Response to pandemic (H1N1) Country experience - Japan Tomimasa Sunagawa Infectious Disease Surveillance Center National Institute of Infectious Diseases, Japan The 3 rd meeting of National Influenza Centres in WP and SEA regions Beijing, China 19 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 Epidemic trend Objectives Surveillance Prevention against disease spreadingPrevention against severe diseaseEvaluation 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 outbreak2. 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?

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 admission48119 Age distribution < 5 (y.o.) and <710 Sex Male2973 Female1946 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 Pregnancy01 COPD (e.g., asthma) 1231 CHD12 Metabolic diseases12 Renal disease12 Immune deficiency (e.g., steroid use) 13 Others413 Source: 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 Accumulate d number of cases as of 11 August Acute encephalopathy due to influenza 13 Mechanical ventilation14 Condition of patients as of 11 August In hospital, with mechanical ventilation 12 In hospital, with no mechanical ventilation 2327 Discharged2387 Died00 No detailed information13 Source: MHLW (press release) Fatal cases reported on 15, 18 and 19 August (total: 3)

ILI surveillance in Japan, from April 1999 to 2 August 2009 Reported number of cases per sentinel clinic 0.56 Source: Dr. Y. Yasui (IDSC/NIID)

ILI surveillance in Japan, from April 1999 to 2 August 2009 (enlarged image) Source: Dr. Y. Yasui (IDSC/NIID) 0.9 in 32 nd week (60,000 cases estimated)

Reported number of ILI cases per sentinel clinic in each prefecture during 31 st 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 32 nd 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