Hiroaki Sugiura

Development of a Web-Based Survey for Monitoring Daily Health and its Application in an Epidemiological Survey

Background Early detection of symptoms arising from exposure to pathogens, harmful substances, or environmental changes is required for timely intervention. The administration of Web-based questionnaires is a potential method for collecting information from a sample population. Objective The objective of our study was to develop a Web-based daily questionnaire for health (WDQH) for symptomatic surveillance. Methods We adopted two different survey methods to develop the WDQH: an Internet panel survey, which included participants already registered with an Internet survey company, and the Tokyo Consumers’ Co-operative Union (TCCU) Internet survey, in cooperation with the Japanese Consumers’ Co-operative Union, which recruited participants by website advertising. The Internet panel survey participants were given a fee every day for providing answers, and the survey was repeated twice with modified surveys and collection methods: Internet Panel Survey I was conducted every day, and Internet Panel Survey II was conducted every 3 days to reduce costs. We examined whether the survey remained valid by reporting health conditions on day 1 over a 3-day period, and whether the response rate would vary among groups with different incentives. In the TCCU survey, participants were given a fee only for initially registering, and health information was provided in return for survey completion. The WDQH included the demographic details of participants and prompted them to answer questions about the presence of various symptoms by email. Health information collected by the WDQH was then used for the syndromic surveillance of infection. Results Response rates averaged 47.3% for Internet Panel Survey I, 42.7% for Internet Panel Survey II, and 40.1% for the TCCU survey. During a seasonal influenza epidemic, the WDQH detected a rapid increase in the number of participants with fever through the early aberration reporting system. Conclusions We developed a health observation method based on self-reporting by participants via the Internet. We validated the usefulness of the WDQH by its practical use in syndromic surveillance.

Prevalence of insomnia among residents of Tokyo and osaka after the great East Japan earthquake: a prospective study.

Background The Great East Japan Earthquake occurred on March 11, 2011. Tokyo and Osaka, which are located 375 km and 750 km, respectively, from the epicenter, experienced tremors of 5.0 lower and 3.0 seismic intensity on the Japan Meteorological Agency scale. The Great East Japan Earthquake was the fourth largest earthquake in the world and was accompanied by a radioactive leak at a nuclear power plant and a tsunami. In the aftermath of a disaster, some affected individuals presented to mental health facilities with acute stress disorder (ASD) and/or post-traumatic stress disorder (PTSD). However, few studies have addressed mental stress problems other than ASD or PTSD among the general public immediately after a disaster. Further, the effects of such a disaster on residents living at considerable distances from the most severely affected area have not been examined. Objective This study aimed to prospectively analyze the effect of a major earthquake on the prevalence of insomnia among residents of Tokyo and Osaka. Methods A prospective online questionnaire study was conducted in Tokyo and Osaka from January 20 to April 30, 2011. An Internet-based questionnaire, intended to be completed daily for a period of 101 days, was used to collect the data. All of the study participants lived in Tokyo or Osaka and were Consumers’ Co-operative Union (CO-OP) members who used an Internet-based food-ordering system. The presence or absence of insomnia was determined before and after the earthquake. These data were compared after stratification for the region and participants’ age. Multivariate analyses were conducted using logistic regression and a generalized estimating equation. This study was conducted with the assistance of the Japanese CO-OP. Results The prevalence of insomnia among adults and minors in Tokyo and adults in Osaka increased significantly after the earthquake. No such increase was observed among minors in Osaka. The overall adjusted odds ratios for the risk of insomnia post-earthquake versus pre-earthquake were 1.998 (95% CI 1.571–2.542) for Tokyo, 1.558 (95% CI 1.106–2.196) for Osaka, and 1.842 (95% CI,1.514–2.242) for both areas combined. Conclusions The prevalence of insomnia increased even in regions that were at a considerable distance from the epicenter. Both adults and minors in Tokyo, where the seismic intensity was greater, experienced stress after the earthquake. In Osaka, where the earthquake impact was milder, disturbing video images may have exacerbated insomnia among adults.

Construction of syndromic surveillance using a web-based daily questionnaire for health and its application at the G8 Hokkaido Toyako Summit meeting.

We constructed a syndromic surveillance system to collect directly information on daily health conditions directly from local residents via the internet [web-based daily questionnaire for health surveillance system (WDQH SS)]. This paper considers the feasibility of the WDQH SS and its ability to detect epidemics. A verification study revealed that our system was an effective surveillance system. We then applied an improved WDQH SS as a measure against public health concerns at the G8 Hokkaido Toyako Summit meeting in 2008. While in operation at the Summit, our system reported a fever alert that was consistent with a herpangina epidemic. The highly mobile WDQH SS described in this study has three main advantages: the earlier detection of epidemics, compared to other surveillance systems; the ability to collect data even on weekends and holidays; and a rapid system set-up that can be completed within 3 days.

Internet survey of the influence of environmental factors on human health: environmental epidemiologic investigation using the web-based daily questionnaire for health

With increasing Internet coverage, the use of a web-based survey for epidemiological study is a possibility. We performed an investigation in Japan in winter 2008 using the web-based daily questionnaire for health (WDQH). The WDQH is a web-based questionnaire survey formulated to obtain information about the daily physical condition of the general public on a real-time basis, in order to study correlations between changes in physical health and changes in environmental factors. Respondents were asked whether they felt ill and had specific symptoms including fever. We analysed the environmental factors along with the health conditions obtained from the WDQH. Four factors were found to influence health: minimum temperature, hours of sunlight, median humidity and weekday or holiday. The WDQH allowed a daily health survey in the general population in real time via the Internet.

