introduction of the infectious disease surveillance system
TRANSCRIPT
Introduction of the Infectious Disease Surveillance System in China
Feng Zijian, MD, DirectorOffice of Disease Control and Emergency Response, Chinese Center for Disease Prevention and Control
June 5, 2007 , Jacksonville, FL, U.S.A
Health System in China
MOH
Provincial Health Department
PrefectureHealth Bureau
County/DistrictHealth Bureau
China CDC
Provincial CDC
Prefecture CDC
County CDC
Township Disease Control Group
Provincial Hospital
Prefecture Hospital
County Hospital
Community hospitalTownship Hospital
Leading role Guiding role
Coordination Office for environmental &Occupational health and Food safety
Coordination Office for environmental &Occupational health and Food safety Organization Structure of
China CDC National Institute forNutrition and Food SafetyNational Institute forNutrition and Food SafetyOffice of Disease
Control &Emergency Response
Office of Disease Control &Emergency Response
National Institute for Environmental Health &Related Product Safety
National Institute for Environmental Health &Related Product Safety
National Immunization Program (NIP)
National Immunization Program (NIP)
National Institute for Communicable Disease Control & Prevention
National Institute for Communicable Disease Control & Prevention
Office of NCD Prevention & Community HealthOffice of NCD Prevention & Community Health
National Institute for Occupational Health &Poison Control
National Institute for Occupational Health &Poison Control
National Institute for Viral Disease Control & Prevention
National Institute for Viral Disease Control & Prevention
National Center for Chronic and NCD Control & Prevention
National Center for Chronic and NCD Control & Prevention
National Institute for Radiological Protection &Nuclear Safety
National Institute for Radiological Protection &Nuclear Safety
National Center for TB Control & PreventionNational Center for TB Control & Prevention
Office for Public HealthPolicy research
Office for Public HealthPolicy research
National Center for Public Health Information ServicesNational Center for Public Health Information Services
National Institute for Parasitic DiseaseNational Institute for Parasitic Disease
National Center for Maternal and Child HealthNational Center for Maternal and Child Health
Office of Epidemiology ProgramOffice of Epidemiology Program
National Center for AIDS/STD Control & Prevention
National Center for AIDS/STD Control & Prevention
National Institute for Health EducationNational Institute for Health Education
Office of DirectorsOffice of Directors
Office of HRDOffice of HRD
Office of FinanceOffice of Finance
Office of Int’ CooperationOffice of Int’ Cooperation
National Center for Rural Water Supply Technical Guidance
National Center for Rural Water Supply Technical Guidance
Chinese Internet based reporting began on Jan
1, 2004 and covers 37 infectious diseases
Notifiable Infectious Diseases
• plague, cholera
• SARS, AIDS, hepatitis, poliomyelitis, human infection of HPAI, measles, EHF, rabies, encephalitis, dengue, anthrax, bacillary & amebic dysentery, TB, typhoid fever, meningitis, pertussis, diphtheria, neonatal tetanus, scarlet fever, brucellosis, gonorrhea, syphilis, leptospirosis, schistosomiasis, malaria
• influenza, mumps, rubella, conjunctivitis, leprosy, typhus, kala-azar, echinococcosis, filariasis, infectious diarrhea.
Internet-based Reporting System of NotifiableInfectious Diseases
DisseminationReporting Management Application
Data Center of China CDC
Information Application and Dissemination
Data Collection
Application ServiceData
Center
Hospitals
Township Hospitals
County CDC
Others
MOH
Health Bureau
CDCs
Others
Internet, B/S, VPN
Real-time Reviewing
Analysis Report
Monitoring and
Analysis
Data Mining
Percent of hospitals covered by internet-based system by province,2007
县级以上医院网络报告率(%)
90 至 10080 至 9070 至 8060 至 70
????
