Communication to epidemiologists, health care workers & public in Japan

: Ebola virus disease (EVD)

1 Dec 2014, ASEAN+3 Ministry of Health, Labor and Welfare

Kazuki Ohshima, MDNational Institute of Infectious Diseases

Takuya Yamagsihi, MD, PhD

1

○ 　 Pre-existing documents based on Infectious Disease Control Law (available through MOHLW website)•Sample collection•Medical transferring •Disinfection•Releasing of isolation

○ 　 Updated documents (available through NIID website)•Risk assessment based on Japan context•Investigation guidance for suspected/confirmed case

Communication to epidemiologists at local government

2

Confirmed case

Suspected case#

No symptoms**

The contact (High risk, Low risk)

Lab Test

Twice a day health check‡

Investigation

Symptoms**

Suspected case*

EVD ruled outTest positive

Test negative †

* Suspected case is a person who developed fever after having been back from the three west African countries

** Symptoms; fever >38℃

† Retested as appropriate

‡ Contacts are checked for their health by local health officers for 21 days from the last contact

Flow of active case finding and contact tracing of EVD

Test positive

Test negative †

Symptoms**Investigation

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ExposureInfection precautions with

appropriate PPEsYes No

(1) Needle stick injury, mucosal or wound exposure to the body fluids of the case High risk

(2) Skin exposure to the blood, saliva, stool, semen, tear, breast milk of the case Low risk High risk

(3) Handling samples of the case Low risk High risk(4) Physical examination, medical procedures, or transportation of the case within a meter of the case

Low risk High risk

(5) A health care worker (HCW), a person who got involved in transportation of the case, a family member of the case who does not fit the criteria above

Low risk Low risk

Ｒｉｓｋ ｃｌａｓｓｉｆｉｃａｔｉｏｎ ｏｆ the ｃｏｎｔａｃｔ to EVD case

4

Low risk: Twice daily health check High risk: Voluntary ban on leaving home

○　 When having an interview with the case, use cellphone or interphone to reduce the chance of exposure

○　 When there is a need to interview with the symptomatic contact of the case, use double gloves, gowns, surgical mask, eye protection (goggles /face shield)

Training workshop (Nov-Dec 2014)•Targets: public health officers at local government to deal with investigation and medical transferring•Lectures & exercise: how to investigate/ use PPE?

○　 Specimen collection is only allowed at the designated hospitals with trained staffs

Infection precautions of epidemiologists

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Communication to health care workers

○ 　 Designate 47 hospitals where treatment for highly lethal infectios diseases including EVD based on The Infectious Diseases Control Law

○ 　 Create and distribute guidance that includes infection prevention for HCWs

○ 　 Conduct workshop for municiparities and designated hospitals

○ 　 Distribute flowchart to municiparities that indicates measures to be taken when a patient suspisious of EVD appears

○ 　 Launch an expert conference that gives suggestion to doctors of designated hospitals

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Facebook: https://www.facebook.com/ncgmdcc?ref=stream

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Communication to travelers

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M easures T aken by Q uarantine

○ 　 Call attention to the occurrence status of EVD

○ Encourage self-declaration about travel to the affected countries against all people who are entering to Japan by multiple language poster and question by quarantine officer

○ 　 Conduct announcement in the airclaft that requests passengers to declare travel history to the affected countries to quarantine officer

○ 　 Oblige people who are comfirmed to have travelled to affected countries to report their health status to quarantine officer twice daily

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http://www.mhlw.go.jp/bunya/kenkou/kekkaku-kansenshou19/ebola.html

Communication to General public

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Open a website that dedicated to EVD and publish a message from minister