Surveillance Systems for Infectious Diseases in Korea

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