*Twenty-seven infectious diseases under the National Epidemiological

Transcription

1 Jpn. J. Med. Sci. Biol., 1989 Japan. J. Med. Sci. Biol., 42, Supplement, Annual Report on Findings of Infectious Agents in Japan, Surveillance System Organization The information on bacterial and viral pathogens in this report was collected based upon the system established by the working group constituting the Research Project for Development of a Surveillance System of Pathogenic Microbes in Japan (active ; leader.: Hiromasa In.oue, M. D., Former Director, Aichi Prefectural Institute of Public Health). In 1981, when the Ministry of Health and Welfare inaugurated its Infectious Disease Surveillance Program (National Epidemiological Surveillance of Infectious Diseases)* to gather both patient and laboratory information, it incorporated the system developed by the Inoue group for the primary purpose of synthesis and distribution of laboratory findings (Fig. 2). Laboratory findings are usually reported later than is information about patients. In addition, the handling of laboratory reports requires close technical and professional control. For this reason, the two information systems, that from laboratories and that from patients, operate independently. The laboratory information system is run by two committees. The first is the Committee for Operation of the Reporting System of Findings of Infectious Agents, National Institute of Health (Chairman: Shudo Yamazaki, M.D., Director, Central Virus Diagnostic Laboratory, National Institute of Health). The other is the Advisory Committee organized by the members of the Association of Public Health Laboratories for Microbiological *Twenty-seven infectious diseases under the National Epidemiological Surveillance of Infectious Diseases: measles, rubella, chickenpox, mumps, pertussis, streptococcal infection, atypical pneumonia, infectious gastroenteritis, infantile vomiting and diarrhea, hand-foot-and-mouth disease, erythema infectiosum, exanthem subitum, herpangina, influenza, acute febrile muco-cutaneous lymphnode syndrome, pharyngo-conjunctival fever, epidemic keratoconjunctivitis, acute hemorrhagic conjunctivitis, meningitis (septic and aseptic), encephalomyelitis (encephalitis, encephalopathy, Reye syndrome, myelitis), viral hepatitis (hepatitis A, hepatitis B, non-a non-b hepatitis), gonorrhoea, genital chlamydial infection, genital herpes, condyloma acuminatum, trichomoniasis and tuberculosis* * tuberculosis reports are not included in this annual report

2 Vol. 42, Suppl. Fig. 2. Network of surveillance of infectious diseases in Japan

3 Jpn. J. Med. Sci. Biol., 1989 Technology (Chairman: Shudo Yamazaki, M. D., Director, Central Virus Diagnostic Laboratory, National Institute of Health). The National Institute of Health operates as the center of the surveillance system as part of its official responsibilities. The information was processed and organized in tabular form at the Serum Reference Bank, Central Virus Diagnostic Laboratory, National Institute of Health, and the report was collated and analyzed by the subordinate organization of the operation committee mentioned above, the Editorial Committee of gfindings of Infectious Agents in Japan h (Chairman: Shudo Yamazaki, M. D., Director, Central Virus Diagnostic Laboratory, National Institute of Health). Information Collected The information gathered in this surveillance system consists of reports of laboratory pathogens detected by tests conducted for the purpose of diagnosing diseases or promoting public health. Pathogenic organisms reported include viruses, rickettsiae, chlamydiae, mycoplasmas, bacteria and protozoa. The pathogens are divided into two categories: viral pathogens and bacterial pathogens. Rickettsiae, chlamydiae and mycoplasmas are included in the virus category for the practical reason that a common individual report card is used. Protozoa is included in the bacterial category. The information system collects exclusively the positive results of pathogen detections, without recording the number of specimens which failed to yield a pathogen. A problem which often gives rise to misinterpretation of laboratory data is the isolation of a passenger agent or non-etiologic agent. In general, most of the pathogen isolations from such clinical specimens as cerebrospinal fluid (CSF), blood, vesicles and biopsy or autopsy materials are considered to indicate a causeand-effect relationship between the pathogen and the disease process. On the other hand, when pathogens are recovered from.feces, throat swabs or urine, results should be interpreted in conjunction with all the epidemiological, clinical and other pertinent laboratory information available. In this publication, the number of isolations quoted for previous years is derived from the uncorrected numbers published in previous years' annual reports. However, the data files at the Information Center are frequently updated by inputting additional and revised reports which are received after compilation of the annual report. Therefore, figures published in the annual report are not necessarily the same as the updated figures on file at the Center, although in the

