Transcript Hospitalization surveillance

The Next Joint Research and Survey
—Enhancement of the Pandemic Influenza Surveillance
System—
Dr. Keiko Sasai, MD
Senior Director for Infectious Diseases Control and Crisis
Management,
Bureau of Social Welfare and Public Health
Tokyo Metropolitan Government
November 2, 2011
Background (1)
June,2009
Start of Cluster Surveillance, Hospitalization Surveillance
and Recuperation of Patients at Home
(person/sentinel clinics)
40.0
Very few reports of
seasonal influenza
during this period
30.0
20.0
10.0
0.0
Jan
Feb Mar
Apl May Jun
Jly
Aug
Sep Oct
Nov Dec
2009
①
Jan
2010
②
③
④
⑤⑥
Background (2)
Implementation of Cluster Surveillance
Fluctuations in the number of groups where the type A influenza virus was detected, according to the
cluster surveillance (weekly total in 2009)
50
46
45
H3N2
40
35
G
r 30
o
25
u
p 20
s
15
A(H1N1）pdm09
17
17
10
5
0
16
13
12
0
21
0
22
6
5
4
0
23
Group Attribution
Number of examined
groups
(May 18 ～July 10)
Nursery School &
Kindergarten
12
Primary School
27
Junior High School
9
High School
12
University
6
Others
15
Total
81
3
0
24
3
0
25
26
0
2
27
0
28
0
29
0
30
1
31
Week
On the 25th week (June 17),
almost all group infections switched over to
A(H1N1)pdm09.
Background (３)
 Lessons learned from “A(H1N1)pdm09” Outbreak and
Future Challenges
 An outbreak must be detected quickly in order to stop a
pandemic
 Cluster surveillance is the key to detecting Pandemic
Influenza outbreaks
3
Background (４)
 Prompt Pandemic Influenza detection
 Detection of outbreaks
・ Need to establish a system which can quickly obtain accurate
information from local communities and report is made
 Epidemiological studies
・ Need to have a framework in place to quickly launch
epidemiological study once a suspected case is found
・ Need to ensure proper collection and transport of specimens
・ Need to establish a system that can quickly and reliably test
suspected cases
4
Next Joint Research and Study Theme
Enhancement of the Pandemic Influenza
Surveillance System
 Enhance systems in each city to promptly detect Pandemic
Influenza outbreaks.
 Based on the consent of each country, build a framework to
share detected information with each city.
5
Significance of Joint Research and Study
 Implement joint survey between member cities
and enhance capabilities for surveillance at the
time of Pandemic Influenza outbreak.
 Strengthen early detection and response
framework for Pandemic Influenza outbreaks,
including avian influenza, linking this with the
implementation of robust infectious disease
countermeasures in major cities of Asia.
6
Implementation Method (Proposal)
(1) Share information on the surveillance system of each
city through conferences and other means.
(2) Formulate an ANMC21 surveillance manual.
(3) Following the manual, implement simulated training
exercises to learn from one another and enhance the
knowledge toward improving and strengthening their
surveillance.
7
Implementation Schedule (Proposal)
July 2011
to
March 2012
○ Current
situation
survey
April 2012
to
March 2013
○ Trial run
○ Formulate
research plan
April 2013
to
March 2014
○ Research
and Study
April 2014
to
March 2015
○ Validation and
wrap-up
8
Implementation (Proposal) [July 2011 – March 2013] (1)
ANMC21 Member Cities
Current situation survey and information sharing
on the surveillance system of each city
Analyze and examine needed improvements based on
current situation and challenges
Formulate ANMC21 surveillance manual
9
Implementation (Proposal) [July 2011 – March 2013] (2)
Conduct simulated training exercise in a model city
ANMC21
Model City
Suspected case of
Pandemic Influenza,
including avian influenza
(2) Collect proper
specimens
Public Health
Center
(3) Quickly
conduct
trial run
test
Quick
testing
Confirmation
testing
Department in charge of
infectious diseases
(1) Quickly
obtain
accurate
information
Share expertise
Share
information
Joint
analysis of
outbreak
and test
results
Tokyo
(Organizing City)
Participating
Cities
Analysis
Quick Response
・Establish consultation
system
・Disseminate information
・Tighten epidemic
prevention system
Research
Institution
10
Implementation (Proposal) [July 2011 – March 2012]
 Conduct current situation survey on surveillance
system
 Hold the Conference on Joint Research and Survey
(February 2012 in Tokyo)
・Current situation survey report
・Presentations by each city on their surveillance
methods / practices
 Determine model city and discuss implementation
methods
11
Implementation (Proposal) [April 2012 – March 2013]
 Formulate Pandemic Influenza joint research
and survey plan
 Formulate ANMC21 surveillance manual
 Conduct trial run simulation in a model city
 Hold Conference on Joint Research and Survey
 Formulate and sign agreement
12
Implementation (Proposal) [April 2013 – March 2015] (1)
Step 1
Participating cities conduct simulated training exercise
・Learn from one another about第二ステップ
proper methods / practices that can improve and
enhance surveillance
Step 2
Participating cities share knowledge / expertise
・Improve and strengthen surveillance system of each city
・Strengthen framework to quickly detect and respond at the time of
Pandemic Influenza outbreak
Step 3
Build system to promptly share detection information
13
Implementation (Proposal) [April 2013 – March 2015] (2)
Conduct simulated training exercise for all cities participating in