Prescription surveillance and polymerase chain reaction testing to identify pathogens during outbreaks of infection.

Syndromic surveillance, including prescription surveillance, offers a rapid method for the early detection of agents of bioterrorism and emerging infectious diseases. However, it has the disadvantage of not considering definitive diagnoses. Here, we attempted to definitively diagnose pathogens using polymerase chain reaction (PCR) immediately after the prescription surveillance system detected an outbreak. Specimens were collected from 50 patients with respiratory infections. PCR was used to identify the pathogens, which included 14 types of common respiratory viruses and Mycoplasma pneumoniae. Infectious agents including M. pneumoniae, respiratory syncytial virus (RSV), rhinovirus, enterovirus, and parainfluenza virus were detected in 54% of patients. For the rapid RSV diagnosis kit, sensitivity was 80% and specificity was 85%. For the rapid adenovirus diagnosis kit, no positive results were obtained; therefore, sensitivity could not be calculated and specificity was 100%. Many patients were found to be treated for upper respiratory tract infections without the diagnosis of a specific pathogen. In Japan, an outbreak of M. pneumoniae infection began in 2011, and our results suggested that this outbreak may have included false-positive cases. By combining syndromic surveillance and PCR, we were able to rapidly and accurately identify causative pathogens during a recent respiratory infection outbreak.

Association between first airborne cedar pollen level peak and pollinosis symptom onset: a web-based survey

Cedar pollinosis in Japan affects nearly 25 % of Japanese citizens. To develop a treatment for cedar pollinosis, it is necessary to understand the relationship between the time of its occurrence and the amount of airborne cedar pollen. In the spring of 2009, we conducted daily Internet-based epidemiologic surveys, which included 1453 individuals. We examined the relationship between initial date of onset of pollinosis symptoms and daily amount of airborne cedar pollen to which subjects were exposed. Approximately 35.2 % of the subjects experienced the onset of pollinosis during a one-week interval in which the middle day coincided with the peak pollen count. The odds ratio for this one-week time interval was 4.03 (95 % confidence interval: 3.34–4.86). The predicted date of the cedar pollen peak can be used to determine the appropriate date for initiation of self-medication with anti-allergy drugs and thus avoid development of sustained and severe pollinosis.

Development and application of an alert system to detect cases of food poisoning in Japan

Recent public health concerns regarding commercial food products have increased the need to develop an automated method to detect food product-related health events. We developed and verified a method for the early detection of potentially harmful events caused by commercial food products. We collected data from daily internet-based questionnaires examining the presence or absence of symptoms and information about food purchased by the respondents. Using these data, we developed a method to detect possible health concerns regarding commercialized food products. To achieve this, we combined the signal detection method used in the reporting system of adverse effects of pharmaceutical products and the Early Aberration Reporting System (EARS) used by the United States Centers for Disease Control. Whiteleg shrimp (Litopenaeus vannamei), which had odds ratio and Odds(−) of 8.99 and 4.13, respectively, was identified as a possible causative food product for diarrhea and vomiting. In conclusion, this study demonstrated that food distributors can implement post-marketing monitoring of the safety of food products purchased via the internet.

Syndromic Surveillance for the G8 Hokkaido Toyako Summit Meeting

We conducted syndromic surveillance during the G8 summit meeting held in Toyako, Hokkaido, July 7–9, 2008, as a counter-measure to bioterrorism attacks or other health emergencies. Surveillance actually started on June 23, 2 weeks prior to the G8 summit, and ended on July 23, 2 weeks after the closing of the meeting. Part of the syndromic surveillance for prescription drugs was fully automated, while the remainder was done manually through the Internet. Similarly, data on ambulance utilization was collected and included in the syndromic surveillance system. We also purchased data on OTC sales from two private research firms in Japan. In an effort to share the surveillance information and discuss whether further investigation was needed, virtual conferences were held and Hokkaido local government, local health departments and laboratory, National Institute of Infectious Diseases, and Ministry of Health, Labor and Welfare personnel were among the attendees. Information was collected automatically from 23 pharmacies on prescription drugs and manually entered for 71 pharmaceutical companies on drug sales. One fire department that covered the Toyako area and was in charge of highlevel officers participated in the fully automated surveillance system, and seven other departments in the surrounding area conducted the manually-entered surveillance. OTC sales information was reported for 79 drugs with a delay of 1 day, and thus had to be processed manually. Health conditions were reported by 472 households that agreed to participate in the web-based survey; this data was analyzed automatically. Fortunately, we did not observe any suspected outbreaks during G8. However, local health departments investigated seven cases based on abberrances in ambulance utilization detected by the syndromic surveillance. Undoubtedly, a fully automated surveillance system is the best method for detecting an early signs of outbreak. Nevertheless, we had to use a semi-automated surveillance system during the G8 summit due to a limitation on our data collection. Our attempt at syndromic surveillance showed that it was useful and suggested that a routine and fully automated surveillance system, without manual data entry, would be needed for closer monitoring to catch signs of any suspected outbreak in the community. A routinized and fully automatic system without manual input is the next step for syndromic surveillance in Japan.