(Characteristics of the Current Novel Influenza)
Characteristics of the current novel influenza (A/H1N1) include the following and are similar to seasonal influenza;
[1] the level of infectiousness is high, but a large majority of the people infected has recovered with only mild disorders
[2] treatment using anti-influenza-virus medications is effective,
On the other hand, the major difference from seasonal influenza is that, while seasonal influenza causes serious illnesses in mostly elderly people, the current novel influenza, according to cases in overseas, has been reported to cause serious illnesses mainly in individuals who have underlying medical conditions (diabetes, asthma, etc), leading to death in some cases.
The incubation period is considered to be 1-7 days.
(Status of Domestic Outbreak)
At present, the number of patients has been rapidly increasing in regions, such as Hyogo and Osaka Prefectures. If the infection spreads further, it is necessary to pay additional attention to the support for individuals who have underlying medical conditions.
As of now, the patients are mostly in a specific age group (high school students and junior high school students).
(Basic Policy)
As for the future preventive measures against the novel influenza, referring to epidemiological findings collected domestically and internationally, objectives of the measures will be concentrated on the following two points.
Namely;
- Prevent further spread of infection.
- In particular, devote efforts on preventing individuals who are likely to develop serious illnesses from contracting the novel influenza and subsequently developing critical condition.
In “Pandemic Influenza Preparedness Action Plan of the Japanese Government”, the counter-measures are established for each phase. On the other hand, based on epidemiological findings obtained through experiences in Hyogo and Osaka, it is also necessary to take measures suggested for the third stage flexibly (especially Infection Spreading Period and Pandemic Period), not applying the “Preparedness Action Plan” as it is, since the infection levels are different in each local community at this moment.
As for the operation, the regions where outbreaks have occurred can roughly be divided into the following 2 groups. Each prefectural government or municipal government with its own healthcare center determines which group it belongs to by consulting with the Ministry of Health, Labour and Welfare.
(1) Regions in an early stage of outbreak with few patients and the main focus is the prevention of infection spread
[1] Response to patients and individuals who were in close contact with patients
Patients (including suspected patients) should be hospitalized to medical institutes designated for infectious diseases based on the “Law concerning the Prevention of Infectious Diseases and Medical Care for Patients of Infections (Law No.114 in 1998)”, in order to prevent new infections through close contact and should be treated appropriately using anti-influenza-virus drugs to prevent further infection and lessen the sources of infection.
Proactive epidemiological surveillance will be implemented, and for individuals who were in close contact with patients will be requested to act not to increase infection (such as voluntary restrain from leaving home), and at the same time, prophylactic administration of anti-influenza-virus drugs and health monitoring will be conducted. This prevents individuals who have been exposed to the virus through contacting with patients from becoming new patients and spreading the infection in the local community.
Moreover, in case medical workers or initial response personnel are exposed to the virus and there is a high possibility of having been infected, anti-influenza-virus drugs should be administered as a prophylaxis.
[2] Medical Services and Fever Clinics
If influenza-like symptom appears, patients should call the Fever Consultation Center first and visit a designated fever clinic.
[3] Schools and Day-care Facilities, etc.
During an initial stage of infection, temporary closure of schools (excluding universities, hereinafter likewise), day-care facilities, etc. is effective for preventing spread of infection. Therefore, if the infected case is a pupil/student attending schools, day-care facilities, etc., or even if it is not but the threat of further infection caused by the secondary infection exists, schools, day-care facilities, etc., will be requested to temporarily close at the municipal level partly or wholly, or, depending on the circumstances, at the entire prefectural level.
Request for closure will be reviewed weekly, and the lifting of temporary closure will be requested considering the infection status and assuming that the thorough infection prevention plan, such as keeping individuals with symptoms home from schools, day-care facilities, etc, is carried out.
As for schools, day-care facilities, etc., in which an outbreak occurred after the lifting of closure, temporary closure will be requested individually.
