Surveillance for Pediatric infectious disease except Influenza

Surveillance for Pediatric infectious disease except Influenza

July 5, ２００６Yajima Children’s Clinic

Shigehiro Yajima, MD.

Five hospitals with pediatric ward in Gifu-cityFive hospitals with pediatric ward in Gifu-city

Mt.Kinka

Gifu Station

Nagara River

University HospitalUniversity HospitalUniversity HospitalUniversity Hospital

Red Cross HospitalRed Cross HospitalRed Cross HospitalRed Cross Hospital

Prefectural HospitalPrefectural HospitalPrefectural HospitalPrefectural Hospital

Municipal HospitalMunicipal HospitalMunicipal HospitalMunicipal Hospital

Children’s HospitalChildren’s HospitalChildren’s HospitalChildren’s Hospital

Population : Gifu-prefecture 2 million and Gifu-city 0.4 million

Surveillance system in Japan in Gifu-city

Important Pediatric disease Measles Rubella ( congenital Rubella syndrome : CRS )

problems

Surveillance for Pediatric infectious diseaseSurveillance for Pediatric infectious disease

Surveillance system in JapanSurveillance system in Japan

National surveillance system in JapanNational surveillance system in 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 1-3 infectious diseasescategory 1-3 infectious diseases

category 2

　 Cholera

　 Diphtheria

　 Paratyphoid fever

　 Poliomyelitis

　 Shigellosis

　 Typhoid fever

category 3　　　 Enterohemorrhagic Escherichia coli infection

category １　 Crimean-Congo hemorrhagic fever

　 Ebola hemorrhagic fever

　 Lassa fever

　 Marburg disease

　 Plague

　ＳＡＲＳ　 Smallpox

Report to the public health center 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

Report to the public health center immediately

Category V 　（　 Notifiable Diseases ）Category V 　（　 Notifiable 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

All cases should to be reported to the public health center within seven days

Category V 　（ Sentinel-Reporting

Diseases) Category V 　（ Sentinel-Reporting

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 report to the public health center within seven days

Pediatric infectious diseasePediatric infectious 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 Infectious Disease Surveillance in JapanPediatric Infectious Disease Surveillance in Japan

Sentinel clinics and Hospitals

Public Health Center

Prefectural governor

Infectious Disease Surveillance Center(IDSC) in National Institute of Infectious Diseases (NIID)

Weekly report will be published.

Every week ( not everyday )

two or three weeks later

Weekly report from IDSCWeekly report from IDSC

Increaseddecreased

Freequency of disease is reported weekly with comment and figure.In this year, Pharyngoconjunctival fever( 　　 ) and Mycoplasma pnuemonia( 　　 ) are epidemic in this year.

Weekly report from IDSC Weekly report from IDSC

2006

Pharyngoconjunctival fever is epidemic for last five years, especially in this year.

Infectious Pediatric Disease SurveillanceInfectious Pediatric Disease Surveillance

Category 5 (sentinel disease) 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 for pediatric infectious disease in Gifu-city

Surveillance for pediatric infectious disease in Gifu-city

System same as the system for influenza in Gifu

Registration by Online-registration with internet or Faxfrom 5 hospitals and some clinics in Gifu-city

Disease for registration Category V 　（ Sentinel-Reporting Pediatric Diseases)

Reports and comments 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 and clinics for childrenHospitals and clinics for children

summary for pediatric Infectious diseasesummary for pediatric Infectious disease

Annual report ( 2005 )Annual report ( 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 in Gifu-city2003~2005 in Gifu-city2003 2004 2005

RS virus infection 0 74 69

Pharyngoconjuncval fever 759 596 577

group A streptococcus 359 212 278

Infectious gastroenteritis 1538 1174 1492

Chikenpox 561 710 554

Hand, foot and mouth disease 763 88 ↓ 82↓

Erythema infectiosum 91 46 68

Exanthema subitum 494 456 433

Pertusis 29 26 1

Rubella 7 6 2

Herpangina 663 733 1043

Measles 4 4 2

Mumps 89 329 897↑

total 5357 4454 7503

20042004

0

50

100

150

200

250

300

１月 ２月 ３月 ４月 ５月 ６月 ７月 ８月 ９月 １０月 １１月 １２月

RSウイルス咽頭結膜熱Ａ群溶連菌感染性胃腸炎水痘手足口病伝染性紅斑突発性発疹百日咳風疹ヘルパンギーナ麻疹流行性耳下腺炎

Infectious gastroenteritis

herpangina

Mumps

Important pediatric Infectious diseaseImportant pediatric Infectious disease

Measles

Rubella

Measles is the most dangerous diseaseMeasles is the most dangerous disease

High-infectability Many complications (pneumonia, otitis media, en

cephalitis, SSPE) Mortality rate is about 0.1% in Japan. In 2001, measles was extensive epidemic in Oki

nawa. The number of patient was over 2000, 9 children died from measles.

Recently, adult patient is increasing.

Newspapers said the risk of adult measles Newspapers said the risk of adult measles

Adult measles patient rapidly increasingMeasles epidemic in university

2 years old girl Admitted with measles Lost right vision Lost consciousness with e

ncephalitis for 1 week Tracheostomy Perforated to the aorta Emergency operation Admitted for 6 months

22 years old graduated from collage

Important pediatric Infectious diseaseImportant pediatric Infectious disease

Measles

RubellaCongenital Rubella syndrome ( CRS ) ( deafness, Cataract, heart disease )

Measles and Rubella can be eliminated by vaccine.

Measles and Rubella can be eliminated by vaccine.

ProblemsProblemsProblemsProblems

In 2006, Measles is epidemic again.In 2006, Measles is epidemic again.

Measles patients were reported from Ibaragi

and Chiba prefecture in April.

Epidemic to high school and university.

So, Infectious Surveillance Center planed the

registration system for all measles cases.

But ・・・・

Ibaragi

ChibaNagoya

Measles surveillance system does not come out yet.Measles surveillance system does not come out yet.

MeaslesMeasles

should be registered without exception can be eliminated, if all the children are

vaccinated twice against measles.

Elimination of measles depends on Elimination of measles depends on not the surveillance system, but on the “ political will ”not the surveillance system, but on the “ political will ”