The National Epidemiological Surveillance of Infectious Disease (NESID) program collects and publishes domestic information regarding infectious diseases, and monitors the occurrence of and trends in infectious diseases, based on reports from physicians and veterinarians. At present, the NESID program is conducted in accordance with the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases (hereinafter referred to as "Infectious Diseases Control Law"), which took effect in April 1999. The goal of NESID is to accurately identify and analyze information regarding the occurrence of infectious diseases and to rapidly provide and publish the results to the general public and healthcare practitioners, thereby promoting measures for the effective and adequate prevention, diagnosis and treatment of infectious diseases, and preventing the occurrence and spread of various infectious diseases, while verifying the detection status and characteristics of circulating pathogens, and facilitating appropriate infection control measures, through the collection and analysis of pathogen information.
As of July 2018, the following seven antimicrobial-resistant bacteria infections are designated as reportable under NESID, which are all classified as Category V Infectious Diseases. The four diseases that are subject to notifiable disease surveillance, which requires reporting by all physicians, are vancomycin-resistant enterococcal infection (VRE, designated in April 1999), vancomycin-resistant Staphylococcus aureus infection (VRSA, designated in November 2003), carbapenem-resistant Enterobacteriaceae infection (CRE, designated in September 2014), and multidrug-resistant Acinetobacter infection (MDRA, designated as a disease reportable from designated sentinel sites in February 2011, and changed to a disease reportable under notifiable disease surveillance in September 2014). The three diseases that are reportable from approximately 500 designated sentinel sites (medical institutions that have 300 or more beds, with internal medicine and surgery departments) across Japan are penicillin-resistant Streptococcus pneumoniae infection (PRSP, designated in April 1999), methicillin-resistant Staphylococcus aureus infection (MRSA, designated in April 1999), and multidrug-resistant Pseudomonas aeruginosa infection (MDRP, designated in April 1999).
A physician who has diagnosed a reportable disease listed above (the manager of a designated notification facility in the case of a disease subject to sentinel surveillance) should report to a Public Health Center using a designated reporting form. The scope of reporting includes cases where bacteria that satisfy the laboratory findings specified in Table A are detected, and the isolated bacteria are regarded as the cause of the relevant infectious disease, or cases where it was detected from specimens that normally should be aseptic. Carriers are excluded from the scope of reporting.
Table A. Reporting criteria
Public Health Centers confirm reported information, and enter the data into NESID. The registered information is further confirmed and analyzed, and additional information is collected, by local infectious disease surveillance centers, the Infectious Diseases Surveillance Center of NIID as the central infectious disease surveillance center, and other relevant bodies. Patient information (e.g. the reported numbers of patients, and trends) that is collected under the Infectious Diseases Control Law, and other related information, are provided to the general public through the Infectious Diseases Weekly Reports (IDWRs) and other media.
A certain level of quality is considered to be guaranteed in the reporting of antimicrobial-resistant bacteria infections under NESID, since reporting is based on case definitions specified by the Infectious Diseases Control Law. Although cases may be underestimated in notifiable disease surveillance, an overall picture of trends in occurrence can be monitored. This surveillance system is also considered useful because, when an unusual trend is observed, it may trigger an intervention (e.g. investigation, guidance) at the relevant medical institution by the Public Health Center. Trends in diseases reportable from designated sentinel sites have been recorded since the launch of the NESID program in 1999, and considered useful for monitoring medium- to long-term trends in the occurrence of the target diseases.
In June 2011, a notification was issued by the Director of the Guidance of Medical Service Division, Health Policy Bureau, MHLW, stating that it was deemed important to strengthen the Public Health Institutes’ capacity to enable the testing of microorganisms causing healthcare-associated infections. In March 2017, a notification was issued by the Director of the Tuberculosis and Infectious Diseases Control Division, Health Service Bureau, MHLW, requiring that, when CRE or other specified infections are reported, Public Health Institutes and other organizations should conduct testing on the relevant antimicrobial-resistant bacteria. In the coming years, the framework of the NESID system will enable access to information of higher quality that is useful for measures against antimicrobial-resistant bacteria, through the comprehensive collection and analysis of carbapenemase genes and other information.