Surveillance System of Communicable Diseases

							Surveillance Systems for Infectious Diseases in Korea
Ok Park, Medical Officer, KCDC Trilateral Seminar on R & D Policies to Emerging And Re-emerging Infectious Diseases, December 14-16, 2005, Boston

Overall Incidence of Notifiable Infectious Diseases in Korea

* The cases of Tuberculosis, Hansen’s disease, and HIV/AIDS were excluded

Emerging Infectious Diseases in Korea
   

Leptospirosis, Legionellosis outbreak (1984) HIV Infection (1985) Entero-hemorrhagic E-coli (O157) infection (1998)

Vancomycin intermediate susceptible Staphylococcus
aureus infection (1999)

 

Brucellosis (2002) Botulism (2003)

Reemerging / Increasing Infectious Diseases in Korea
  

Reemergence of vivax Malaria (1993) Reemergence of Rabies (1998) Increase in Food-borne diseases
• Shigellosis : caused by Shigella sonnei • Food poisoning • EHEC infection : increasing since first outbreak in 2003



Increase in Hantavirus hemorrhagic fever syndrome, Scrub typhus, Leptospirosis (since 1998) Increase of HIV/AIDS



Reported Cases of Shigellosis by Year
10,000 8,000

No. of cases

6,000 4,000 2,000 0

1910

1919

1928

1937

1946

1955

1964

1973

1982

1991

Year

2000

Reported Cases of Measles by Year
40,000 35,000

No. of cases

30,000 25,000 20,000 15,000 10,000 5,000 0

Adapted measles elimination strategy and conducted mass immunization campaign, 2001

1955

1959

1963

1967

1971

1975

1979

1983

1987

1991

1995

1999

Year

2003

Reported Cases of Malaria by Year
18,000 16,000 14,000

No. of cases

12,000 10,000 8,000 6,000 4,000 2,000 0

Adapted malaria elimination strategy in 1999 and launched DPRK project in 2001

1961

1964

1967

1970

1973

1976

1979

1982

1985

1988

1991

1994

1997

2000

Year

2003

Enhancement of Infectious Disease Surveillance and Response
Increase of Emerging and Re-emerging Infectious Disease • Adopt Proactive Strategy for Communicable Disease (Control→ Elimination) • Build Infrastructure to Respond Communicable Disease

Organization Legislation

Human resources •Revision of •FETP •FMTP CDPL • KCDC •Onsite •Sentinel supervision • Formation surveillance •Cyber of Task •Immunieducation Forces •Training zation courses Registry

IT
•EDI •DB

Stockpiling
•Vaccine

R&D
•Vaccine

•Antibiotics •Diagnosis

•Modeling •Antiseptics •Therapy •Serum •PPE •Info bank sharing •Ventilators

Reporting System of Notifiable Diseases
Physicians
Report (Tel/Fax) Feedback

Health Center (District level)
Report (EDI) Feedback

Specimen Referral

Feedback

Dept. of Health (Provincial level)
Report (EDI) Feedback

Prov. Inst. of Health & Environment

KCDC

Specimen Referral

Feedback

Enhancement of Legal Framework
 Revision of Communicable Disease Prevention Law • Enacted in 1953 • Revised in 2000 to strengthen legal basis for EID
- Extend diseases for notification (3 groups 29 diseases to 5 groups 64 diseases) - Change notification criteria - Shorten the reporting time - Stipulate Notification form, Notification process, Scope of notification of each disease Punishment for delinquent reporting

Classification and Reporting Time of Notifiable Infectious Diseases
Group
1 2 3

Classification criteria
- Spread rapidly and pose a high level of health risk to national health or Requiring immediate control measures at the onset of an outbreak
-Vaccine preventable communicable diseases that are subject to the national immunization program - Require continuous monitoring or establishment of preventive measures because of the potential for an outbreak - Newly emerging diseases within Korea - Reemerging in Korea or importable diseases from overseas that require urgent prevention measures - Not included in Groups 1 and 4 that require surveillance to detect outbreaks, Designated by the MOHW

Time
Immediately
Immediately Within 7days Immediately Within 7days

4 Appo inted

Adapt IT for surveillance and Enhance analysis and Feedback
 Adapt IT for surveillance
• • • • Electronic data interchange system for reporting Data management program Statistical program Develop Disweb as a portal site for sharing information on communicable diseases
CDWR(Communicable Disease Weekly report) CDMR(Communicable Disease Monthly Report) Statistical Year Book Press releases

 Enhance Data Analysis and Feedback
• • • •

Information Flow
Management Management program program
PHC DB Prov. DB

Management program

Management program Management program

Doctor
TEL,FAX

Health center

EDI

Province EDI

KCDC

Database

Sentinel site

Feedback

Statistic DB Statistical Program

EDI System for Reporting

Data Management Program

Statistical Program of Communicable Diseases

Portal Site for Information on the Communicable Disease (http://dis.cdc.go.kr)

English version of Disweb
http://dis.mohw.go.kr/english/index.htm

Establishment of Various Surveillance Systems
 Sentinel Surveillance by the CDPL • Influenza, Viral hepatitis A, B, C, STDs • Imported Parasitic Diseases, VRSA infection, CJD  Sentinel surveillance on the voluntary basis • Pediatric Sentinel Surveillance, Viral conjunctivitis  Network for information sharing and surveillance • Infection specialists network (2002) • EpiNet (2003)  Syndromic Surveillance and Rumor Surveillance System • Emergency room based syndromic surveillance (2002) • Enhanced syndromic surveillance during major international events (2003) • K- ProMed

Website for sentinel or syndromic surveillance

Website for Influenza Surveillance
(Korean/English version)

Human Resources Development and Collaboration with Private Sector
 Development of Human Resources
• Field Epidemiology Training Program (1999) • Field Management Training Program (2002) • Training program by each Div. - Training for communicable disease surveillance : 3 to 4 times a year

 Enhancement of Collaboration with Private Sector
• Development and operation of sentinel surveillance in the collaboration with private sector • Co-hosting of seminar, conferences • Research Project

Gaps for Infectious Disease Surveillance
 Insufficient capacity at local government
• Lack of human resources at local government to respond to emerging infectious diseases
• Frequent rotation of health care workers

 Insufficient operation of various surveillance system
• Development of various surveillance systems which can serve as an early warning system • Lack of experts to operate each surveillance system

Gaps for ID Surveillance
 Insufficient integration among surveillance systems • Insufficient integration between Notifiable Disease Surveillance & laboratory surveillance  Low participation rate for notification from physicians • Low notification rate of notifiable diseases - Shin et al, 1994, notification rates of group 1 and group 2 diseases are respectively: 71.0% (95% PI, 96.2 - 75.3), 20.0% (95% PI, 18.9 – 21.3) - Shin et al, 2003, small scale survey result, notification rates of group 1, 2, & 3 are 76.4%, 50.5% & 43% respectively

- Survey in one city, 2002, report always (28%) ; report generally (37%), report sometimes (18%) ; report rarely (9%) ; no experience of infectious disease (8%), N=727

Future Plans
 Development of web-based reporting system
• Convenience of data management • Real-time analysis

 Integration of Notifiable Disease Surveillance and Laboratory Surveillance • Comprehensive surveillance • Increase notification rate

Future Plans
 Extension of electronic reporting system to private sector • Convenience of notification from the private sector • Enhance notification rate automatically • Decreasing duplicated work in public health sector  Development of human resources • Continuous training to develop human resources  Collaboration with private sector to enhance participation in disease surveillance • Enhance R & D • Operation of various surveillance system

Thank You