Assessment of border control measures and community containment measures used in Japan during the early stages of Pandemic (H1N1) 2009.

BACKGROUND: In the early stages of Pandemic (H1N1) 2009, border control measures were taken by quarantine stations to block the entry of infected individuals into Japan and community containment measures were implemented to prevent the spreading. The objectives of this study were to describe these measures and the characteristics of infected individuals, and to assess the measures' effectiveness. METHODOLOGY/PRINCIPAL FINDINGS: Border control and community containment measures implemented from April to June (Period I: April 28-May 21, Period II: May 22-June 18) 2009 were described. Number of individuals identified and disease characteristics were analyzed. For entry screening, a health declaration form and an infrared thermoscanner were used to detect symptomatic passengers. Passengers indicated for the rapid influenza test underwent the test followed by RT-PCR. Patients positive for H1N1 were isolated, and close contacts were quarantined. Entry cards were handed out to all asymptomatic passengers informing them about how to contact a health center in case they developed symptoms. Nine individuals were identified by entry screening and 1 during quarantine to have Pandemic (H1N1) 2009. Health monitoring by health centers was performed in period I for passengers arriving from affected countries and in period II for those who had come into contact with the individuals identified by entry screening. Health monitoring identified 3 infected individuals among 129,546 in Period I and 5 among 746 in Period II. Enhanced surveillance, which included mandatory reporting of details of the infected individuals, identified 812 individuals, 141 (18%) of whom had a history of international travel. Twenty-four of these 141 passengers picked up by enhanced surveillance had been developing symptoms on entry and were missed at screening. CONCLUSION/SIGNIFICANCE: Symptomatic passengers were detected by the various entry screening measures put in place. Enhanced surveillance provided data for the improvement of public health measures in future pandemics.

[Factors to be considered in decision making for quarantine detention with emergence of a novel influenza virus].

OBJECTIVES: In the early phase of the emergence of influenza A (H1N1) 2009 abroad, quarantine detention measures based on exposure assessment of infected persons at airports were enacted in Japan. Detention, while being a step needed to protect safety and health of citizens, restricts healthy individuals' activities for several days until they can be confirmed to be not infected. Thus, the number of persons detained must be minimized in the interest of human rights. In this study, we reviewed factors to be considered in decision-making to carry out optimal detention in the early phase of emergence of a novel influenza virus in the future. METHODS: We reviewed manuscripts on contagiousness of influenza, cases of infections in public transportation such as airplanes, and the effectiveness of detention, and interviewed persons who were involved in detentions in the early phase of the influenza A(H1N1) 2009 pandemic. RESULTS: When a decision is made about detention, it is essential to assess the necessity of detention, the measures for minimizing the scope of individuals to be detained, the measures for ensuring the human rights of individuals affected, and possible means to substitute for detention. Assessment of the necessity of detention should cover the following: (1) whether or not the novel influenza is a sufficiently severe threat to public health to justify detention; (2) whether or not detention at a given point of time can delay the beginning of a domestic epidemic; and (3) who is responsible and how revision of the once decided detentions should be made. Regarding measures for minimizing the scope of individuals to be detained, discussions are needed as to: (1) giving advice to the nation to refrain from getting aboard an airplane when aware of flu-like symptoms so that exposure of people to infected individuals may be avoided; and (2) whether or not selection of individuals to be detained is going to be made, taking into account the level of exposure to infected individuals. To ensure the human rights of the individuals affected by detention, assessment is needed as to: (1) whether or not the detention period is as short as possible; (2) whether or not human rights (privacy, comfort at the detention facility) will be protected during detention; (3) whether or not adequate measures can be taken to ensure mental health and management of chronic disease of the detained; and (4) whether or not adequate explanations can be given to foreigners to be detained, with their mother language taken into account. Regarding substitutes for detention, alternatives such as keeping the individuals at their own home as home quarantine should be considered. CONCLUSION: The decision on detention has to be made in the early phase of an influenza pandemic when information available about pathogenicity and other relevant information are limited. To date, sufficient evidence useful in making a decision as to detention has not been obtained. Under such circumstances, it is essential to make an optimum decision as to the necessity and means of detention based on assessment of multiple aspects and factors.

