Preparation for mass gathering events from the perspective of a non-host country: the experience of Japan during the 2018 PyeongChang Olympics and Paralympic Winter Games

@#The World Health Organization recommends that countries or organizations that host mass gatherings plan ahead and prepare for possible public health events to ensure a safe environment for local residents, participants and travellers.1 Public health events during mass gatherings can also affect non-host countries. There are numerous reports of the spread of infectious diseases by travellers returning from mass gatherings,2 which can potentially pose the risk of an outbreak of new infectious diseases to travellers’ home countries. With more frequent travel across borders, it is prudent that non-host countries prepare for mass gathering events.

Case-control study of risk factors for incident syphilis infection among men who have sex with men in Tokyo, Japan

Introduction@#In Japan, syphilis notifications have increased. Men who have sex with men (MSM) in Tokyo have contributed substantially to the increase in syphilis notifications. We thus aimed to determine the correlates of incident syphilis among them.@*Methods@#MSM who attended a Tokyo clinic that serves sexual minorities were recruited in a case-control study in 2015. A case was seropositive for primary/secondary/asymptomatic syphilis at enrolment visit and seronegative at prior visit or had oral ulcers positive for Treponema pallidum DNA at enrolment. For each case, two controls seronegative at enrolment and prior visit were selected. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated to assess for correlates of case status.@*Results@#Among 35 cases, the median age was 37 (range = 21–63) years and was similar to the 71 controls. Among HIV-positive participants (26 cases and 67 controls), cases were independently associated with higher frequency of anal or oral sex (OR = 3.4; 95% CI = 1.4–8.6; increase per category from < 1/month, ≥ 1/month but < 1/week, to ≥ 1/week) and no or inconsistent condom use during anal or oral sex (OR = 3.0; 95% CI = 1.1–8.3; increase per category from using every time, occasionally, to never), adjusted for residency and time between visits. @*Discussion@#Modifiable behaviours were associated with incident syphilis, and dissemination of prevention messages are needed.

An approach to building Field Epidemiology Training Programme (FETP) trainees’ capacities as educators

@#Field Epidemiology Training Programmes (FETPs), which are modelled after the Centers for Disease Control and Prevention’s Epidemic Intelligence Service programme, began in 1980 and have produced graduates in more than 70 countries, including 12 in the Western Pacific Region.1,2 These programmes aim to “build sustainable capacity for detecting and responding to public health threats” and “develop expertise so that disease outbreaks can be detected locally and prevented from spreading”.3 FETPs thus include training in applied epidemiology and public health services. FETP trainees and graduates, however, often have additional responsibilities: mentoring newer trainees, supervising in the field, leading short training courses, facilitating meetings, etc. Programmes therefore must provide trainees with the knowledge and skills to fulfil these responsibilities.

Epidemiology of vaccine-preventable diseases in Japan: considerations for pre-travel advice for the 2019 Rugby World Cup and 2020 Summer Olympic and Paralympic Games

Introduction@#In 2019 and 2020, Japan will host two international sporting events estimated to draw a combined 22 million visitors. Mass gatherings like these ones increase the risk of spread of infectious disease outbreaks and international transmission. Pre-travel advice reduces that risk. @*Methods@#To assist ministries of health and related organizations in developing pre-travel advice, we summarized national surveillance data in Japan (2000–2016, to the extent available) for rubella, invasive pneumococcal disease, measles, non-A and non-E viral hepatitis, hepatitis A, invasive Haemophilus influenzae disease, tetanus, typhoid fever, invasive meningococcal disease, Japanese encephalitis, influenza, varicella, mumps and pertussis by calculating descriptive statistics of reported cases and reviewing trends. (See Annex A for details of reviewed diseases.)@*Results@#Our findings showed notable incidences of rubella (1.78 per 100 000 person-years), influenza (243.5 cases per sentinel site), and mumps (40.1 per sentinel site); seasonal increases for influenza (November–May) and Japanese encephalitis (August–November); and a geographical concentration of Japanese encephalitis in western Japan. Measles cases decreased from 11 013 in 2008 to 35 in 2015, but outbreaks (n = 165 cases) associated with importation occurred in 2016. Though invasive meningococcal disease incidence was only 0.03 per 100 000, international transmission occurred at a mass gathering in Japan in 2015.@*Discussion@#Ministries of health and related organizations should use these findings to develop targeted pre-travel advice for travellers to the 2019 Rugby World Cup and the 2020 Summer Olympic and Paralympic Games, especially for mumps, measles, rubella, influenza, and meningitis. Travellers with increased exposure risk should also be advised about hepatitis A and Japanese encephalitis.