Universities will be requested to contrive a management means, including closure, to minimize infection spread.
(2) Regions where the number of patients is rapidly increasing and the main focus is the prevention of serious illnesses
[1] Response to patients and individuals who were in close contact with patients
The main purpose of preventive measures in the region is to minimize the risk of individuals with underlying medical conditions from becoming seriously ill.
Individuals with underlying medical conditions will be prioritized for hospitalization even if their initial symptoms are mild.
In addition, individuals whose underlying medical conditions are uncertain will also be hospitalized immediately after an indication of severity has been observed. Whilst, individuals with milder symptoms will be treated at home, take medicine and their health status monitored at home.
In case there is an individual(s) with underlying medical conditions in the family of patients with milder symptoms staying at home, anti-influenza-virus drugs will be administered as prophylaxis.
Anti-influenza-virus drugs will not be administered other than these cases.
Anti-influenza-virus drugs should be administered as a prophylaxis to medical workers and initial response personnel with underlying medical conditions in case they are exposed to the virus and there is a high probability of infection.
[2] Medical Services and Fever Clinics
The number of medical institutions with fever clinics should be increased according to increase of patients.
Under cooperation of the concerned parties, capable general medical institutions may function as fever clinics and accept patient visits..
In this case, the utmost attention should be put on separating the general patients and patients of novel influenza, such as by setting different entrances or separate consultation time. In particular, sufficient preventive measures should be taken to prevent individuals with underlying medical conditions from contracting the virus.
Moreover, general hospitals should secure beds for patients with serious conditions, since it is possible that seriously ill patients may be admitted to general hospitals other than medical institutions designated for infectious diseases in the local community. Close attention should be paid, also in that case, to prevent individuals with underlying medical conditions from contracting the virus during hospitalization.
[3] Schools and Day-care facilities, etc.
When the number of patients is rapidly increasing in a local community, the temporary closure of schools, day-care facilities, etc. in wide areas in the region is not effective in preventing spread of infection. However, when an outbreak occurs at schools, day-care facilities, etc., such schools, day-care facilities may determine closure by their own decision in order to protect their pupils/student from contracting the virus. Thus, it will be a similar response to seasonal influenza.
Universities will be requested to contrive a management means, including closure, to minimize speed of infection.
Considering the similarities in symptoms between the current novel influenza and seasonal influenza, when individuals with influenza-like symptoms are increasing (such as temporary closure of classes, etc.) even in a local community where an outbreak has not yet occurred, it is important to proactively utilize the diagnosis test of novel influenza (PCR test) to discriminate novel influenza and understand the actual situation of infection as soon as possible.
When an outbreak has occurred beyond a certain level, in the view of comprehending an outbreak in new area, it is acceptable to place an order of priority on implementing PCR test, such as giving priority to a specimen(s) from a local community where an outbreak has not yet occurred.
Hereinafter, PCR test should be implemented preferentially to individuals who are strongly suspected to have had contact with patients in a country or region with reported cases of novel influenza, and have symptoms of high fever, etc.
Surveillance of seasonal influenza will be strengthened to track the trends of novel influenza infection.
Regarding strategies at the border, quarantine operations at the time of immigration should be focused on assured comprehension of health status based on Questionnaire on Health Status; specifically “Booth Quarantine” will be implemented. Nevertheless, in case an individual(s) with apparent symptoms has been reported before the quarantine, onboard quarantine will be implemented depending on the situation.
In case a patient(s) is identified through quarantine, the patient(s) will still be isolated. As for individuals who were in close contact with a patient(s), detention will not be applied but the cautious health monitoring will be implemented, such as request for voluntary refrain from leaving home, and immediately reported to the prefecture, etc. in which the relevant individuals reside, etc..
Moreover, the other passengers will not be subjects to the health status monitoring, but the reporting to the Fever Consultation Center in case of abnormal health condition will be thoroughly carried out.
