Situation report on identified cases and responses in Japan-1

May 9, 2009

Minister of Health, Labour and Welfare, Mr. Masuzoe announced just after 8:30 a.m. this morning that three travelers returned yesterday evening from Ontario, Canada through Detroit, USA tested positive to current epidemic influenza A (H1N1) infection. These are the first three positive cases reported from Japan.

As of 0:00 UTC/GMT, 9th May 2009, three Japanese reported fever and/or cough, sneeze have tested positive for novel influenza A(H1N1) virus infection. All are male belonging to the same group of travelers from one high school in the region. One teacher in 40s and two are teenager students. No death or critically ill case has reported. The group was in Oakville for cultural exchange since 24th April and traveled around the region. They took a flight from Toronto, transited at Detroit, and arrived in Narita by Northwest 025 on 8th May evening.

Contacts, 33 of those from same group, 14 passengers on the same aircraft seated at close proximity to the three, and 2 crew members are under medical surveillance and will be in quarantine for 10 days in accordance with the pandemic planning. Further 7 cases were reported unwell in the same 9th evening and are waiting for the test results. The Japanese government is also contact tracing for those in transit at Narita as well as those already passed immigration by the time of detection.

The Minister also announced that the case of second student was identified only after he passed onboard quarantine which illustrates the limitation of entry screening. He stated that Japan will continue the entry screening but also needs to consider ways to strengthen domestic surveillance for early detection. He also touched on the issue that medical community and regions need to be prepared for cases from the community.

Since this first report was detected at the border and there is no apparent evidence for human to human transmission in the community, no major changes on response plan or medical treatments are recommended. Good personal hygiene is strongly recommended for individual protection, including masks in the crowd, hand washing, and gargling.

Report from National surveillance

The national case-based early reporting surveillance received 14 cases (9 May, +1:00 UTC/GMT).   Result of laboratory diagnostic tests at either Regional Public Health Laboratories or the National Institute of Infectious Diseases (NIID) were all negative except the first case which has no result reported yet. These cases are excluding those identified at the port of entry Quarantine Stations. Under Japanese regulations, cases prior to the immigration are reported separately through the quarantine system.

Comments

Successful detection at the entry point by Quarantine Station, proved the effectiveness of current measures in place and provided early warning to the nation for a blinks of time to prepare.

However, if the cases rise from now as seen in North Americas and Europe, it is just a matter of time to face multiple communitywide infection throughout country.

Above situation only pose heavy stress to the quarantine activity and increase risk of mild case or latent phase cases entry.

Looking toward seasonal flu season to come in few months time, now is time to consider to shift towards early detection with effective rapid test and early mitigation by personal protection and medical treatment.