1. Seoul Metropolitan Government Health & Welfare Headquarters Health Policy Division Kui-Nam Kim

2. I. Understanding Influenza and World Surveillance Scheme II. Korea Influenza Surveillance Scheme (KISS ) 2 Overview

3. Ⅰ. U NDERSTANDING I NFLUENZA AND W ORLD S URVEILLANCE S CHEME 3

4. 1) What is Influenza Virus? Influenza Virus (Influenza A, B, C) causes Acute Respiratory Disease 5-20% of Infections occur during Winter ~1,600 Death Rate/Year (South Korea) ~4 Mil. Infections/Year (United States) 2) Composition of Influenza Virus Consists of 8 RNA Fragments Form  Type A  The most common Influenza Virus  Combination of 16 HAs, 9 NAs  Main Cause for Annual Flu and Pandemics  Type B  Type C Influenza Virus : Outline & Composition 4

5. (Figure 1). Flu Strain Model 5 Indirect Infection Human Type Avian Type New Flu Strain 2^8 Types of Flu Strain

6. (Figure 2). Major Influenza Pandemic 191 8 195 7 196 8 197 7 199 7 200 9 201 1 H1N1 Spanish Flu H2N2 Asian Flu H3N2 ‘Hong Kong Flu’ Novel H1N1 Russian Flu ？ ？ ？ Deaths: 40-50 million Deaths: 2 million Deaths: 1 million Deaths: Low mortality Deaths: 18,449 6

7. WHO Global Influenza Surveillance Network (GISN) 1) Establishment of GISN (1952) 136 National Influenza Centers in 106 Countries 4 WHO Collaborating Centers (WHOCC): Reference & Research on Influenza 1 WHOCC: Surveillance, Epidemiology, Influenza Control 1 WHOCC: Animal Influenza Ecology 4 Key National Reference Laboratories; Vaccine virus selection and Development 2) WHO H5 Reference Laboratory Network (2004) 3) Influenza Surveillance Data – based Vaccine Composition Recommendation Annual Issue of Vaccine Composition on WHO Website  Northern Hemisphere: February  Southern Hemisphere: September - October  Equator: Differs on Flu Pandemic Situation Weekly Epidemiological Record 4) Monitoring new emerging viral-pandemic 7

8. WHO Global Influenza Surveillance Network (GISN) 8

9. Ⅱ. Korea Influenza Surveillance Scheme (KISS ) 9

10. 1) Purpose Early Detection Procurement & Analysis Tolerance & Variance Monitoring of Influenza Epidemic 2) Introduction 1997: Establishment of Influenza Surveillance Network (700,000 Private Medical Centers Nationwide) 2000: Influenza designated as Level 3 Legal Communicable Disease (Sentinel Surveillance) 2000: Korea Influenza Surveillance Scheme (KISS) 2004: Introduction of KISS Daily Surveillance System Influenza Sentinel Surveillance: Purpose & Introduction 10

11. (Figure 1). KISS Flow Chart Korea Center for Disease Control and Prevention (KCDCP) City · Province Research Institute of Public Health & Environment Public Health Center Sentinel Medical Institute Data Analysis & Feedback Feedback Report Encourage Reporting Request Inspectio n Result Notification Patient 11 Feedback

12. 1) Clinical / Epidemiologic Sentinel Surveillance Continuous Surveillance on outbreak trends of Influenza to provide preliminary data on Influenza countermeasures and management, through the number of reported Influenza patients acquired from Sentinel Medical Institutes Sentinel Medical Institutes are designated in proportion to the population ratio from Primary, Secondary Medical Treatment Facilities with Pediatrics, Internal Medicine, Family Medicine, ENT. 820 Facilities Designated 2) Virologic Sentinel Surveillance In order to monitor emerging viruses, and gather preliminary data for vaccine production, Virus Specimen are taken from influenza patients to study its characteristics and analyze its cause. Designated Private Medical Facilities with Participating Doctors and City, District, Town Public Health Centers 93 Facilities Designated Sentinel Surveillance 12

