Surveillance for Pediatric infectious disease except Influenza

1. Surveillance for Pediatric infectious disease except Influenza July 5, ２００６ Yajima Children’s Clinic Shigehiro Yajima, MD.

2. University Hospital Children’s Hospital Nagara River Red Cross Hospital Mt.Kinka Municipal Hospital Prefectural Hospital Gifu Station Five hospitals with pediatric ward in Gifu-city Population : Gifu-prefecture 2 million and Gifu-city 0.4 million

3. Surveillance for Pediatric infectious disease • Surveillance system • in Japan • in Gifu-city • Important Pediatric disease • Measles • Rubella ( congenital Rubella syndrome : CRS ) • problems

4. Surveillance system in Japan

5. 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．　　　　　　　　　　　　　　　　　　　・

6. category 1-3 infectious diseases Report to the public health center immediately

7. Report to the public health center immediately

8. Category V（　Notifiable Diseases ） All cases should to be reported to the public health centerwithin seven days

9. Category V　（Sentinel-Reporting Diseases) Sentinel clinics have to report to the public health centerwithin seven days

10. Pediatric infectious disease Vaccine (＋) vaccine (ー)

11. 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

12. 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.

13. Weekly report from IDSC 2006 Pharyngoconjunctival fever is epidemic for last five years, especially in this year.

14. 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.

15. 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 ! )

16. Hospitals and clinics for children

17. summary for pediatric Infectious disease

18. 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. Annual report ( 2005 )

19. 2003~2005 in Gifu-city

20. 2004 herpangina Infectious gastroenteritis Mumps

21. Important pediatric Infectious disease Measles Rubella

22. 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.

23. Newspapers said the risk of adult measles Measles epidemic in university Adult measles patient rapidly increasing

24. 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

25. Important pediatric Infectious disease Measles Rubella Congenital Rubella syndrome ( CRS ) ( deafness, Cataract, heart disease )

27. Measles and Rubella can be eliminated by vaccine.

28. Problems

29. Ibaragi Chiba Nagoya 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 ・・・・

30. Measles surveillance system does not come out yet.

31. 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 ”