Surveillance Systems for Infectious Diseases in Korea

1. Surveillance Systems for Infectious Diseases in Korea Ok Park, Medical Officer, KCDC Trilateral Seminar on R & D Policies to Emerging And Re-emerging Infectious Diseases, December 14-16, 2005, Boston

2. Overall Incidence of Notifiable Infectious Diseases in Korea * The cases of Tuberculosis, Hansen’s disease, and HIV/AIDS were excluded

3. Emerging Infectious Diseases in Korea • Leptospirosis, Legionellosis outbreak (1984) • HIV Infection (1985) • Entero-hemorrhagic E-coli (O157) infection (1998) • Vancomycin intermediate susceptible Staphylococcus aureus infection (1999) • Brucellosis (2002) • Botulism (2003)

4. Reemerging / Increasing Infectious Diseases in Korea • Reemergence of vivax Malaria (1993) • Reemergence of Rabies (1998) • Increase in Food-borne diseases • Shigellosis : caused by Shigella sonnei • Food poisoning • EHEC infection : increasing since first outbreak in 2003 • Increase in Hantavirus hemorrhagic fever syndrome, Scrub typhus, Leptospirosis (since 1998) • Increase of HIV/AIDS

5. Reported Cases of Shigellosis by Year

6. Reported Cases of Measles by Year Adapted measles elimination strategy and conducted mass immunization campaign, 2001

7. Reported Cases of Malaria by Year Adapted malaria elimination strategy in 1999 and launched DPRK project in 2001

8. Enhancement of Infectious Disease Surveillance and Response Increase of Emerging and Re-emerging Infectious Disease • Adopt Proactive Strategy for Communicable Disease (Control→ Elimination) • Build Infrastructure to Respond Communicable Disease Organization • Revision of • CDPL • Sentinel • surveillance • Immuni- • zation • Registry Legislation Human resources IT Stockpiling R & D • FETP • FMTP • Onsite • supervision • Cyber • education • Training • courses • Vaccine • Antibiotics • Antiseptics • PPE • Ventilators • Vaccine • Diagnosis • Therapy • Serum • bank • EDI • DB • Modeling • Info • sharing • KCDC • Formation • of Task • Forces

9. Reporting System of Notifiable Diseases Physicians Report (Tel/Fax) Feedback Health Center (District level) Specimen Referral Feedback Feedback Report (EDI) Prov. Inst. of Health & Environment • Dept. of Health • (Provincial level) Report (EDI) Feedback Specimen Referral Feedback KCDC

10. Enhancement of Legal Framework • Revision of Communicable Disease Prevention Law • Enacted in 1953 • Revised in 2000 to strengthen legal basis for EID- Extend diseases for notification (3 groups 29 diseases to 5 groups 64 diseases) - Change notification criteria - Shorten the reporting time - Stipulate Notification form, Notification process, Scope of notification of each disease Punishment for delinquent reporting

11. Classification and Reporting Time of Notifiable Infectious Diseases

12. Adapt IT for surveillance and Enhance analysis and Feedback • Adapt IT for surveillance • Electronic data interchange system for reporting • Data management program • Statistical program • Develop Disweb as a portal site for sharing information on communicable diseases • Enhance Data Analysis and Feedback • CDWR(Communicable Disease Weekly report) • CDMR(Communicable Disease Monthly Report) • Statistical Year Book • Press releases

13. Information Flow Management program Management program Management program Management program Management program Prov. DB PHC DB Management program Doctor Health center TEL,FAX Province Database EDI EDI KCDC Sentinel site Feedback Statistic DB Statistical Program

14. EDI System for Reporting

15. Data Management Program

16. Statistical Program of Communicable Diseases

17. Portal Site for Information on the Communicable Disease (http://dis.cdc.go.kr)

18. English version of Diswebhttp://dis.mohw.go.kr/english/index.htm

19. Establishment of Various Surveillance Systems • Sentinel Surveillance by the CDPL • Influenza, Viral hepatitis A, B, C, STDs • Imported Parasitic Diseases, VRSA infection, CJD • Sentinel surveillance on the voluntary basis • Pediatric Sentinel Surveillance, Viral conjunctivitis • Network for information sharing and surveillance • Infection specialists network (2002) • EpiNet (2003) • Syndromic Surveillance and Rumor Surveillance System • Emergency room based syndromic surveillance (2002) • Enhanced syndromic surveillance during major international events (2003) • K- ProMed

20. Website for sentinel or syndromic surveillance

21. Website for Influenza Surveillance (Korean/English version)

22. Human Resources Development and Collaboration with Private Sector • Development of Human Resources • Field Epidemiology Training Program (1999) • Field Management Training Program (2002) • Training program by each Div. - Training for communicable disease surveillance : 3 to 4 times a year • Enhancement of Collaboration with Private Sector • Development and operation of sentinel surveillance in the collaboration with private sector • Co-hosting of seminar, conferences • Research Project

23. Gaps for Infectious Disease Surveillance • Insufficient capacity at local government • Lack of human resources at local government to respond to emerging infectious diseases • Frequent rotation of health care workers • Insufficient operation of various surveillance system • Development of various surveillance systems which can serve as an early warning system • Lack of experts to operate each surveillance system

24. Gaps for ID Surveillance • Insufficient integration among surveillance systems • Insufficient integration between Notifiable Disease Surveillance & laboratory surveillance • Low participation rate for notification from physicians • Low notification rate of notifiable diseases - Shin et al, 1994, notification rates of group 1 and group 2 diseases are respectively: 71.0% (95% PI, 96.2 - 75.3), 20.0% (95% PI, 18.9 – 21.3) - Shin et al, 2003, small scale survey result, notification rates of group 1, 2, & 3 are 76.4%, 50.5% & 43% respectively - Survey in one city, 2002, report always (28%) ; report generally (37%), report sometimes (18%) ; report rarely (9%) ; no experience of infectious disease (8%), N=727

25. Future Plans • Development of web-based reporting system • Convenience of data management • Real-time analysis • Integration of Notifiable Disease Surveillance and Laboratory Surveillance • Comprehensive surveillance • Increase notification rate

26. Future Plans • Extension of electronic reporting system to private sector • Convenience of notification from the private sector • Enhance notification rate automatically • Decreasing duplicated work in public health sector • Development of human resources • Continuous training to develop human resources • Collaboration with private sector to enhance participation in disease surveillance • Enhance R & D • Operation of various surveillance system

27. Thank You