Meningococcal disease outbreak related to the World Scout Jamboree in Japan, 2015

Problem: Six invasive meningococcal disease cases occurred among Scottish and Swedish nationals associated with the World Scout Jamboree (WSJ), an international mass gathering, held in Japan. The index case developed symptoms while returning home. The strains from all six cases were identical and seldom seen in Japan. Context: Over 33 000 participants from 155 countries attended WSJ. At the Jamboree site, participants of the North of Scotland’s and Sweden’s units camped within the same subcamp and kept the same schedule of events. No information was available about the Swedish and Scottish cases’ close personal contact history. Action: Health Protection Scotland investigated Scottish cases, conducted active case finding, provided chemoprophylaxis, vaccinated close contacts and advised Scottish WSJ participants and contacts to seek medical care if they developed symptoms. The Public Health Agency of Sweden recommended chemoprophylaxis to all participants in Sweden. In Japan, the Ministry of Health, Labour and Welfare (MHLW) requested the Scout Association of Japan advise all participants to seek medical attention if they developed symptoms. MHLW shared information about the event with local authorities, medical associations, and the Ministry of Education, Culture, Sports, Science and Technology. Outcome: No additional case related to WSJ has been reported. This outbreak highlighted the risk for international spread of invasive meningococcal disease at international mass gatherings. Discussion: Assessing risk, educating participants, enhancing surveillance and sharing timely information among related countries are significant for prevention and response against invasive meningococcal disease outbreaks at mass gatherings.

Ongoing increase in measles cases following importations, Japan, March 2014: times of challenge and opportunity

Since late 2013 through March 2014, Japan experienced a rapid rise in measles cases. Here, we briefly report on the ongoing situation and share preliminarily findings, concerns and challenges and the public health actions needed over the coming months and years. Measles is a notifiable disease in Japan based on nationwide case-based surveillance legally requiring physicians to report all clinically diagnosed and laboratory-confirmed cases within seven days, but preferably within 24 hours. After a large outbreak in 2007–2008 (more than 11 000 cases reported in 2008 alone) and a goal of elimination by April 2015, a catch-up programme using the bivalent measles-rubella (MR) vaccine was offered for grades seven and 12 (ages 12–13 and 17–18 years) from April 2008 through March 2013. During this period, there was an estimated 97% decline in measles notifications, and the cumulative number of reported cases has been steadily declining over the last five years (732 cases in 2009, 447 cases in 2010, 439 cases in 2011, 293 cases in 2012 and 232 cases in 2013). However, since late 2013 through March 2014, the country experienced a resurgence only a year after a large rubella outbreak.

Assessment of gender distribution in dengue surveillance data, the Lao People’s Democratic Republic

Objective: Adolescent and young adult males account for a large proportion of dengue cases reported through national surveillance systems in the Western Pacific Region. To preliminarily assess the validity of these observed distributions, a field investigation was conducted in the Lao People’s Democratic Republic’s Savannakhet Province in November 2011. Methods: Mixed quantitative and qualitative methods were used. Dengue surveillance data from Savannakhet Province, and aggregate hospital admission data from the Savannakhet Provincial Hospital for outpatients and inpatients were analysed by age and sex. Unstructured informal interviews were conducted with local health care workers, primary and secondary school officials and villagers. Results: An excess of males was found among reported dengue cases in Savannakhet Province in the 15–49 year age group. Females in the same age group, however, were found to access health care more than their male counterparts. Qualitative assessments attributed this distribution to young females being more health-conscious and having greater health care-seeking behaviour. Discussion: The excess of male dengue cases in the surveillance data appeared to be associated with a truly higher risk of dengue rather than greater health care access or health care-seeking behaviour by young men. This investigation indicated the importance of assessing the reported surveillance data within the context of health care utilization behaviour of the population under surveillance.

