CHINESE INFORMATION SYSTEM FOR INFECTIOUS DISEASES CONTROL AND PREVENTION Center for Public Health Surveillance and Information Services, China CDC
PREFACE 2003 SARS (VPN) In 2003, a precipitate disaster SARS attacked us, and it exposed our weaknesses, such as the backward development of the public health, the distempered system in handling with public health emergencies. The CPC Central Committee and the State Department request to strengthen the construction of infectious diseases and public health emergencies system, with focus on promoting the timeliness, sensitivity and accuracy of report. As request by Ministry of Health (MOH), Center for Disease Control and Prevention (CDC) should make the construction project as soon as possible. Under the lead of MOH, based on the detail and comprehensive analysis of operation demand, a new operation model has been established based on infectious disease individual cases and public health emergencies, which has recombined and revised the working ow of epidemic report and established a comprehensive disease surveillance information model, functional model and data model. And it has completed the application software development and technology integration satisfying multi levels and multi users among different departments. A Virtual Private Network (VPN) has been constructed using the information safety technology. The internet report system can satisfy amount of users at the same time though the application of high performance of calculation, large memory and fast statistic method; besides, the local internet circumstance has been improved increasingly; the capability of computer application and disease surveillance has been enhanced. CISDCP 2
Development of Surveillance & Reporting for Noti able Infectious Diseases 2004 37 Web-based, real-time, daily case reporting, data sharing between central & local level, and covered 37 noti able infectious diseases 1985 2003 county-based monthly report by electronic les 1950 1985 county-based monthly report by paper with mailing system () Working Procedure of the Web-based Reporting System 47000 About 47000 medical units have the ability of using the system; 5000 About 5000 users every day; 12000 Approximately 12,000 cases are reported everyday; 20054428548 4428548 cases in 2005. Short message by internet MEM OLTP CISDCP OLTP Mobile phone VPN OLTP CDC MEM 18395 19716 25474 38518 3099 3099 Hospitals Town health units Local CDC Medical institutes and other units Manager CISDCP 3
The Flow of Information Reporting and Feedback for Noti able infectious diseases The surveillance information is reported to the national database directly through the internet. However, the management is classified, national, provincial, prefecture and county level included in the system. The center for disease control and prevention make information communication and feedback with health authority department at every level. Hospitals Finding and Diagnose Fill in ( ) County Health Bureau Reporting () Con rmed or Expected Cases ( ) County CDC Individual Investigation Entering Report Card Revisement / Special Dis. Management Information ( ) Prefecture Health Bureau ( ) Prefecture CDC Following, Investigation and Revisement ( ) Provincial Health Bureau ( ) Provincial CDC China CDC Feedback Veri cation Analyzing National Individual Database MOH Results Epidemic Dimension Reporting Feedback 2004 1 1 The system was put into use in Jan. 1, 2004 Following, Investigation and Revisement CISDCP 4
(37 ) Noti able infectious diseases (2) Group A (25) Group B Plague, Cholera SARS, AIDS, Viral hepatitis, Poliomyelitis, HPAI, Measles, HFRS, Rabies, Japanese encephalitis, Dengue fever, Anthrax, Bacillary & amebic dysentery, TB, typhoid fever/paratyphoid fever, Meningococcal Meningitis, Pertussis, Diphtheria, Neonatal Tetanus, Scarlet fever, Brucellosis, Gonorrhea, Syphilis, Leptospirosis, Schistosomiasis, Malaria (10) Group C Influenza, Mumps, Rubella, Acute hemorrhagic Conjunctivitis, Leprosy, Epidemic typhus/endemic typhus, kala-azar, Echinococcosis, Filariasis, Infectious diarrhea Principles of Infectious Dis. Surveillance Continuous watchfulness and reporting the unusual events everyday Directly reported to the central when the epidemic happens CDC Surveillance, Investigation, validation and risk assessment are carried out in several department of National CDC CISDCP 5
The Uniform Surveillance Information Platform Running Systems Since 2004 Infectious Disease Reporting System Emergency Event on Public Health Reporting System Speci c Infectious Disease Management Information System > HIV/AIDS > Tuberculosis > Plague > / Flu/Avian Flu Surveillance Information System > Hospital-based Death Cases Reporting System Health Risk Factors Reporting System (air, water, food, ) Basic Information System for Disease Control and Prevention Infectious Disease Surveillance System AIDS Surveillance Treatment T.B Surveillance Laborotary Surveillance In u. Surveillance Plague Surveillance CISDCP 6
Application Status 2005 93.3% System Coverage: 93.3% medical units at county and above level, 2005 2005 66.1% (14>80%) System Coverage: 66.1% medical units at township level, 2005 (over 80% in 14 provinces) Working Model of disease surveillance Data Collection Daily Report Weekly Report Feedback Data Veri cation Monthly Report MOH Data Analysis and Report Yearly Report Special analytic report CDC CDC at ~ levels Other Units CISDCP 5
