Surveillance for Pediatric infectious disease except Influenza

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Surveillance for Pediatric infectious disease
except Influenza

• July 5, 2006
• Yajima Childrens Clinic
• Shigehiro Yajima, MD.

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Five hospitals with pediatric ward in Gifu-city
Population Gifu-prefecture 2 million and
Gifu-city 0.4 million
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Surveillance for Pediatric infectious disease

• Surveillance system
• in Japan
• in Gifu-city
• Important Pediatric disease
• Measles
• Rubella ( congenital Rubella syndrome CRS )
• problems

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Surveillance system in Japan
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National 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.
  

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category 1-3 infectious diseases
category 2
Cholera
Diphtheria
Paratyphoid fever
Poliomyelitis
Shigellosis
Typhoid fever
category 1
Crimean-Congo hemorrhagic fever
Ebola hemorrhagic fever
Lassa fever
Marburg disease
Plague
SARS
Smallpox
category 3
Enterohemorrhagic Escherichia coli infection
Report to the public health center immediately
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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
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Category V ( Notifiable Diseases )
AIDS AIDS
Acute encephalitis (excluding Japanese encephalitis and West Nile encephalitis) Acute encephalitis (excluding Japanese encephalitis and West Nile encephalitis) Acute encephalitis (excluding Japanese encephalitis and West Nile encephalitis)
Acute viral hepatitis Hepatitis B?Hepatitis C?Hepatitis D Hepatitis B?Hepatitis C?Hepatitis D
Amebiasis
Congenital rubella syndrome (CRS) Congenital rubella syndrome (CRS) Congenital rubella syndrome (CRS)
Creutzfeldt-Jakob disease Creutzfeldt-Jakob disease Creutzfeldt-Jakob disease
Cryptosporidiosis Cryptosporidiosis Cryptosporidiosis
Fulminant group A streptococcal infection Fulminant group A streptococcal infection Fulminant group A streptococcal infection
Giardiasis Giardiasis
Meningococcal meningitis Meningococcal meningitis Meningococcal meningitis
Syphilis Syphilis
Tetanus Tetanus
Vancomycin-resistant Enterococcus infection Vancomycin-resistant Enterococcus infection Vancomycin-resistant Enterococcus infection
Vancomycin-resistant Staphylococcus aureus infection Vancomycin-resistant Staphylococcus aureus infection Vancomycin-resistant Staphylococcus aureus infection
All cases should to be reported to the public
health center within seven days
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Category V (Sentinel-Reporting Diseases)
Number of sentinel clinics in Japan 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
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Pediatric 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 (?)
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Pediatric 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
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Weekly report from IDSC
Increased
decreased
Freequency of disease is reported weekly with
comment and figure. In this year,
Pharyngoconjunctival fever( ) and Mycoplasma
pnuemonia( ) are epidemic in this year.
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Weekly report from IDSC
2006
Pharyngoconjunctival fever is epidemic for last
five years, especially in this year.
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Infectious 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.

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Surveillance for pediatric infectious disease in
Gifu-city

• System same as the system for influenza in Gifu
• Registration by Online-registration with
  internet or Fax from 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 ! )

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Hospitals and clinics for children
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summary for pediatric Infectious disease
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Annual report ( 2005 )
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20032005 in Gifu-city
2003 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
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2004
herpangina
Infectious gastroenteritis
Mumps
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Important pediatric Infectious disease

• Measles
• Rubella

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Measles is the most dangerous disease

• High-infectability
• Many complications (pneumonia, otitis media,
  encephalitis, SSPE)
• Mortality rate is about 0.1 in Japan.
• In 2001, measles was extensive epidemic in
  Okinawa. The number of patient was over 2000, 9
  children died from measles.
• Recently, adult patient is increasing.

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Newspapers said the risk of adult measles
Adult measles patient rapidly increasing
Measles epidemic in university
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• 2 years old girl
• Admitted with measles
• Lost right vision
• Lost consciousness with encephalitis for 1 week
• Tracheostomy
• Perforated to the aorta
• Emergency operation
• Admitted for 6 months
• 22 years old
• graduated from collage

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Important pediatric Infectious disease

• Measles
• Rubella
• Congenital Rubella syndrome ( CRS )
• ( deafness, Cataract, heart disease )

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(No Transcript)
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Measles and Rubella can be eliminated by vaccine.
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Problems
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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

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Measles surveillance system does not come out yet.
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Measles

• should be registered without exception
• can be eliminated, if all the children are
  vaccinated twice against measles.

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