海南省
香港澳门
内蒙古自治区
甘肃省 天津市河北省北京市
山西省
辽宁省
吉林省
上海市
黑龙江省
江苏省
贵州省 湖南省
宁夏回族自治区
陕西省
广东省广西壮族自治区
青海省
江西省
安徽省
浙江省
河南省
山东省
西藏自治区 湖北省
云南省
新疆维吾尔自治区
重庆市四川省
福建省
台湾台湾
94.9%
Percent of Township hospitals covered by internet-based system by province,2007
乡镇卫生院网络报告率(%)
90 至 100 (5)80 至 90 (9)70 至 80 (6)60 至 70 (1)50 至 60 (2)10 至 50 (8)
???? 香港澳门
天津市
安徽省
江西省
海南省
内蒙古自治区
甘肃省 河北省
北京市
山西省
辽宁省
吉林省
上海市
黑龙江省
江苏省
贵州省 湖南省
宁夏回族自治区陕西省
广东省广西壮族自治区
青海省
浙江省
河南省
山东省
西藏自治区 湖北省
云南省
新疆维吾尔自治区
重庆市四川省
福建省
台湾
70.3%
Percent of cases reported by hospital/clinic type
Hospi t al s66. 97%
Townshi pHospi t al s
12. 89%
CDCs11. 98%
Ot her s8. 16%
Total No. of Internet-based Reporting Units : 67232
Cases of brucellosis by week,2004-2007
0
200
400
600
800
1000
1 5 9 13 17 21 25 29 33 37 41 45 49 1 5 9 13 17 21 25 29 33 37 41 45 49 1 5 9 13 17 21 25 29 33 37 41 45 49 1 5 9 13 17 周
报告病例数
2004 2005 2006 2007
Cases of brucellosis by county through January 1 to May 31,2007
0
20
40
60
80
100
120
140
160
180
200
1-1
1-6
1-11
1-16
1-21
1-26
1-31 2-
52-
102-
152-
202-
25 3-2
3-7
3-12
3-17
3-22
3-27 4-
14-
64-
114-
164-
214-
26 5-1
5-6
5-11
5-16
5-21
5-26
5-31 月-日
例审核日期
Health protection officer (HPO) collects new cases from doctors and enters data
• Clinical reports– Doctors fill card to give to HPO
– Doctors call HPO to get case data
– HPO goes to collect cases from doctors
• Laboratory input– Some HPOs go to laboratory to confirm clinical cases
– Some HPOs go to laboratory to identify cases
– Doctor can update reports with HPO
Do doctors and HPOs use case definitions?
• They apply them to high priority diseases.– Measles, polio, HIV/AIDS, pulmonary TB, SARS,
Human HPAI
• MOH published simplified diagnostic criteria for case reporting in 1989– These are not generally used
– Doctors use “experience” to diagnose for reporting
Capacity for laboratory confirmation depends on province and hospital
• High level hospital– Viral isolation– Special serologic tests
• Average hospital– Culture and identification of common bacteria– Smears for microscopy– Hepatitis B surface– HIV screening – Widal tests
• Township level– No Lab test at township level
Hospitals may request local or regional CDC for diagnostic assistance
• Hemorrhagic fever (hantavirus)
• Plague F-1 antibody
• Japanese B encephalitis IgM
• Streptococcus suis identification
• Influenza isolation and identification
• Brucellosis (Rose Bengal and agglutination)
• And many more
Some infectious diseases are always confirmed at the CDC (county to province)
• Province
– HIV– Polio– SARS– HPAI
• Lower level
– Measles IgM– Malaria– TB– Cholera– Diptheria
Diseases of Unknown Cause
• Many infections not tested
• Negative laboratory specimens are not
retested for other organisms
• Special training of doctors and HPO to
identify unusual cases is needed
• No service for diagnosis of unusual cases
• No funds for testing of unknowns
What are the most important next steps for the laboratory in surveillance?
• Laboratory network• Quality management• Clarify the role of the public health laboratory
– Basic Research?– Applied research?– Service?– Generate revenue?
• Advocate to national and provincial governments• Increase laboratory activity• Select syndromes of high priority for increased
sampling
The enhanced system covers 17 of the 37 notifiable diseases
• 31 provinces (all)• 762 sentinel sites• Laboratory confirmation• Epidemiologic Case investigation• Pathogen characterization• Antibiotic resistance• Vector surveillance• Reservoir surveillance• Serosurveys• Environmental surveillance
Three High Priority Infectious diseases are included
• Hepatitis B– Cross-sectional survey every 10 years
• Tuberculosis– Registry– Follow-up for case management
• HIV/AIDS– Registry– Follow-up for case management
The 14 other included diseases are:
• Plague• Cholera• Typhoid• Dysentery (Shigella)• Meningococcal disease• Hemorrhagic fever
– (hantavirus)
• Measles• AFP (polio)• Neonatal tetanus
• Malaria• Rabies • Brucellosis• Leptospirosis• Anthrax• Japanese B
Encephalitis• Schistosomiasis
China-US Collaborative Programs on Emerging and Re-emerging Infectious Disease
• Sub-project1: Strengthening Surveillance Rapid Response and
Containment of H2H Transmission of AI Virus
Sub-Project 2: Field Epidemiology Training Program-AI
Sub-Project 3: Field Epidemiology Training Program
Sub-Project 4: Knowledge Center Development
Sub-Project 5: Development of Laboratory Management System
• Sub-Project 6: Building Capacity for Laboratory-base Surveillance
for Emerging Food-related Diseases
• Sub-Project 7: International Emerging Infectious Diseases Program
• Sub-Project 8: Laboratory Safety
•Thank you!