Response to pandemic (H1N1)2009

- Country experience - JapanTomimasa Sunagawasunatomi@nih.go.jp

Infectious Disease Surveillance CenterNational Institute of Infectious Diseases, Japan

The 3rd meeting of National Influenza Centres in WP and SEA regionsBeijing, China19 August 2009

Case-based surveillance as of 23 July 2009 （ n=4,496

*）(*case with information of date of

onset)Case Accumulated number of

cases

Date of onset

More than 3000 schools closed in Hyogo and Osaka

Enhanced entry-screening at int. port and airport

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

Overview of surveillance system for novel influenza (A/H1N1 ｐｄｍ）Strategy

Epid

em

ic trend

Ob

jective

sS

urve

illan

ce

Prevention against disease spreading Prevention against severe disease Evaluation and preparedness

　　　　　　　　　　 ILI surveillance (sentinels/ outpatients) (No lab tests)

　　　　　　　　　　 Virus surveillance (sentinel/ outpatients) (lab tests) 　 *including identification of drug resistance 　

　　　　　　　　　　 Surveillance of absentee (nursery, elementary/junior high/ high school)

　　　　　　　　　　 Notification of cases by law (cluster)

　　　　　　　　　　 Cluster surveillance

1. Early detection of outbreak 2. Monitoring of trend

　　　　　　　　　　 Hospitalization surveillance (inpatients)

For monitoring of viral mutation

and disease severity

For monitoring

Epidemic

trend

For early detection

of outbreak Schools, nursery, nursing homes, etc

Sporadic cases or clusters imported from oversease countries

(Lab tests initially for all the cases but for partial cases when pandemic)

(Lab tests initially for all the cases in all the hospitals)

(the number of cases only reported from sentinel hospitals when pandemic)

PCR positive 　　　　　→ confirmed case

No PCR test/ Yes symptom →probable case

PCR tests for representative cases for all the clusters

(No lab tests)

#5

Current status?Current status?

Hospital surveillance as of 11 August 2009 – result (1)

Admitted # of cases from 5 to 11 August

Accumulated # of cases as of 11 August

Number of admission

48 119

Age distribution

< 5 (y.o.) 7 20

5-19 30 77

20-39 4 9

40-59 0 3

60 and < 7 10

Sex

　Male 29 73

　Female 19 46

Source: MHLW (press release)

Hospital surveillance as of 11 August 2009 – result (2)

Admitted # of cases from 5 to 11 August

Accumulated # of admitted cases as of 11 August

Underlying diseases (partially

overlapped)

(Total) 18

(Total) 50

　 Pregnancy 0 1

　 COPD (e.g., asthma)

12 31

　 CHD 1 2

　 Metabolic diseases 1 2

　 Renal disease 1 2

　 Immune deficiency(e.g., steroid use)

1 3

　 Others 4 13Source: MHLW (press release)

Hospital surveillance as of 11 August 2009 – result (3)

Severe cases (partially overlapped)

Admitted number of cases from 5 to 11 August

Accumulated number of cases as of 11 August

　Acute encephalopathy due to influenza

1 3

　 Mechanical ventilation

1 4

Condition of patients as of 11 August

In hospital, with mechanical ventilation

1 2

In hospital, with no mechanical ventilation

23 27

Discharged 23 87

Died 0 0

No detailed information

1 3

Source: MHLW (press release)

Fatal cases reported on 15, 18 and 19 August (total: 3)

Fatal cases reported on 15, 18 and 19 August (total: 3)

0.00

10.00

20.00

30.00

40.00

50.00

60.00

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53

990123456789

ILI surveillance in Japan, from April 1999 to 2 August

2009Reported number of cases per sentinel clinic

0.56

Source: Dr. Y. Yasui (IDSC/NIID)

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

2.00

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53

990123456789

ILI surveillance in Japan, from April 1999 to 2 August

2009(enlarged image)

Source: Dr. Y. Yasui (IDSC/NIID)

0.9 in 32nd week

(60,000 cases estimated)

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

全国平均

北海道

青森県

岩手県

宮城県

秋田県

山形県

福島県

茨城県

栃木県

群馬県

埼玉県

千葉県

東京都

神奈川県

新潟県

富山県

石川県

福井県

山梨県

長野県

岐阜県

静岡県

愛知県

三重県

滋賀県

京都府

大阪府

兵庫県

奈良県

和歌山県

鳥取県

島根県

岡山県

広島県

山口県

徳島県

香川県

愛媛県

高知県

福岡県

佐賀県

長崎県

熊本県

大分県

宮崎県

鹿児島県

沖縄県

2009年第31週インフルエンザ定点当たり報告数県別グラフ

Reported number of ILI cases per sentinel clinic in each prefecture

during 31st epi week in 2009 (from 27 July to 2 Aug 2009)

Source: IDSC/NIID, amended

Okinawa

HyogoTokyo

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)*

Average Aichi

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