13. 1) Definition of Reportable Illness Influenza-like illness (ILI)  Cough, or sore throat accompanied by a fever, 38 ℃ and higher. 2) Clinical / Epidemiologic Sentinel Surveillance Report Method Clinical / Epidemiologic Sentinel Surveillance Class Repor t Perio d Report Due Date Report Term Report Content Report Methods Weekly Report One Week Every Tuesday All year round Report total sum of patients and influenza patients for the corresponding period. Internet, Fax, Phone Daily Report One Day Daily, After Treatment Sep - May * Daily Reports are submitted by the 100 designated Sentinel Medical Institutes only during the period from September of corresponding year, until May of the following year. 13

14. (Figure 2). Clinical / Epidemiologic Sentinel Surveillance Report System Flow Chart Korea Center for Disease Control and Prevention (Infectious Disease Surveillance Dept,) City · Province Public Health Dept. Clinical Sentinel Medical Institute District Public Health Dept, Report Data Feedback Report Data Feedback Report Data Feedback Weekly Infectious Disease Outbreak Bulletin Weekly Influenza Newsletter Weekly Infectious Disease Outbreak Bulletin Weekly Influenza Newsletter City · Province Analysis Public Health Center Analysis Internet Mail · Internet 14

15. 1) Specimen Sampling Target Influenza-like illness (ILI) Patients with typical symptoms. Less than 20% of daily visited Influenza-like illness patients with cough, or sore throat accompanied by a fever, 38 ℃ and higher. 2) Specimen Sampling Method Sample Type: Throat Swab, Nasopharyngeal Aspirate.  Swab patient’s throat area, put inside a virus transport medium (VTM), or 3 - 5ml of Nasopharyngeal aspirate in a sterile container. Virologic Sentinel Surveillance 15

16. (Figure 3). Virologic Sentinel Surveillance Report System Flow Chart Korea Center for Disease Control and Prevention National Institute of Public Health (Influenza Virus Team) City · Province Research Institute of Public Health & Environment Virologic Sentinel Medical Institute Patient Examinatio n Request Result Notification Examinatio n Request Result Notification VTM Distribution Web Examination Result Report VTM Distribution Web Examination Result Report Gene Analysis Virus Isolation Gene Analysis Virus Isolation Specimen Sampling RAT Test Request Specimen Sampling RAT Test Request Participate in Worldwide Influenza Surveillance Final Confirmation Variant Analysis Final Confirmation Variant Analysis 16

17. Virologic Sentinel Surveillance: Objectives Vaccine Development Response to Specimen Growth International Cooperation Monitoring Antiviral Resistance Procurement of Resources Prompt Analysis / Isolation of Epidemic Strains 17

18. Influenza Sentinel Surveillance Web Report (http://is.cdc.go.kr) 18

19. Situation Analysis / Newsletter (http://www.cdc.go.kr) 19 Influenza Sentinel Surveillance Report

20. (Table 1). Regional Definition of Influenza Activity LevelDefinition Inactiv e No increase of ILI, No indication of Virus Isolation Sporadi c No Increase of ILI, Only Indication of Virus Isolation Topical Increasing or exceeding levels of ILI in a certain region, and Indication of Virus Isolation Region al Increasing or exceeding levels of ILI in less than 50% (at least two regions) of the area, and Indication of Virus Isolation Widesp read Increasing or exceeding levels of ILI in more than 50% (at least three regions) of the area, and Indication of Virus Isolation In comparison to previous week, Increase of ILI Rate In comparison to previous week, No change of ILI Rate In comparison to previous week, Decrease of ILI Rate  Capital & Gangwon Area: Seoul, Gyungki, Incheon, Gangwon Chungchung Area: Daejeon, Chungnam, Chungbuk Honam Area: Gwangju, Chonnam, Chonbuk, Jeju Youngnam Area: Busan, Daegu, Gyungbuk, Gyungnam, Ulsan 20

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