The Law Concerning the Prevention of Infectious Diseases and Medical Care for Patients of Infections (the Infectious Diseases Control Law) enacted on April 1, 1999, accompanies an additional rule for reconsideration in five years after putting the law in operation and for taking necessary steps when needed. In compliance with this rule, the Section of Infectious Diseases (headed by Dr. Hiroshi Yoshikura), Health Sciences Council of the Ministry of Health, Labour and Welfare (MHLW), started investigation on June 5, 2002 anticipating an amendment in the forthcoming 2004, and established four working groups concerning the infectious disease control strategy, infectious disease surveillance, infectious diseases of animal origin, and AIDS and STD. The responses against bioterrorism involving anthrax and smallpox after the terrorist attacks on September 11, 2001, in the United States of America (a notice on October 11, 2001 by the Tuberculosis and Infectious Diseases Control Division, MHLW) and the response to severe acute respiratory syndrome (SARS), an emerging infectious disease upon which a Global Alert was issued on March 12, 2003, by WHO (see IASR, Vol. 24, No. 10), became important topics of discussion. On August 21, 2003, a proposal was made on reconsideration of the infectious disease control by the Section, upon which MHLW submitted a bill concerning partial amendment of the Infectious Diseases Control Law and the Quarantine Law to a special diet session. This bill passed the House of Representatives on October 3, 2003, was approved unanimously at the plenary session of the House of Councilors on October 10, and put into operation on November 5, 2003 (see IASR, Vol. 24, No. 12).

Outline of the amendment

In the present amendment, the following three points were principally reconsidered: 1. strengthening infectious disease control in an emergency, particularly the role of national government, 2. reviewing control strategy of infectious diseases of animal origin, and 3. reviewing target diseases of the Infectious Diseases Control Law and categories of infectious diseases.

1. Strengthening infectious disease control in an emergency, particularly the role of national government: When Infectious Diseases Control Law was established, participation of the nation was restricted by the request for decentralization, however in the recent response to SARS, necessity for active participation of the nation in addition to the response of the local government was discussed again and the following amendments were made.

1) Active epidemiological investigation: Active epidemiological investigation used to be the duty of prefectures, ordinance designated cities and special wards (hereafter referred to as prefectures). The national government dispatched personnel when requested for technical assistance by prefectures. When prevention of an infectious disease and its spreading is urgently needed, the national government may provide necessary suggestions to the epidemiological investigation undertaken by prefectures and may undertake active epidemiological investigations even by themselves (concerning Article 15). For intensification and cooperation with the investigation system of the local public bodies, prefectures can ask other fellow prefectures for cooperation by dispatching experts for examination and research (concerning Article 15).

2) Preparedness: The plan for prevention of an infectious disease in an emergency used to be prepared by prefectures. Since it is not simple to make concrete action plans in usual days, the national government may advise for establishing more concrete action plans when a severe infectious disease is anticipated to break out (concerning Articles 9 and 10) (see p. 6 of this issue).

3) Establishment of the authority of the national government to advise the local governor, and clarification of his role as the function of adjusting office work: The authority of the national government to advise the local government was not clearly defined, but when prevention of an infectious disease and its spread is urgently needed, necessary suggestions may be given to the work to be done by prefectures (concerning Articles 51, Section 2 and Articles 63, Section 2).

2. Reviewing control strategy of infectious diseases of animal origin in compliance with the Infectious Diseases Control Law: Many emerging infectious diseases are of animal origin. Ebola hemorrhagic fever (see WHO, WER, Vol. 78, No. 48), avian influenza virus infection (A/H5N1, A/H7N7, and A/H9N2) (see IASR, Vol. 24, Nos. 3 and 6), Nipah virus infection (see IASR, Vol. 20, No. 6), monkeypox (see IASR, Vol. 24, No. 7), and West Nile fever (see IASR, Vol. 23, No. 11) are recent examples of such diseases. The possibility of animal origin of SARS has been implicated (see IASR, Vol. 24, No. 10). In the past, vehicles are specified and prohibition of importation and quarantine at importation are executed aiming at Categories I to III infectious diseases, and such measures to animals and goods as extermination of mosquitoes have been executed aiming also at Categories I to III infectious diseases. When responding to West Nile fever, such measures against animals and goods as extermination of mosquitoes were not applicable (see page 4 of this issue), and when responding to prairie dogs in relation to plague and tularemia (the ministerial ordinance designating import prohibition areas by Section 1 of Article 54 of the Infectious Diseases Control Law; see partial amendment issued on February 25, 2003), it used to be difficult to trace the distribution after importation. In the present amendment, the followings have been done (see p. 4 of this issue).

