5. Infectious disease surveillance designated by the Infectious Disease Control Law, and the situation of emerging/re-emerging infectious diseases in Japan.
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Communicable Disease Control↗
Biomedical subjects
Nobuhiko Okabe
Publications and source records attributed to Nobuhiko Okabe.
Evaluation of a sentinel surveillance system for influenza, 1995-2000, Kyoto City, Japan.
We compared a municipal sentinel surveillance system for influenza with the Microbial Isolation Surveillance System (MISS) in Kyoto City, Japan. Sensitivity, specificity, and predictive value positive (PVP) of the Influenza Sentinel Surveillance System (ISSS) compared to the MISS were calculated by influenza season and by month. Sensitivity ranged from 80 to 97%, specificity ranged from 55 to 77%, and PVP ranged from 29 to 52% by season (P < 0.001). On the other hand, sensitivity ranged from 86 to 100%, specificity ranged from 38 to 66%, and PVP ranged from 31 to 50% by month (P < 0.001). Specificity was calculated as 93% in November. The sensitivity of ISSS was found to be sufficient regardless of the magnitude of influenza activity. Specificity varied by season, indicating the difficulty of clinically diagnosing other respiratory illnesses. The PVP remained at less than 50% before and after the influenza seasons and it varied year by year. In general, the ISSS is a good surveillance system for monitoring influenza activity.
Disease Outbreaks↗
[Management of patients with viral hemorrhagic fever in Germany a comparison with the current Japanese system based on the who guidelines on emerging viral diseases].
OBJECTIVES: We investigated the German system for managing patients with viral hemorrhagic fever (VHF) in comparing with the current Japanese system. METHODS: In Germany, we visited the Robert Koch Institute and the isolation centers in Berlin and Leipzig. In Japan, we visited the isolation wards in the Narita Red Cross Hospital and the Rinku General Medical Center in Izumi-Sano, Osaka, to allow determination of differences in the systems. In terms of the "WHO program on emerging virus diseases, 1994", we then evaluated the two countries' systems. RESULTS: In Germany, the finding of a suspected case with VHF is promptly reported to the competent authorities at the local level. Public health physicians on 24-hour duty declare a quarantine alert and the case is transferred to one of five isolation centers not by plane but by ambulance car. The isolation rooms in Berlin, constructed some 20 years ago, are enclosed with plastic film and kept under negative pressure and this hinders it difficult to perform intensive care in the small space available. In contrast, intensive care and routine clinical tests can be readily conducted in the isolation facilities in Leipzig installed in 2000, since the rooms are spacious and kept under negative pressure. It is also noteworthy that the same ward is utilized for patients with drug-resistant infectious diseases to train medical staff. With 3 of the 4 goals in the WHO program, establishing efficient surveillance of infectious diseases, provision of a qualified national laboratory and performance on practical research on infectious diseases, there are no large differences, between the two countries, in continuous efforts in line with recently-modified infectious disease laws. However, we found differences with regard to an effective strategy to circumvent VHF, 1) local government has a main role against VHF and control team is promptly designated in Germany, 2) only 10 beds are equipped to deal with VHF in Germany, 3) management of air-droplet infection seems insufficient in Japan, 4) highly-equipped isolation rooms are not utilized for patients other than those with VHF in Japan. CONCLUSIONS: These findings require urgent discussion among Japanese experts concerning; 1) operation of BSL4 facilities in national laboratories; 2) collaboration among quarantine stations, local government and national reference laboratories; 3) the appropriate number of isolation wards; 4) practical procedures to run of isolation wards efficiently; 5) the possibility of utilizing isolation wards for non-VHF.
Disease Management↗
Evaluation of National Tsutsugamushi Disease Surveillance--Japan, 2000.
In Japan, Tsutsugamushi disease, which is caused by Orientia tsutsugamushi, is re-emerging with newly recognized strains and is now endemic in all prefectures except Hokkaido and Okinawa. We analyzed recent surveillance data to describe the epidemiology of Tsutsugamushi disease and to evaluate the newly implemented national surveillance system according to the CDC guidelines for evaluating surveillance systems. In 2000, 756 cases of Tsutsugamushi disease were reported from 37 of 47 prefectures; two of these cases were fatal. The median age of case-patients was 64 years (range: 2 - 94 years); 414 (54.8%) were male. In northern Japan, most cases were diagnosed in the months of May through July and in the months of October through December, and in southern Japan, cases were diagnosed almost year-round with a peak from October through December and in January. Reporting and transfer of surveillance information from the prefecture to the national level was effective and timely, but the completeness and quality of case reporting could still be improved. The current system for Tsutsugamushi disease surveillance is useful for describing epidemiologic patterns by time, prefecture, and demographic characteristics. However, collection of additional information on suspected place of transmission, activity performed at the place of transmission, or the case-patient's profession would likely make the system more valuable for outbreak detection and for better defining populations at risk.
Adolescent↗