Factors of working conditions and prolonged fatigue among teachers at public elementary and junior high schools.

Prolonged fatigue among elementary and junior high school teachers not only damages their health but also affects the quality of education. The aim of this study was to determine the factors of working conditions associated with prolonged fatigue among teachers at public elementary and junior high schools. We distributed a self-reported, anonymous questionnaire to 3,154 teachers (1,983 in elementary schools, 1,171 in junior high schools) working in public schools in a city in Japan. They were asked to assess 18 aspects of their working conditions using a seven-point Likert scale. Prolonged fatigue was measured using the Japanese version of the checklist individual strength questionnaire. Multiple regression analysis was used to examine the association between working conditions and prolonged fatigue. Gender, age, and school type were introduced as confounders. In all, 2,167 teachers participated in this study. Results showed that qualitative and quantitative workload (time pressure due to heavy workload, interruptions, physically demanding job, extra work at home), communication with colleagues (poor communication, lack of support), and career factors (underestimation of performance by the board of education or supervisors, occupational position not reflecting training, lack of prospects for work, job insecurity) were associated with prolonged fatigue.

[Evidence-based public health for pandemic flu].

Various public health interventions for mitigating the effect of pandemic flu such as quarantine, school closures, and social distancing have been implemented in Japan for influenza A (H1N1) 2009. However, there has been arguments on the effectiveness of these interventions. Evidence for the effectiveness of public health interventions often does not meet the criteria used in evidence-based medicine (EBM) because of the study design used in evidence-based public health (EBPH). Public health experts in various fields try to find better solutions as a team, even though there is not always sufficient evidence for effectiveness of these strategies. In cases of the occurrence of emerging infectious diseases, prompt decision making is required. Thus, continuous efforts to review evidence and to establish the systems for decision making are necessary.

Maintenance of influenza virus infectivity on the surfaces of personal protective equipment and clothing used in healthcare settings.

OBJECTIVES: The maintenance of infectivity of influenza viruses on the surfaces of personal protective equipment and clothing is an important factor in terms of controlling viral cross-infection in the environment and preventing contact infection. The aim of this study was to determine if laboratory-grown influenza A (H1N1) virus maintained infectivity on the surfaces of personal protective equipment and clothing used in healthcare settings. METHODS: Influenza A virus (0.5 mL) was deposited on the surface of a rubber glove, an N95 particulate respirator, a surgical mask made of non-woven fabric, a gown made of Dupont Tyvek, a coated wooden desk, and stainless steel. Each sample was left for 1, 8, and 24 h, and hemagglutination (HA) and 50% tissue culture infective dose (TCID(50))/mL were measured. RESULTS: The HA titer of this influenza A virus did not decrease in any of the materials tested even after 24 h. The infectivity of influenza A virus measured by TCID(50) was maintained for 8 h on the surface of all materials, with the exception of the rubber glove for which virus infectivity was maintained for 24 h. CONCLUSIONS: Our results indicate that the replacement/renewal of personal protective equipment and clothing by healthcare professionals in cases of exposure to secretions and droplets containing viruses spread by patients is an appropriate procedure to prevent cross-infection.

Establishment and evaluation of the Japanese edition of the Weekly Epidemiological Record (WER) website by the Faculty of Health Sciences of Kobe University School of Medicine.

To report on the establishment of the Japanese version website of the Weekly Epidemiological Record (WER) by the faculty and to evaluate its accessibility and the educational outcome: all articles from the WER since 2000 have been translated into Japanese by graduate students with teachers' guidance, verified by the committee members, and delivered to the website. The server log files and retrieval keywords were analyzed using Analog 6.0. An on-line questionnaire survey of visitors to the website was performed. Opinion sheets reported by the students for translation were evaluated as the educational outcome. Over 6 years, there were 820,571 requests to the website and, the number of requests increased with disease outbreaks. According to domain analysis, most requests were during daytime on weekdays, and the website was utilized by users in educational institutions and the Japanese government and by overseas visitors. Among respondents to the questionnaire, 47% were laypersons and 69% found the website easy to understand. SARS and HIV/AIDS were the terms most frequently used for retrieval. The students recognized the importance of the World Health Organization (WHO) and had broadened their perspective on international health. The website is useful for Japanese. The translating process was effective for international health education.