Transcript Surveillance Conducted by Implementing Cities

Joint Research and Survey on
Strengthening the Surveillance System
for Pandemic Influenza
How to compile the final report in 2014
(Proposal)
Dr. Yukiko Morikawa
Supervisor for Pandemic Influenza Control
Infectious Disease Control Section
Health and Safety Division
Bureau of Social Welfare and Public Health
Tokyo Metropolitan Government
February 5, 2014
Recent Developments

2011
Status survey on pandemic influenza

February 7-9, 2012: Conference on Joint
Research and Survey (Tokyo)
Decided on what to implement from April 2012March 2013
(1) Implement a surveillance in a model city using a rapid test kit.
(2) Conduct a communication training among the member cities.
(3) Confirm plans to designate Jakarta as the model city.
Recent Developments

September 2012 –
An influenza cluster surveillance was implemented
in the model city (Jakarta) using a rapid test kit.

September 14, 2012
A communication training was conducted among
the member cities (by K-net).

2013 - 2014
Implement influenza cluster surveillance in the
member city (Metropolitan Manila), using a rapid
test kit.
*K-net: Kansensho (a Japanese word means “infectious diseases”) information
network system, operated by Tokyo.
Influenza Surveillance System in Member Cities
(Influenza Surveillance Situation Report 2011)
City
Bangkok
Hanoi
Implemented by
Type of Surveillance
National gov’t
Notifying and reporting of designated infectious
diseases
National gov’t (NIH)
Influenza virus surveillance
Bangkok
Influenza-like illness surveillance
National gov’t
Notifying and reporting of designated infectious
diseases
National gov’t (NIHE)
Influenza virus surveillance
National gov’t
Notifying and reporting of designated infectious
diseases
National gov’t
(US-CDC)
Jakarta
Influenza virus surveillance
Severe Acute Respiratory Infection (SARI) virus
surveillance
Jakarta
Avian surveillance
Jakarta, national gov’t
（US-CDC)
Influenza-like illness surveillance
Jakarta, National
gov’t（US-CDC)
Severe Acute Respiratory Infection (SARI) virus
surveillance
City
Implemented
by
Type of Surveillance
Notifying and reporting of designated infectious diseases
School surveillance
Surveillance at large-scale customer-drawing facilities
National gov’t
Taipei
Real-time outbreak and disease surveillance
Symptom surveillance
Self-health management and home quarantine information
system
Virus surveillance
Taipei
School surveillance
Notifying and reporting of designated infectious diseases
Seoul
National gov’t
Influenza-like illness surveillance
Virus surveillance
<Reference>
Influenza Surveillance in Tokyo
Notifying and reporting of designated infectious diseases
Influenza virus surveillance (pathogen surveillance)
National
gov’t
National Epidemiological surveillance of vaccine
preventable diseases
Influenza hospitalization surveillance
Tokyo
Status of influenza outbreak, by facility
Cluster surveillance
Tokyo
Tokyo infection alert
Surveillance Conducted
by Implementing Cities
Implementing
city
Outbreak suspected
as pandemic influenza
Advice,
cooperation
Tohoku
University
(Supervisor)
Guidance
Tokyo
Provision of
manuals
and know-how
(1) Quickly obtain
accurate
information
ANMC21 member cities
Health center, etc
Survey
company
Commission
(2) Acquire
appropriate
samples
Rapid test
(3) Conduct
rapid test
Background of
outbreak
Test results
National research
center, etc.
Confirmation testing
Analysis
Reflection in policies and
measures
• Information provision to
healthcare providers
• Estimation of influence on
society
• Information transmission
• Enhancement of
epidemics prevention
Past Achievements

Conducting a cluster surveillance in the
implementing city (Jakarta, Metropolitan
Manila) contributed in preparing the
ground for developing the ability for early
detection and response to influenza in
local regions.

Through the use of K-net, an information
sharing system (report line) among
member cities could also be built.
Final Report of the Joint Research and
Survey on Pandemic Influenza (Draft)
 Objective:
・To Enhance the quality of surveillance in
Asia
・To Develop measures for early detection
and appropriate ways to prevent the
spread in the case of an outbreak of any
emerging infectious diseases.
Final Report of the Joint Research and
Survey on Pandemic Influenza (Draft)

Survey Report
・Survey period: March – May 2014 (plan)
・Method: Questionnaire
・Process:
Tokyo will email the questionnaire to and
collect replies from member cities.
Final Report of the Joint Research and
Survey on Pandemic Influenza (Draft)
Report Items:
(A) Overview of member cities’
influenza-related surveillances
・Lists
・About each surveillance (notifiable,
sentinel, others; overview)

