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Infectious Disease Early Warning

An early detection system for infectious diseases, integrating data from outpatient clinics, hospitals, ambulance transport, pharmacies, schools, nursery schools, and elderly care facilities across Japan.

Explore the System
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Multi-Channel Data

Eight surveillance channels including outpatient, inpatient, ambulance, OTC pharmacy, nursery school, school absenteeism, elderly facilities, and laboratory testing.

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Early Detection

Syndromic surveillance identifies unusual patterns before laboratory confirmation, enabling faster public health responses to emerging outbreaks.

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Event Monitoring

Enhanced surveillance was conducted at major mass gatherings including the Hokkaido Toyako Summit 2008, APEC Yokohama 2010, and COP10 Nagoya 2010.

How Syndromic Surveillance Works

Syndromic surveillance monitors health-related data in near real-time to detect signals of infectious disease outbreaks before conventional diagnosis-based systems. By tracking symptoms and proxy indicators — such as school absenteeism, pharmacy dispensing, and ambulance transports — public health authorities can identify anomalies and respond earlier.

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Surveillance Channels

Syndromic surveillance in Japan draws on a broad range of data sources, each contributing a distinct signal for outbreak detection. These channels collectively provide a comprehensive picture of community health status, from clinical settings to everyday community indicators.

  • Outpatient (外来) — clinic visit symptom data
  • Inpatient (入院) — hospital admission surveillance
  • Ambulance Transport (救急車搬送) — emergency call patterns
  • OTC Pharmacy (OTC) — over-the-counter medication sales
  • Nursery School (保育園) — preschool absenteeism tracking
  • School Absenteeism (学校欠席) — nationwide school-based system
  • Elderly Facilities (高齢者施設) — care-home health monitoring
  • Laboratory Testing (検査) — test-ordering pattern analysis
Abstract map of Japan divided into prefectural regions, shaded in a gradient from pale gray through amber to deep red, indicating surveillance coverage intensity
School Absenteeism System

As of January 2016, approximately 23,618 schools across 25 prefectures, 6 designated cities, and 2 special wards — covering about 53% of elementary, junior high, and high schools nationwide.

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Pharmacy Surveillance

Daily influenza estimates derived from anti-influenza drug dispensing data across 10,064 participating pharmacies, with prefecture-level and designated-city breakdowns from the 2009/2010 through 2014/2015 seasons.

Tracking asthma spikes in Australian schools during thunderstorms

Monitoring asthma exacerbation spikes during thunderstorm events using school nurse logs can give public-health teams an early signal that respiratory illness is rising. A sudden increase in inhaler use, breathing difficulty, first-aid referrals or ambulance calls may appear in schools before hospitals report a clear change in emergency presentations.

This approach fits within syndromic surveillance, which uses near-real-time health indicators rather than waiting for confirmed diagnoses. Australia’s geography, variable school health staffing and strong seasonal pollen patterns make local data especially valuable. A school in Melbourne may experience a different risk profile from one in Brisbane, Perth or Canberra, yet a consistent reporting method can connect these observations into a useful warning system.

Why thunderstorms can trigger asthma emergencies

Thunderstorm asthma occurs when storm conditions concentrate and distribute airborne allergens. In southeastern Australia, grass pollen is a major concern. Before or around a storm, pollen grains can rupture into smaller particles that travel deeper into the airways. Wind gusts may then carry those particles across populated areas, exposing people who have asthma, hay fever or previously unrecognised airway sensitivity.

The 2016 Melbourne thunderstorm asthma event demonstrated how quickly this hazard can escalate. Ambulance demand and emergency department presentations rose sharply, with many people experiencing severe breathing difficulty within a short period. Similar risks can occur around Geelong, the Dandenong Ranges, Canberra and other areas where grass growth, dry weather and unstable spring conditions overlap.

A storm warning should therefore be treated as a possible respiratory-health event, rather than simply a weather update. School staff may observe clusters of coughing, wheezing, chest tightness or requests for reliever medication during the same afternoon. Those signals can guide faster communication with families and health authorities.

What school logs can reveal

A school record does not need to contain a clinical diagnosis to support surveillance. Useful entries include the time of symptoms, year level, broad symptom category, whether a student used a personal reliever, whether an asthma action plan was followed, whether a parent or carer was contacted, and whether an ambulance was called. These fields describe demand for care while limiting unnecessary personal information.

The timing is important. A rise in breathing-related incidents over a two-hour period may be more informative than the total number recorded across a term. Comparing the event with the previous four weeks can help identify an unusual increase. Schools can also record whether windows were closed, outdoor sport was cancelled or students had recently returned from recess, because these details help explain exposure.

In Australia, the phrase “school nurse” does not describe a uniform national service. Some schools have regular nurses, while others rely on first-aid officers, visiting health staff, teachers and administrative personnel. A practical system should allow the designated staff member to submit a simple log, rather than assuming every campus has a nurse available throughout the day.

Building a reliable reporting workflow

A school-level reporting form should use a small set of standard categories. “Breathing symptoms,” “reliever administered,” “medical treatment sought,” “ambulance called” and “possible asthma cluster” are easier to apply consistently than long free-text descriptions. A brief notes field can capture unusual circumstances, such as a sports carnival, a dusty oval or a sudden wind change.

