50 y.o., +underlying disease) as of
19 August
• Strategic approach of public health intervention
should urgently be prepared for coming pandemic
situation