Epidemiologic update on the dengue situation in the Western Pacific Region, 2011

Dengue is an emerging vectorborne infectious disease that is a major public health concern in Asia and the Pacific. Official dengue surveillance data for 2011 provided by ministries of health were summarized as part of routine activities of the World Health Organization Regional Office for the Western Pacific. Based on officially reported surveillance data, dengue continued to show sustained activity in the Western Pacific Region. In 2011, Member States reported a total of 244 855 cases of which 839 died. More than 1000 cases were reported each from Cambodia, the Federated States of Micronesia, the Lao People’s Democratic Republic, Malaysia, the Philippines, the Marshall Islands, Singapore and Viet Nam. Cambodia, the Federated States of Micronesia and the Marshall Islands reported more cases relative to 2010. There continues to be great variability among the dengue-endemic countries and areas in the Region in the number of cases and serotype distribution. The continued high notification rate and complex dengue epidemiology in the Region highlight the need for information-sharing on a routine and timely basis.

Epidemiologic update on the dengue situation in the Western Pacific Region, 2010

Dengue is an emerging vectorborne infectious disease that is a major public health concern in the Asia Pacific region. Official dengue surveillance data for 2010 provided by the ministries of health were summarized as part of routine activities of the World Health Organization Regional Office for the Western Pacific. Based on reported data, dengue has continued to show an increasing trend in the Western Pacific Region. In 2010, countries and areas reported a total of 353 907 dengue cases, of which 1073 died, for a case fatality ratio of 0.30%. More than 1000 cases were reported each from Australia (North Queensland), Cambodia, the Lao People's Democratic Republic, Malaysia, the Philippines, Singapore and Viet Nam. All of these countries, except for Australia where the dengue virus is not endemic, reported an increase in the number of reported cases in 2010 compared to 2009. The elevated number of cases reported in 2010 in some countries, such as the Philippines, is likely due to several factors, such as enhanced reporting and continued epidemic activity. However, increases in reported number of cases in other areas, such as Singapore and Malaysia, appear to indicate sustained epidemic activity in those countries. The continued epidemic dengue activity in the Region highlights the need for timely and routine regional sharing of information.

The Great East Japan Earthquake: a need to plan for post-disaster surveillance in developed countries

After a devastating earthquake and tsunami struck north-eastern Japan in March 2011, the public health system, including the infectious disease surveillance system, was severely compromised. While models for post-disaster surveillance exist, they focus predominantly on developing countries during the early recovery phase. Such models do not necessarily apply to developed countries, which differ considerably in their baseline surveillance systems. Furthermore, there is a need to consider the process by which a surveillance system recovers post-disaster. The event in Japan has highlighted a need to address these concerns surrounding post-disaster surveillance in developed countries. In May 2011, the World Health Organization convened a meeting where post-disaster surveillance was discussed by experts and public health practitioners. In this paper, we describe a post-disaster surveillance approach that was discussed at the meeting, based on what had actually occurred and what may have been, or would be, ideal. Briefly, we describe the evolution of a surveillance system as it returns to the pre-existing system, starting from an event-based approach during the emergency relief phase, a syndromic approach during the early recovery phase, an enhanced sentinel approach during the late recovery phase and a return to baseline during the development phase. Our aim is not to recommend a specific model but to encourage other developed countries to initiate their own discussions on post-disaster surveillance and develop plans according to their needs and capacities. As natural disasters will continue to occur, we hope that developing such plans during the “interdisaster” period will help mitigate the surveillance challenges that will arise post-disaster.