Main Functions Reporting card Data Manage for Cases of Infectious Dis Reporting card Daily Report Weekly Report Information feed backing The timely transition of epidemic situation between national and local level promotes the transparency in reporting the epidemic than before, which would be bene c to the social stability and the communication with the foreign, promoting our international credit in the public health eld. Daily Report Weekly Report Analytical report Special analytical report
Major Advantages of the system Improving the timeliness of report; Improving the completeness and accuracy of surveillance data; Improving the ability of outbreak early detection; Improving the ability of the emerging diseases detection according to the indicator cases, such as pneumonia with unknown pathogen. More quickly report of infectious dis. case 4.9 3.5 2003 2004 Finding more TB patients 0.8 () Between diagnosis and report(days) 0.2 () Between report and data entry (Days) A large increase in the number of reported cases, underreporting cases decreased HIV() The real-time internet reporting model of infectious diseases increases the finding of Tuberculosis, realizing the promise to WHO in advance. Besides, this also improves the capability of following up and management for HIV carrier. 400000 160000 350000 140000 300000 120000 250000 100000 200000 150000 100000 50000 0 2005 3508114 2004 3180370 2003 2591493 1 2 3 4 5 6 7 8 9 10 11 12 80000 60000 40000 20000 0 2006 2005 1259308 2004 970278 1 2 3 4 5 6 7 8 9 10 11 12 CISDCP 7
Example: Detection of Measles Outbreak in County GIS Outbreak defection via observing cluster of cases by GIS 2006 3 274 2 Outbreak of measles in county, province on March 27-April 2, 2006 52 cases 2006 3 114 2 Time distribution of measles in on March 11-April 2, 2006 2006 3 114 2 Age Distribution of measles in on March 11-April 2, 2006 16 16 40 37 14 12 A large increase of cases 11 35 30 40% 14 40% of cases were >14 years old 10 25 8 6 4 2 0 7 7 7 6 6 5 5 4 4 4 3 3 2 1 1 1 3/11 3/13 3/15 3/17 3/19 3/21 3/23 3/25 3/27 3/29 3/31 4/2 20 15 10 5 0 18 16 10 10 11 8 8 5 5 5 2 3 2 2 1 1 0-1- 2-3- 4-5- 6-7- 8-9- 10-15- 20-25- 30-35- 40 CISDCP 10
2006 3 114 2 Occupation distribution of measles in on March 11-April 2, 2006 2006 3 114 22 Decrease in measles after measures taken in on March 11-April 22, 2006 18 16 14 12 Intervention measures 34.7% 34.7% of cases belonged to pre-school-age children 10 8 6 4.9% 9.7% 9% 20.8% 20.8% 34.7% 4 2 0 3/11 3/13 3/15 3/17 3/19 3/21 3/23 3/25 3/27 3/29 3/31 4/2 4/4 4/6 4/8 4/10 4/12 4/14 4/16 4/18 4/20 4/22 National Surveillance of Public Health Emergency 180 160 140 157 Time Distribution of events occurred in school 82% (824/1005) Location: 82% (824/1005) occurred in school 120 100 80 85 115 107 88 83 72 18% 60 60 82% 40 20 24 26 0 4 3 1 2 3 4 5 6 7 8 9 10 11 12 CISDCP 9
Unknown pneumonia surveillance, as an indicator of possible emerging infectious diseases The timely discovery of epidemic situation and public health emergencies decreases the disease outbreaks and spreads, and as well as reducing the impact of public health emergencies on society and economy. (131 ) Unknown pneumonia (131 cases) (7 ) Determined as human avian- u (7 cases) (102 ) Determined as other diseases (106 cases) (18 ) Still not to be excluded (18 cases) 2004 2005 Comparison of incidence of noti able infectious Diseases for 2004 with 2005 120 100 80 60 40 20 0 50 100 150 200 250 300 350 : 2005 7 2004 Note: 7 human avian- u cases in 2005, while zero in 2004 CISDCP 8
Problems and Challenges Need to establish or improve some sub-systems, such as LIMS system, vital registration system; IT Need to improve IT environment and the capacity of data-analysis and information-sharing for more quickly response and making policy of disease control; Need to strengthen cooperation and information sharing with other internal and external institutes. The Public Health Management Life Cycle must be executed collaboratively across the ecosystem Policy Analysis Planning & Policy Surveillance Surveillance System Inter management Evaluation Intervention Suppor system CISDCP 11
IT CISDCP 14
It is the largest disease surveillance information TRAITS OF THE SYSTEM system in the world, with the merits of low cost, high coverage, and easy popularization. In our country, it initially realizes the reporting of epidemic situation and public health emergencies by the way of individual case, real time, on line, covering all the hospitals and township health institutes. As it is integration system of virtual private network on the basis of internet, it initially realizes the applied public health, and greatly improving the response speed in epidemic situation and public health emergencies, therefore it saves the time for epidemic situation and public health emergencies control. Independent innovation of the data collection and statistical software of real-time internet reporting. By the large data processing technique and advanced IT, it achieves dynamic fast statistical analysis of the monitoring data and early detection of outbreak. Compared with the traditional method that the surveillance data are reported level by level monthly, it is an innovation that the epidemic situation and public health emergencies are directly reported by medical and health institutes to the national CDC, which would be a major revolution in the information management innovations in other fields of information management mode of public health. It promotes the progress of public health information surveillance standards of relative information of infectious disease and public health emergencies; moreover, it supports the base for the share of public health information resources. CISDCP 15
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