Reports should be submitted at an agreed interval during high-risk periods. Daily summaries may be sufficient during ordinary spring weather, while hourly reporting could be appropriate during a severe thunderstorm asthma warning. The receiving public-health team can then compare school information with ambulance dispatches, emergency department syndromic data, pharmacy demand and meteorological conditions.

The broader syndromic surveillance system model is useful because it brings together several imperfect but timely indicators. No single school log can establish the cause of an outbreak. When school reports rise alongside asthma-related ambulance calls and increased reliever dispensing, however, the combined pattern becomes much more persuasive.

Protecting students while using the data

Health information collected at school must be handled carefully. Schools should gather the minimum data needed for a public-health purpose and avoid sending names, full dates of birth or detailed clinical histories in routine aggregate reports. A count by campus, age band or year level will often be enough to detect a spike.

Australian privacy obligations vary according to the organisation and state or territory. Government schools operate under public-sector privacy rules, while independent and Catholic schools may have additional policies alongside federal requirements such as the Privacy Act 1988. State and territory education departments also set rules for student records, parental contact and health information. Local legal and department guidance should shape the reporting process before it is introduced.

Access controls matter as much as data collection. A principal may need a campus-level summary, while a public-health analyst may need time-stamped counts across several schools. Teachers generally need practical advice about prevention and first aid, not a downloadable list of affected students. Clear retention periods and secure transmission reduce the risk that a temporary warning system becomes an uncontrolled medical database.

Connecting school signals with local conditions

Weather and environmental context can improve interpretation. A school near Melbourne’s western grasslands may record a different pollen exposure from a coastal Sydney campus. Canberra’s dry spring conditions, Adelaide’s hot northerly winds and Perth’s seasonal grass growth each create distinct local backgrounds. Monitoring should therefore retain the school location and the relevant meteorological period.

Routine behaviours also influence exposure. Students may spend lunch outdoors, travel by tram or bus with open windows, attend afternoon sport or walk home through grassy areas. In Brisbane, humid storm conditions may coincide with other respiratory irritants, while in Melbourne a cool change can arrive after a warm, pollen-heavy day. These everyday patterns help explain why symptoms cluster at particular times.

Pharmacy and primary-care information can add another layer. A sudden increase in requests for salbutamol, spacers or urgent asthma advice may support the school signal, although dispensing data must be interpreted carefully because a purchase does not prove an acute exacerbation. Hospital, ambulance, general-practice and school indicators work best when analysts examine their timing together.

Turning a warning into a response

When reports cross a locally agreed threshold, the response should be immediate and practical. Schools can check that asthma action plans are accessible, confirm that reliever medication and spacers are available, move activities indoors and ensure staff know how to respond to severe symptoms. Families may need a concise notice explaining the weather risk, symptoms requiring urgent help and the importance of following an individual action plan.

Messages should avoid implying that every cough is an asthma emergency. They should distinguish mild symptoms from red flags such as difficulty speaking, exhaustion, blue or pale lips, rapidly worsening breathing or poor response to reliever medication. In a life-threatening situation, staff should call Triple Zero (000) and follow the student’s asthma first-aid plan while waiting for help.

Communication channels should match local habits. A school may use a department-approved app, SMS, email, website notice or a printed message for families who have limited digital access. Online information must be checked before it is circulated; a public-health alert should not be mixed with unrelated commercial material, such as content about free five-reel pokies, which belongs in a separate communication context.

Measuring performance after the event

After a storm, analysts should review both the data and the response. Questions include how quickly the first school report arrived, whether multiple campuses saw symptoms at the same time, how many students required ambulance assistance and whether hospital or pharmacy indicators followed the school signal. This retrospective analysis can show whether the reporting threshold was too sensitive or too slow.

False alarms are expected in an early-warning system. A burst of coughs may result from dust, cleaning products, influenza, COVID-19 or a sporting event rather than thunderstorm asthma. The answer is not to discard school data, but to compare it with symptom type, weather, pollen information, laboratory surveillance and clinical outcomes.

Training should be repeated before each high-risk season. Staff turnover, changes to digital systems and new school buildings can weaken reporting continuity. A short annual exercise using a simulated storm can test whether staff can identify symptoms, locate action plans, submit an anonymised count and escalate an emergency without delaying care.

A mature program can also reveal prevention gaps. If several students repeatedly need urgent treatment but do not have current asthma plans, the school may work with families and clinicians to update them. If one campus records higher rates after outdoor sport, its timetable, grounds management or indoor-air arrangements may need review.

Schools can begin with a simple, privacy-conscious log and agree on escalation arrangements with their local public-health unit. Health departments, education authorities, meteorological services, ambulance providers and pharmacies can then connect these early observations with wider surveillance streams. Used promptly and responsibly, school records can help communities act before a thunderstorm asthma surge becomes a larger emergency.

Technical Support

For inquiries about the syndromic surveillance systems, including the school absenteeism information collection system and pharmacy surveillance:

Contact: Yasushi Ohkusa, Senior Researcher

Institution: Infectious Disease Epidemiology Center, National Institute of Infectious Diseases

FAX: 03-5285-1129

Email: ohkusa@nih.go.jp

All inquiries accepted by FAX or email only. For school absenteeism system login issues, please contact your municipal board of education or childcare division.