Summary of the Joint Research and
Survey on Pandemic Influenza (Draft)
(B) Survey Report
(1) Target: Selected from a or b of the following:
a. The most effective of the influenza-related
surveillances conducted in member cities.
b. A new surveillance that was put in place in
recent years.
Summary of the Joint Research and
Survey on Pandemic Influenza (Draft)
(2) Survey items:
a. Name of the selected surveillance
b. Case definition
c. Method of receiving information on influenza
patients.
d. Department which collects the surveillance
information (city,national government)
e. Flow chart of how surveillance information is
received and accumulated
(city, national government)
f. Sharing the surveillance information
Final Report of the Joint Research and
Survey on Pandemic Influenza (Draft)
(C) Considerations
Based on (A) and (B), the following points are to
be considered:
1. Benefits of conducting surveillances
2. Issues that arise in conducting surveillances
3. The causes of the issues that arise from
conducting surveillances
(D) Conclusion
1. Future issues
2. Efforts toward improvement
<Reference> Tokyo:
(A) Overview of Influenza-Related Surveillances
• List
(1) Notifying and reporting of designated infectious
diseases
(2) Influenza virus surveillance (pathogen surveillance)
National
gov’t
(3) Epidemiological surveillance of vaccine preventable
diseases
(4) Influenza hospitalization surveillance
Tokyo
(5) Status of influenza outbreak, by facility
(6) Cluster surveillance
Tokyo
(7) Tokyo infectious disease alert
<Reference> Tokyo:
(A) Overview of Influenza-Related Surveillances
・About each surveillance
(1) Notifying and reporting of designate infectious
diseases: sentinel
・Overview: Receives report from sentinel
clinics on number of infected patients.
(2) Influenza virus surveillance (pathogen
surveillance): sentinel
・Overview: Discovers the characteristics of virus
by obtaining samples from sentinel clinics of
influenza pathogens.
<Reference> Tokyo:
(A) Overview of Influenza-Related Surveillances
(3) National epidemiological surveillance of VPD:
conducted in different regions every year.
・Overview: By determining the people’s antibody
prevalence by age groups, promotes effective
operation of various vaccination projects and
further, comprehensively forecast epidemics from
a long-term standpoint.
<Reference> Tokyo:
(A) Overview of Influenza-Related Surveillances
(4) Influenza hospitalization surveillance: sentinel
・Overview： Receives information from sentinel clinics
on number of hospitalizations caused by influenza
and clinical information, in order to understand the
trend in patient hospitalization caused by influenza
and its severity.
(5) Status of influenza outbreak, by facility: notifiable
・Overview: To gain a grasp of the status regarding
temporary closing of daycare centers, kindergartens,
elementary schools, junior and senior high schools
due to influenza-like illnesses.
<Reference> Tokyo:
(A) Overview of Influenza-Related Surveillances
(6) Cluster surveillance: other
・In the event that a notification is received of temporary
closing or a mass outbreak based on the above (5), or of
a mass outbreak at a social welfare facility, some of the
patients within the group affected with the influenza-like
illness will be examined for virus to determine the virus
type of the outbreak.
(7) Tokyo infectious disease alert: notifiable
・Overview: Notification is sent, from healthcare providers
to a health center, of suspicion of diseases such as the
avian influenza and influenza H7N9, in order to conduct
pathogen testing at an early stage.
<Reference> Tokyo:
(B) Survey Report
a.Name of the selected surveillance :
Cluster surveillance (Tokyo)
b. Case definition:
A case affecting a large group which falls under
one of the following four categories and in which
at least one person has been proven positive
using a quick test kit.
<Reference> Tokyo:
(B) Survey Report
1. A case affecting a large group for which a school (kindergarten,
elementary school, junior and senior high school, university, special
needs school, etc.) or daycare center is temporarily closed due to an
influenza-like illness.
2. At a social welfare facility, a death has occurred, or two or more
people have been hospitalized within a seven-day period due to
influenza or suspicion of influenza.
3. At a social welfare facility, ten or more, or over half of the facility’s
users have come down with an influenza-like illness within a sevenday period.
4. A case affecting a large group that does not fall under the above
(1), (2) or (3).
<Reference> Tokyo:
(B) Survey Report
c. Method of receiving information on outbreaks:
Medical institution, schools, daycare centers, social
welfare facilities, etc., will notify the public health
center.
d. Department which collects the surveillance
information (city, national government)
Tokyo: Bureau of Social Welfare and Public Health
<Reference> Tokyo:
(B) Survey Report
e. Flow chart of how surveillance information is received and
accumulated
Public schools and
daycare centers
Board of education
Bureau of Social Welfare and
Public Health, Tokyo
Notification
Infectious Disease
Control Section
Notification
Notification
Private schools and
daycare centers
Social welfare facilities
Regional public
health center
Notification
Request
for PCR testing
Sharing of
information
Tokyo Metropolitan Institute
of Public Health
Test
results
<Reference> Tokyo:
(B) Survey Report
f. Sharing the surveillance information
(1) Sharing the information with the citizens of Tokyo:
・ By posting information about detected virus type,
etc. on the relevant websites.
・ By publishing the information magazine, Tokyo
Influenza Information.
(2) Reflecting findings in policies and measures
・ When a pandemic influenza, etc. is detected, the
public health center will conduct a proactive
epidemiological research.