The Topic of This Month Vol. 31, No. 3 (No. 361)
Pathogen Surveillance System: A budgetary measure was taken for the nationwide infectious disease surveillance program in July 1981. Preceding this event, however, NIID (former National Institute of Health, NIH) and PHIs had already established the Association of Public Health Laboratories for Microbiological Technology (APHLMT) (in 1980) so as to facilitate networking of their infectious disease control@activities. APHLMT now has Reference Committee and Laboratory-based Information Committee that discuss issues related to operation of the infectious disease surveillance in Japan and promotion of execution of their mission. APHLMT holds the general assembly once a year, which is accompanied with several study group meetings. To complement such activities, NIID established NIID Reference Committee and IASR Committee.
The infectious disease surveillance has a legal status as the National Epidemiological Surveillance of Infectious Diseases (NESID) under the Law Concerning the Prevention of Infectious Diseases and Medical Care for Patients of Infections (the Infectious Diseases Control Law) since its enactment in April 1999. Pathogen surveillance started to have a defined role in the NESID under the law and has been conducted as shown in Fig.1 after further amendment of the law in November 2003.
The case definition for reporting is available for each of the categories I-V infectious diseases that need the reporting of the all cases and for category V infectious diseases reportable only from sentinel medical facilities (http://www.mhlw.go.jp/bunya/kenkou/kekkaku-kansenshou11/01.html). Table 1 lists target infectious diseases in the pathogen surveillance (sexually transmitted diseases and a few other diseases are not among them).
Health centers are authorized to make request to doctors for specimens or isolated pathogens under the active surveillance provision in the law. Upon the request, the doctors have to send the specimens to a health center nearby together with the pathogen examination card (see p. 72 of this issue) that carries information on patient's age, sex, clinical findings, etc. Upon receipt, the health center fills in the space for epidemiological findings in the card, and sends specimens and the card to the PHI.
After laboratory examination, PHIs fill in the space for laboratory data in the pathogen examination card, and send the cards back to health centers and inform IDSC of detection of pathogens. Laboratory data of pathogens implicated in diseases other than the NESID targets, such as pathogens associated with food poisoning outbreaks, those detected through inspection of environment, foods, animals, etc are processed in the same manner as a reporting category “others”. Quarantine stations report isolation of pathogens when they detect/isolate them from those who returned from abroad or in foreigners who entered into Japan.
The Reference Committee in APHLMT has established for the purpose of pathogen surveillance (see p. 76 & 77 of this issue) 13 pathogen specific reference centers to work on typing and genetic analyses of isolates, and in collaboration with PHIs and NIID produced laboratory manuals, which can be downloaded from the NIID website (http://www.nih.go.jp/niid/reference/index.html).
On-line System: Reporting of pathogen detection from PHIs and quarantine stations to IDSC first used pathogen examination cards that are sent by mail and dissemination of the information from IDSC back to PHIs, quarantine stations, etc was only through a monthly report sent by mail. The mail system was replaced with the on-line system using Wide-area Information-exchange System for Health and welfare administration (WISH) in January 1997. WISH is an intranet system accessible only to the its founder Ministry of Health, Labour and Welfare (MHLW, former Ministry of Health and Welfare), local governments, PHIs, quarantine stations, health centers and other specified organizations.
When the on-line system started, the pathogen detection data sent from various parts of Japan every day were first stored in a personal computer in IDSC, NIID; then at the end of the month, the nationwide data thus compiled were processed by the file transport protocol to be placed on the WISH as a file. The system is now much improved as detailed below.
In May 2006, the reporting of pathogen detection and the reporting of infectious disease cases were integrated together into the NESID system, whose database is managed centrally. The System for Laboratory Findings of Infectious Agents was constructed as a subsystem of NESID, in which all the data reported by PHIs since 1980 are compiled. IDSC in NIID checks new reports and corrections of previous data/reports that it receives every day, and releases them immediately to the users having access to NESID. The data updated daily enter automatically into preformatted tables and figures overnight, which appear on the next morning. In addition, users of any organizations accessible to NESID can use the compiled data for their own analysis through data search and processing.
Dissemination of Information: Data and information obtained by PHIs and quarantine stations appear in monthly publication of Infectious Agents Surveillance Report (IASR) and in Supplement of Japanese Journal of Infectious Diseases published once a year. They are also available in the format of tables and figures daily updated on IASR homepage (http://idsc.nih.go.jp/iasr/index.html).
IASR was first published in March 1980 by the Working Group of the Research Project for Development of a Surveillance System of Pathogenic Microbes in Japan (1979-1982, under direction by Hiromasa Inoue, Director General of Aichi Prefectural Institute of Public Health at that time) (see IASR 1: 1, 1980 reproduced in p. 74 of this issue). Since then, IASR has been published every month for 30 years without interruption. The editorial activities are carried out by the IASR secretariat in NIID/NIH.
Since 1983, it has been jointly published by NIID/NIH and Tuberculosis and Infectious Diseases Control Division in MHLW. It is the only infectious disease journal that is published regularly by the national government. IASR is distributed to information originators (e.g. PHIs, quarantine stations, health centers, collaborative medical institutions), public health departments of local governments, departments concerned in MHLW, NIID and other institutions. Internet version is available in IASR homepage, too.
From November 1982, every IASR issue contains a special article, “Topic of This Month”, which provides updated general epidemiological information on one selected disease or pathogen (see p. 73 of this issue). The “Topic of This Month” is usually accompanied with invited articles related to the topic. PHIs are invited to write an article in IASR when they report cases or outbreaks that merit special attention. Such articles appear under the title of “domestic information”. Articles under “information abroad” are abridged translations of selected articles among those that appeared in publications of World Health Organization, U.S. Center for Disease Control and Prevention, U.K. Health Protection Agency, etc. IASR reports monthly detection of viruses, rickettsiae, chlamydiae, bacteria, protozoae and parasites, in addition.
Conclusion: The outbreak of botulinus intoxication caused by fried mustard-stuffed lotus roots (karashi-renkon) that were sold in vacuum-packs in 1984 (IASR Vol. 5, No. 11, 1984) necessitated prompt online exchange of pathogen information. The patient information was placed on the on-line system in 1987 and the pathogen information 10 years later. Owing to this development, the AH1pdm detection data could be updated everyday from the beginning of the influenza A(H1N1)2009 pandemic (http://idsc.nih.go.jp/iasr/influ-e.html). However, both surveillance and reporting system contain many problems (see p. 75 of this issue). The required improvement of the system and enrichment of IASR are possible only through comprehension and cooperation of many people concerned.
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