the joint research and survey
All Participating Cities
Suspected case of
Pandemic Influenza,
including avian influenza
(2) Collect proper
specimens
Public Health
Center
(3) Quickly
conduct
trial run
test
Quick
testing
Confirmation
testing
Department in charge of
infectious diseases
(1) Quickly
obtain
accurate
information
Share expertise
Share
information
Joint
analysis of
outbreak
and test
results
Tokyo
(Organizing City)
Each Participating
Cities
Analysis
Quick Response
・Establish consultation
system
・Disseminate information
・Tighten epidemic prevention
system
Research
Institution
14
Implementation (Proposal) [April 2013 – March 2015] (3)
ANMC21
Bangkok
Hanoi
Tokyo
Hold Conference on Joint
Research and Survey
・ Share surveillance system expertise
・ Examine information-sharing system
Jakarta
Kuala Lumpur
Taipei
Seoul
15
Implementation (Proposal) [April 2013 – March 2014]
 Conduct simulated training exercises in all cities
participating in the joint survey
 Share knowledge of surveillance methods /
practices
 Hold Conference on Joint Research and Survey
 Discuss ways of sharing information during
H1N1, H5N1 outbreak
16
Implementation (Proposal) [April 2014 – March 2015]
 Conduct simulated training exercise for all cities
participating in the joint research and survey (continuing
from previous fiscal year)
 Examine and build system for sharing information during
H1N1, H5N1 outbreak
 Verify implementation results in each city: Create reports
on the results of each city
(Including improvements made to each city’s surveillance
system as a result of the 3-year initiative, etc.)
 Create final report
 Hold Conference on Joint Research and Survey
(reporting of results from each city)
17
Tokyo’s Surveillance System (1)
Prior to
Outbreak
No Outbreak in
Tokyo
Early Stage
Outbreak in Tokyo
Epidemic Period in Tokyo
First Stage
Declaration of emergency
by the governor
Third Stage
Second Stage
Normal surveillance system (implemented throughout the year)
Influenza surveillance (influenza fixed point)
Virus surveillance (pathogen fixed point / virus testing)
Hospitalization surveillance (monitor those hospitalized and with severe cases)
[TMG Standalone] Virus testing under the Tokyo Infectious Disease Alert
Influenza-like disease occurrence report (schools, nursery schools, etc.)
Group infectious disease outbreak report (social welfare facilities)
*
*
Normal surveillance system (implemented according to the fixed points)
*
Cluster
surveillance
(virus testing)
[TMG Standalone] Utilize individual fixed points for quasi-infections
hospitalization surveillance (26 medical institutions in Tokyo)
Changes once 1.0 per
fixed point is exceeded
Emergency surveillance system
*
Tokyo Infectious Disease Alert
Virus testing for all cases
(travel history / close contact)
Hospitalization
surveillance
(identify all cases)
Normal surveillance
*
Additional surveillance
implemented during an
outbreak
*
Virus testing
Tokyo’s Surveillance System (2)
<No Outbreak / Early Stage Outbreak in Tokyo>
■ Quick detection of Pandemic Influenza patients, virus analysis and
identification of all cases
■ Need to promptly detect infectious diseases in order to delay its spread
■ Enhance detection of group outbreaks in nursery schools and schools, etc.
■
Conduct emergency surveillance in addition to year-round surveillance
Year round
・ Influenza surveillance
・ Virus surveillance
・ Tokyo Infectious Disease Alert
・ Group outbreak report (schools, nursery schools, social welfare facilities)
・ Hospitalization surveillance
Emergencies
・ All suspected Pandemic Influenza cases receive virus testing by
influenza specialist outpatient departments under the Tokyo Infectious
Disease Alert
・ National standard hospitalization surveillance (covering all medical
institutions)
Tokyo’s Surveillance System (3)
<Epidemic Period in Tokyo>
■ The number of cases increases, and sufficient information is available
on the clinical picture of patients thanks to surveillance programs
implemented up to that point
■ This reduces the need to identify all cases, and since this work results
in an excessive burden on healthcare practitioners, it is important to limit
information collection only to serious cases and deaths
■ Once 1.0 is exceeded per fixed point, the following surveillance
programs are terminated:
・ Virus testing for all cases under the Tokyo Infectious Disease Alert
・ Cluster surveillance followed by virus testing
・ Hospitalization surveillance based on reporting of the national
government
■ Launch the TMG standalone hospitalization surveillance (covering 26
medical institutions in Tokyo) that utilizes individual fixed points for quasiinfections in order to monitor the occurrences of hospitalizations
Tokyo Infectious Disease Alert
A system where medical institutions report suspected
cases of specific infectious diseases to the nearest public
health center, followed by a prompt epidemiological study
by the public health center and pathogen testing by the
Tokyo Metropolitan Institute of Public Health
Report
Survey
Report
Test
Report
Tokyo Metropolitan Institute of
Public Health
TMG
Infectious Disease
Control Section
Rainbow Bridge
Tokyo Sky Tree
Thank you for your attention!
Kaminari-mon Gate
TMG Buildings
Conference on Joint Research and Survey
in Tokyo (Early in February,2012)
We look forward to welcoming you!