Dr. Zhen XU Branch of Respiratory Disease Prevention and Control Division for Disease Control and Emergency Response Chinese Center for Disease Control and Prevention June, 2011

ILI surveillance in outpatients of sentinel hospitals 556 sentinel hospitals, 411 labs SARI surveillance in inpatients Sentinel-based: 10 hospitals Population-based: Jingzhou city in Middle China ILI/ARI outbreak report Events reporting, virus detection National notifiable communicable disease reporting H5N1, pdm H1N1: Class B; seasonal flu: Class C No virological info Etiology-unknown pneumonia surveillance

 Integration of ILI sentinel surveillance system and ILI outbreak event report system  Data input, query and auto analysis  Lab info management  Surveillance quality monitoring

Epidemiology Surveillance Diagnosis and Registry: daily Reporting of ILI case: weekly Collect and analyze the surveillance data Laboratory Surveillance Specimen collection: 5-15 nose ＆ throat swabs from ILI cases per week per hospital Lab detection: PCR test or virus isolation, antigenic and genetic analysis, antiviral resistance 5

Specimens info & results Re- identification Network laboratories Specimens collection Send specimens to labs ILI sentinel hospitals CCDC Detection Isolates to CCDC ILI reporting ILI surveillance information reporting

Input data of ILI counts and ILI% by week and age group; Data query by date, by week, by age group, by hospital and by area ;

Input data of PCR and virus isolation results by specimen within 48h; Data query by patient, by date, by week, by hospital and by area ;

event-based report basic info of ILI outbreak: major symptoms, case number, lab results, duration and location of the outbreak progress report of outbreak response;

ILI analysis Virus typing Surveillance quality monitoring

environment surveillance data Serological surveillance data

Influenza Weekly Report Information dissemination: Weekly Report

Information Sharing FluID

 To monitor the severity of Pandemic H1N1 and understand the characteristics of SARI cases caused by pdm H1N1  Following WHO case definition  Support by MOH and EID program  Data source: ◦ Epi data by case: Respiratory, Internal ICU, and Infectious Departments from 10 hospitals ◦ Lab data: 10 network Labs where the hospitals located  Data report: EPI Database weekly sent from hospitals and labs by  Data sharing: Brief report sent to hospitals and labs regularly

Most are clinical cases; No virological info; Limited use for flu surveillance

Case patients hospitalized with 2009 pandemic influenza A (H1N1) virus infection, by date of onset, China, Sep 2009–Feb ICU,

 Still lack of a comprehensive surveillance system to oversee the virus and diseases caused by flu virus ◦ Characteristics and burden of mild, severe and fatal case  Maintain the current giant ILI network—cost, willingness and enthusiasm  Translating data into practice is much more important than collecting data ◦ Surveillance data, research data  Risk assessment of surveillance data  Quality monitoring didn’t followed by in time quality improvement action  SARI surveillance info is independent from ILI system. Mild and severe case caused by flu virus cannot be linked well

 Vaccine gap ◦ Supply: 30m doses VS 570m population ◦ Capacity: 126m doses VS 570m population  Vaccination strategy ◦ Annual technical recommendations for target population only ◦ Flu vaccination not covered by national government or medical insurance ◦ Beijing is the only city to provide the free vaccination service to local population: ﹥ 65yrs, primary and middle school students

 Improve the sentinel SARI surveillance ◦ Internet-based reporting of epi and lab data ◦ Integration with HIS and LIS in hospitals ◦ Publication and sharing of SARI findings  Modeling the ILI seasonal pattern  Application of early warning based on long-term and good-quality flu data in pilot areas  Describe the burden of severe and fatal cases caused by flu virus ◦ Population-based inpatients surveillance ◦ DSP site: ICD code-based deaths analysis Use the data for vaccination policy making

Information Platform Sequence Database Lab Data ManagementWebsite Surveillance Information System Security check Public propaganda New Technical support Data Entry Analysis&Report Result feedback Submission Share Search Download Take&Return Result Entry Receipt Integrated information system