Response to pandemic (H1N1)2009 - Country experience - Japan

1. The 3rd meeting of National Influenza Centres in WP and SEA regions Beijing, China 19 August 2009 Response to pandemic (H1N1)2009 - Country experience - Japan Tomimasa Sunagawa sunatomi@nih.go.jp Infectious Disease Surveillance Center National Institute of Infectious Diseases, Japan

2. Case-based surveillance as of 23 July 2009（n=4,496*）(*case with information of date of onset) Accumulated number of cases Case Enhanced entry-screening at int. port and airport More than 3000 schools closed in Hyogo and Osaka Date of onset

3. Case-based surveillance as of 10 July 2009（n=2,064*）(*case with information of date of onset) History to go overseas country within past 1 wk YES linkage with traveler from overseas country NO linkage with travelers from overseas country Unknown Source: MHLW

4. Overview of surveillance system for novel influenza (A/H1N1ｐｄｍ） #5 Current status? Sporadic cases or clusters imported from oversease countries 1. Early detection of outbreak 2. Monitoring of trend Notification of cases by law (cluster) PCR positive　　　　　→confirmed case No PCR test/ Yes symptom →probable case For early detection of outbreak Cluster surveillance PCR tests for representative cases for all the clusters Schools, nursery, nursing homes, etc Surveillance of absentee (nursery, elementary/junior high/ high school) (No lab tests) Virus surveillance (sentinel/ outpatients) (lab tests)　 *including identification of drug resistance For monitoring of viral mutation and disease severity (Lab tests initially for all the cases but for partial cases when pandemic) Hospitalization surveillance (inpatients) (Lab tests initially for all the cases in all the hospitals) (the number of cases only reported from sentinel hospitals when pandemic) ILI surveillance (sentinels/ outpatients)(No lab tests) For monitoring Epidemic trend

5. Hospital surveillance as of 11 August 2009 – result (1) Source: MHLW (press release)

6. Hospital surveillance as of 11 August 2009 – result (2) Source: MHLW (press release)

7. Hospital surveillance as of 11 August 2009 – result (3) Fatal cases reported on 15, 18 and 19 August (total: 3) Source: MHLW (press release)

8. ILI surveillance in Japan, from April 1999 to 2 August 2009 Reported number of cases per sentinel clinic 0.56 Source: Dr. Y. Yasui (IDSC/NIID)

9. ILI surveillance in Japan, from April 1999 to 2 August 2009(enlarged image) 0.9 in 32nd week (60,000 cases estimated) Source: Dr. Y. Yasui (IDSC/NIID)

10. Reported number of ILI cases per sentinel clinic in each prefecture during 31st epi week in 2009 (from 27 July to 2 Aug 2009) Okinawa Fatal cases as of 19 August 2009 (n=3) *Media information included -A 50s male in Okinawa with underlying disease (dialysis) -A 70s male in Hyogo with underlying disease (dialysis, COPD)* -A 80s female in Aichi with underlying disease (detail unknown)* Aichi Average Tokyo Hyogo Source: IDSC/NIID, amended

11. Summary • Novel influenza (A/H1N1pdm) is spreading nationwide in Japan in spite of summer season • More than 1000 outbreaks in the past 2 weeks as of 15 August • 60,000 cases estimated in 32nd epi week – preliminary data • Median age: still in teenagers? • Severe cases are increasing • Approximately 100 hospitalizations; 3 acute encephalopathy (<10 y.o.) and 4 mechanical ventilations (probably more) • Three deaths reported (>50 y.o., +underlying disease) as of 19 August • Strategic approach of public health intervention should urgently be prepared for coming pandemic situation