1) Establishment of the reporting system for importation of animals: Those who are importing animals or carcasses possibly transmitting an infectious disease are obliged to attach a certificate showing the absence of infectious diseases issued by the exporting country and to report the animal species and quantity and the time of importation (concerning Article 56, Section 2, this part will be enacted on the date scheduled by a government ordinance within two years after the proclamation).

2) Investigation of animals: In investigation of infectious diseases, it has become clear that investigation can be done to the owner of animals or their carcasses that may possibly transmit an infectious disease (concerning Article 15).

3) Establishing a rule of responsibilities of veterinarians: Brute medical staff are obliged to cooperate with staff of the national and local government in the measures taken by them; animal handlers must provide adequate handling of animals and take other necessary steps (concerning Article 5, Section 2).

4) Measures against animals and goods: The past Category IV infectious diseases have been reconsidered and the categories changed (described later), restriction of importation of vector animals, disinfection, extermination of such vector animals as mosquitoes and rats have become applicable (concerning Article 6). In practice of disinfection and extermination, prefectures may not only direct to cities, towns and villages but practice by themselves (concerning Articles 27 and 28).

3. Reviewing target diseases of the Infectious Diseases Control Law and categories of infectious diseases (see Table on page 3'): To Category I, smallpox and SARS have been added. No change has been made of Categories II or III. Among the previous Category IV infectious diseases, those requiring measures against animals and goods, restriction of importing vector animals, disinfection, and extermination of such vector animals as mosquitoes and rats, have been placed under the new Category IV. Such infectious diseases of animal origin as avian influenza virus infection, monkeypox, Nipah virus infection, tularemia, lyssavirus infection, and leptospirosis have been added to the new Category IV. Of viral hepatitis, hepatitis A and E have been added to the new Category IV. Infant botulism has been changed to botulism and included in the new Category IV. Physicians who diagnosed a new Category IV infectious disease is required to notify immediately after diagnosis to the prefectural governor through the head of the near-by health center. The previous Category IV infectious diseases, except those transferred to the new Category IV, have been placed under the new Category V. Vancomycin-resistant Staphylococcus aureus (VRSA) infection has been included in Category V to be notified by all physicians and respiratory syncytial (RS) virus infection to be reported by pediatric sentinel clinics. Acute encephalitis other than West Nile fever and Japanese encephalitis has been changed from a reportable disease by sentinel hospitals to a notifiable disease by all physicians. Concerning the National Epidemiological Surveillance of Infectious Diseases (NESID), a large-scale improvement of the surveillance network system is planned to carry out in 2004. The details of reporting the preexisting diseases under the NESID will be amended simultaneously with the renewal of electronic reporting system. New reporting criteria for the surveillance have been made for newly added infectious diseases (see the notice from the Health Science Bureau, MHLW, November 5, 2003), but for old diseases it continues as before.

For the present revision of the Infectious Diseases Control Law, the following supplementary decision was made by the diet (abstract).

1) For SARS, clarification of pathogenesis and of the route of infection and development of therapeutic methods, remedies, and vaccines must be hurried, and reconsider the category based on the Infectious Diseases Control Law in two years on accumulation of medical knowledge.

2) For health centers, strengthen the organization in order to fully perform their duties as the local center of infectious disease control.

3) Thorough education at places of work, regions, and schools so as to avoid discrimination and prejudice against patients with infectious diseases and their family members.

4) For medical examinations of outpatients suspected of SARS, try to avoid disorder in the medical infrastructure, by fixing base medical institutions (cooperation hospitals).

5) For bioterrorism, continue to ensure remedies and vaccines and try to perform education to physicians, nurses and public health workers and enrich research works.

6) For globalization problems of infectious diseases, strengthen the organization of research institutes according to priority and actively collect experts so as to cope with the infectious diseases. International medical cooperation should further be promoted through WHO and bilateral deliberations between two countries.

7) Try to give education to physicians, nurses and public health workers, intensify research works and bring up physicians specialized in infectious diseases so that high quality and adequate medical services can be provided to patients and carriers of infectious diseases with consideration to their human rights.

In the Quarantine Law amended simultaneously with the Infectious Diseases Control Law, it became possible to expand the range of examination and inspection by physicians at quarantine stations, and it became possible that those who are suspect of an infectious disease are obliged to report their health conditions for a certain period after entry into Japan and, if any abnormal condition is found, the quarantine station can report to the prefecture (see p. 5 of this issue).