4 Vol. 42, Suppl. final analysis there may not be a change in overall trends. These differences are not as common for reports on bacteria as they are for viruses. As references, data files updated as of the end of September 1989 are listed on pages and Sources of Information for Pathogenic Bacteria Under this surveillance system reports of bacterial pathogens are supplied by and separately tabulated for four types of institutions: (1) prefectural and municipal public health institutes and health centers (PHI/HC); (2) general clinical institutions (GCI); (3) infectious diseases hospitals (IDII); and (4) quarantine stations. Each institution conducts laboratory examinations for independent purposes, so that the objectives of theirr tests vary. PHI/HC reports tend to consist of results from tests conducted for administrative purposes. Mainly, these are studies of epidemics, outbreaks of food poisonings, periodic fecal examinations of food handlers and examinations for safety assessment of food, or records of surveys carried out for research purposes, e.g. periodic screenings at designated hospitals and the like. GCI supply results of tests conducted for the purpose of diagnosis and treatment of infectious diseases, which provide data more directly reflecting the general patient population. IDH (data limited to inpatients) and quarantine stations mainly examine legally designated notifiable infectious diseases**, particularly those involving enteric infectious diseases. Some of these data, especially on legally designated notifiable diseases, may be provided from more than one source for an individual case. At this time, there are no procedures within the system for eliminating such duplication. Therefore, results for these pathogens are tabulated, but total figures may not be meaningful. In addition to the surveillance system, reports of outbreaks of Salmonella typhi (S. typhi) and Salmonella paratyphi A (S. paratyphi A) are gathered in **Legally -designated notifiable communicable diseases in Japan: Class 1: cholera, dysentery, typhoid fever, paratyphoid fever, scarlet fever, diphtheria, meningococcal meningitis, Japanese encephalitis, small pox, epidemic typhus and plague Class 2: acute poliomyelitis and Lassa fever Class 3: influenza, infectious diarrhea, whooping cough, measles, tetanus, malaria, tsutsugamushi, filariasis, rabies, anthrax, yellow fever and relapsing fever

5 Jpn. J. Med. Sci. BioL,1989 accordance with a notice issued by the director of the Bureau of Public Health in the Ministry of Health and Welfare, gon the Implementation of Countermeasures for Typhoid and Paratyphoid Fevers h (Publication #788, 16 November, 1966). The isolated bacteria are sent from various institutions to the National Institute of Health for phage typing. The results are included in this annual report. Sources of Information on Viruses The reports of virus detections in this surveillance system are supplied mainly by PHI but also by some universities and national hospitals and private clinical laboratories. The virus reports from PHI are the results of examinations conducted for diagnosis (including those conducted in the course of operating the Infectious Disease Surveillance Program) and reports of isolations derived from systematic studies at specified institutions or from the National Epidemiological Surveillance of Vaccine-Preventable Diseases. Cooperating Institutions in 1988 In 1988, PHI in 47 prefectures and 21 designated municipal areas reported findings of pathogenic bacteria and viruses (Fig. 1). Cooperating GCI which provided bacterial information numbered 191 in 35 different municipal or prefectural regions nationwide. The number of institutions per city or prefecture varied; in most cases, it was just a few. IDH which contributed to this system numbered 14 in 11 cities. The names of the institutions are listed on pages 4, 5 and 6. In 1988, PHI in 46 prefectures and 11 designated municipal areas reported results of virus isolations. In addition, two national hospitals and two private clinical laboratories cooperated as reporting laboratories. These laboratories are also listed on page 6. Collection of Information Responsibility for the collection of pathogen information in each region rests with the PHI, each of which serves as an information center for its prefectural or municipal region. Reports of bacterial pathogens at PHI themselves are combined with the reports from the health centers on a monthly basis, while reports from GCI in the region are gathered separately. The tabulated figures are sent every month from PHI to the National Institute of Health (Fig. 3). However, results on type analyses

6 Vol. 42, Suppl. Report Form 3 (Rev. 7 ) *( ):imported cases included in the total * Isolates from diarrheal cases Fig. 3. Reporting form for isolation of pathogenic bacteria

