1. Surveillance for Pediatric infectious disease except Influenza July 5, ２００６ Yajima Children’s Clinic Shigehiro Yajima, MD.

2. Five hospitals with pediatric ward in Gifu-city Mt.Kinka Gifu Station Nagara River University Hospital Red Cross Hospital Prefectural Hospital Municipal Hospital Children’s Hospital Population : Gifu-prefecture 2 million and Gifu-city 0.4 million

3.  Surveillance system  in Japan  in Gifu-city  Important Pediatric disease  Measles  Rubella ( congenital Rubella syndrome : CRS )  problems Surveillance for Pediatric infectious disease

4. Surveillance system in Japan

5. National surveillance system in Japan  Infectious Disease Surveillance Center (IDSC) was established newly in 1997, expanding its responsibility and replacing former Division of Infectious Disease Epidemiology, and it has been designated as a National Infectious Disease Surveillance Center. In local or district level, it is encouraged to designate Local Infectious Disease Surveillance Centers. The main targets of our surveillance are category 1-5 infectious diseases prescribed in the Law ． ・

6. category 1-3 infectious diseases category 2 Cholera Diphtheria Paratyphoid fever Poliomyelitis Shigellosis Typhoid fever category 3 Enterohemorrhagic Escherichia coli infection category １ Crimean-Congo hemorrhagic fever Ebola hemorrhagic fever Lassa fever Marburg disease Plague ＳＡＲＳ Smallpox Report to the public health center immediately

7. category 4 Anthrax LegionellosisNipah virus infection Botulism LeptospirosisTularemia Brucellosis Lyme diseaseWest Nile fever B virus disease MalariaAvian influenza virus infection Coccidioidomycosis MonkeypoxEpidemic louse-borne typhus fever Dengue fever Scrub typhusHantavirus pulmonary syndrome Echinococcosis PsittacosisHemorrhagic fever with renal syndrome Hepatitis A Q feverJapanese spotted fever Hepatitis E RabiesLyssavirus infection Infant botulism Relapsing feverJapanese encephalitis Yellow fever Report to the public health center immediately

8. Category V （ Notifiable Diseases ） AIDS Acute encephalitis (excluding Japanese encephalitis and West Nile encephalitis) Acute viral hepatitis Hepatitis B 、 Hepatitis C 、 Hepatitis D Amebiasis Congenital rubella syndrome （ CRS) Creutzfeldt-Jakob disease Cryptosporidiosis Fulminant group A streptococcal infection Giardiasis Meningococcal meningitis Syphilis Tetanus Vancomycin-resistant Enterococcus infection Vancomycin-resistant Staphylococcus aureus infection All cases should to be reported to the public health center within seven days

9. Category V （ Sentinel-Reporting Diseases) Number of sentinel clinics in Japan Influenza (excluding avian influenza ） 4,694 Pediatric diseases3,046 Ophthalmic diseases644 Sexually-transmitted diseases919 Specially-designated sentinel clinics weekly reporting 470 monthly reporting 469 Sentinel clinics have to report to the public health center within seven days

10. Pediatric infectious disease Measles Pharyngoconjunctival fever Rubella Group A streptococcus infection Chickenpox Hand-Foot-Mouth disease Mumps Erythema infectiosum Pertusis Exanthem subitum Herpangina RS virus infection Infectious gastroenteritis Vaccine ( ＋ )vaccine ( ー )

11. Pediatric Infectious Disease Surveillance in Japan  Sentinel clinics and Hospitals  Public Health Center  Prefectural governor  Infectious Disease Surveillance Center(IDSC) in National Institute of Infectious Diseases (NIID)  Weekly report will be published. Every week ( not everyday ) two or three weeks later

12. Weekly report from IDSC Increased decreased Freequency of disease is reported weekly with comment and figure. In this year, Pharyngoconjunctival fever( ) and Mycoplasma pnuemonia( ) are epidemic in this year.

13. Weekly report from IDSC 2006 Pharyngoconjunctival fever is epidemic for last five years, especially in this year.

14. Infectious Pediatric Disease Surveillance  Category 5 (sentinel disease)  This surveillance does not reflect low-frequency disease such as Measles and Rubella, correctly.  All the cases of Measles should be reported immediately to prevent widespread epidemic.

15. Surveillance for pediatric infectious disease in Gifu-city  Systemsame as the system for influenza in Gifu  Registrationby Online-registration with internet or Fax from 5 hospitals and some clinics in Gifu-city  Disease for registration Category V （ Sentinel-Reporting Pediatric Diseases)  Reports and comments  the number of the disease is counted automatically if registered from internet  comments for surveillance is send to clinics once or twice a month by mail ( comment for Influenza is made by Dr.Kawai everyday ! )

16. Hospitals and clinics for children

17. summary for pediatric Infectious disease

18. Annual report ( 2005 ) Infectious gastroenteritis is common in Japan, children never die from gastroenteritis. Mumps and chikenpox spread every year, because less than half of the children get vaccine. Government does not support the vccination for these disease. Measles was not epidemic for last 5 years, however, widely spreads in this year.

19. 2003~2005 in Gifu-city 200320042005 RS virus infection 07469 Pharyngoconjuncval fever 759596577 group A streptococcus 359212278 Infectious gastroenteritis 153811741492 Chikenpox 561710554 Hand, foot and mouth disease 76388 ↓82↓ Erythema infectiosum 914668 Exanthema subitum 494456433 Pertusis 29261 Rubella 762 Herpangina 6637331043 Measles 442 Mumps 89329897↑ total535744547503

20. 2004 Infectious gastroenteritis herpangina Mumps

21. Important pediatric Infectious disease Measles Rubella

22. Measles is the most dangerous disease  High-infectability  Many complications (pneumonia, otitis media, encephalitis, SSPE)  Mortality rate is about 0.1% in Japan.  In 2001, measles was extensive epidemic in Okinawa. The number of patient was over 2000, 9 children died from measles.  Recently, adult patient is increasing.

23. Newspapers said the risk of adult measles Adult measles patient rapidly increasingMeasles epidemic in university

24.  2 years old girl  Admitted with measles  Lost right vision  Lost consciousness with encephalitis for 1 week  Tracheostomy  Perforated to the aorta  Emergency operation  Admitted for 6 months  22 years old  graduated from collage

25. Important pediatric Infectious disease Measles Rubella Congenital Rubella syndrome ( CRS ) ( deafness, Cataract, heart disease )

27. Measles and Rubella can be eliminated by vaccine.

28. ProblemsProblems

29. In 2006, Measles is epidemic again.  Measles patients were reported from Ibaragi and Chiba prefecture in April.  Epidemic to high school and university.  So, Infectious Surveillance Center planed the registration system for all measles cases.  But ・・・・ Ibaragi Chiba Nagoya

30. Measles surveillance system does not come out yet.

31. Measles  should be registered without exception  can be eliminated, if all the children are vaccinated twice against measles. Elimination of measles depends on not the surveillance system, but on the “ political will ”