7 Jpn. J. Med. Sci. Biol., 1989

8 Vol. 42, Suppl Rev.7.1 Fig. 4. Individual card for virus report

9 COLLECTED Jpn. J. Med. Sci. Biol., 1989 ABBREVIATIONS used in Individual Card for Virus Report BY: INSTITUTION 1: national, 2: prefectural, 3: municipal, 4: other, 5: institute, 6: health center, 7: hospital and clinic, 8: university, 9: private clinical laboratory, 10: other REASON FOR COLLECTION SPO: sporadic case, EPI: epidemic case, MON: National Epidemiological Surveillance of Vaccine-Preventable Diseases, OS: regional (epidemiological) surveillance/special study, SUR: National Epidemiological Surveillance of Infectious Diseases, IMP: imported case, OT: other COLLECTED FROM HU: human, SW: swine, AV: avian, MO: monkey, MQ: mosquito, EQ: equine, BO: bovine, OA: other animal, EN: environment, OT: other NATURE OF SPECIMEN FC: feces, rectal swab, NP: nasopharyngeal secretion, nasopharyngeal swab, sputum, ES: eye swab, SF: spinal fluid, SK: skin/vesicle, UR: urine, BL: blood, BR: brain, LV: liver, LB: lung, bronchia, WB: whole body, RW: river water, sea water, DW: drink water, WW: waste water, FO: food, OT: other METHOD USED FOR ISOLATION AND DIRECT DETECTION OF VIRUS AND/OR VIRUS AGENT CL: culture method (AN: animal, CE: chick embryo, CC: cell culture, CM: culture medium, OC: other culture methods), LM: light microscopy, EM: electron microscopy, FA: immunofluorescence, EA: immunoenzymatic techniques, RP: reversed passive hemagglutination test, OM: other method CLINICAL INFORMATION NO DATA: no clinical information available, NO ILL.: healthy-no illness, FEVER: fever, VESICLE: vesicle, ERUPTION: eruption, STOMATITIS: stoxnatitis, HERPANGINA: herpangina, H-F-M DIS.: hand-foot-and-mouth disease, MUSL. & JNT: disease of muscles and joints, RESP.UPPER: upper respiratory tract infection, RESP. LOWER: lower respiratory tract infection (including pneumonia), GASTR-INTES: gastro-intestinal disease, HEPATITIS: hepatitis, NEPHRITIS: nephritis, CARD-VASC: cardiovascular disease, KERAT/CONJN: keratitis, conjunctivitis, keratoconjunctivitis, MENINGITIS: meningitis, ENCEPHALITIS: encephalitis, PARALYSIS: paralysis, GENIT/URIN: genitourinary disease, LYMPH: enlarged lymph nodes, SALIVA GLND: salivary glandular disease, HEMORRHAGIC: hemorrhagic predisposition, CONGENITAL: congenital disease, OTHER: other syndrome POLIOVIRUS VACCINATION 1: non, 2: unknown, 3: 1 dose, 4:2 doses, 5: doses unknown

10 Vol. 42, Suppl. of some of the pathogens such as Salmonella and Streptococcus can only be included in the annual report. Information from quarantine stations is sent to the Port Health Administration Office of the Ministry of Health and Welfare, which forwards figures on the number of findings at each station to the National Institute of Health. Individual cards are provided with reports of virus detections (Fig. 4), as well as with those of bacterial pathogen detections at IDH. They are sent directly, upon completion of testing, by the various institutions to the National Institute of Health in the form of individual case reports. Distribution and Use of Information Information gathered through the surveillance system as described above is tabulated at the National Institute of Health, and the figures are compiled into a monthly report (Monthly Report on Findings of Infectious Agents in Japan), which is distributed to interested individuals and institutions. The information in the monthly report is also used in the preparation of a special monthly article analyzing the results in combination with patient data derived from the Infectious Diseases Surveillance Program. Viral detection reports had also been submitted to the WHO Virus Diseases Unit every month until the end of 1986, when the Unit stopped the collection of viral detection reports. Information on detection of influenza viruses in Japan continues to be reported to the WHO Collaborating Center for Influenza, where it is analyzed in relation to findings of viruses worldwide and thus contributes to the global effort for surveillance of infectious diseases. -20-