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2013 Modularization of Koreas Development Experience: Establishment of Korea’s Infectious Disease Surveillance System

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커버이미지
  • 저자 보건복지부, 한국국제보건의료재단
  • 발행일 2014/05/01
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요약 Infectious disease surveillance is part of public health surveillance applied to the prevention and control of infectious diseases. The results of infectious disease surveillance provide the basis of planning and evaluation of infectious disease prevention and control programs. Therefore, a surveillance system for infectious disease functions as the first step in the prevention and control of infectious diseases.

The most important basis for controlling infectious diseases is an intensive surveillance system for continuous monitoring of infection occurrences. Korea has overcome various infectious diseases that still cause social problems in developing countries, and continues to maintain adequate control of traditional infectious diseases. In this sense, this paper shares an effective surveillance system template that was developed over several decades. Such an effective surveillance system is expected to have positive effects on identifying the prevalence of a disease, discovering new health problems in a variety of fields, discovering the factors involved in the spreading of the disease, understanding the disease processing aspect, clarifying the scale of the disease, and studying the natural history of the disease.

Korea has operated an infectious disease surveillance system since the Prevention of Contagious Disease Act in 1954. This effort to manage infectious diseases was one of the most important health policies in treating acute infectious diseases in the 1950s. In 1946, Korea was under the U.S. military administration, and Cholera became a nation-wide epidemic. Other acute infectious diseases, hemorrhagic fever, and re-emerging malaria also became big problems due to the outbreak of the Korean War in 1950. Following these outbreaks, related prevention acts with regard to specific infectious diseases were promulgated, and the government continuously took over investigations by the Korea National Institutes of Health. In particular, research on Japanese encephalitis had been begun in 1949, and the number of related deaths decreased to less than 10 people by 1980. Likewise, food poisoning, shigellosis, and HIV/AIDS have been under the efficient management system,
resulting in related Acts being passed and investigations taking place as occurrences of the illnesses became more frequent.

To be specific, Korea has achieved a reduction in mortality and incidence rates as a result of its infectious disease surveillance system. Regarding acute infectious diseases,water and food borne diseases, and vaccine preventable diseases, such incidences have been declining for about five decades. Tuberculosis, among the chronic infectious diseases,has decreased dramatically compared to 50 years ago, but continues to appear in society.
The total mortality rate by infectious disease in Korea fell continuously in the last 60~70years, and the rate of reduction has been stable for the last 30 years. Four specific diseases in reductions compared to 50 years ago. At the same time, the reporting rate, one of the major elements of the disease surveillance system, was limited to only five percent 50 years ago,but has recently been increasing continuously.

However, the transference and development of the new effective infectious diseases surveillance system did witness some problems. The function of hygiene management was transferred to the Ministry of Health and Social Affairs from the “sanitary police” in the early 1960s. During the “sanitary police” administration, the infectious disease surveillance system placed medical personnel into a passive position, and the public suffered from coercive monitoring. The revision of the official names of infectious diseases was delayed until 1976, more than 30 years after Korea’s liberation from Japanese colonial rule.
This framework was an obstacle even after the Republic of Korea government had been established in 1948, for almost half a century.

The Prevention of Contagious Disease Act was completely revised and promulgated by 2000. This was a milestone in that Korea made its own framework beyond what had been followed for more than half a century under the coercive Japanese sanitary police system.
The norms regarding controlling infectious diseases such as the role of governments and protecting the rights of a patient were considered for the first time. Also, promoting public awareness of and educating the public on the surveillance system continued. As a result of such efforts, various surveillance systems have been constructed, and the reporting rate has improved continuously. However, as medical personnel still lack understanding of the diagnostic criteria of infectious diseases and the amended Act, further efforts and studies are required to perform periodic assessments of the surveillance system, to understand the problems of the existing surveillance system, to provide reform measures, and to improve utilization of surveillance data.

There are nine key projects regarding infectious disease surveillance in the process of development. The Prevention of Contagious Disease Act was promulgated in 1954. The government divided infectious diseases into 3 Groups of notifiable infectious diseases. In addition, the “Department of Infectious Diseases” was established in 1999 by the Korea National Institutes of Health in order to manage quickly and effectively various infectious diseases. This department was expected to make several response systems unified.
The Prevention of Contagious Disease Act was then amended in 1999. According to the amended Act, the classification of notifiable infectious diseases was re-organized, and a nationwide infectious diseases surveillance system with sentinel doctors was launched.
The Korea National Institutes of Health launched the sentinel surveillance system of major infectious diseases in 1999. And the Korea National Institutes of Health was expanded and reorganized into the Korea Centers for Disease Control and Prevention in 2004. This has led to a centralized response in disease management as the Korea National Institutes of Health and Quarantine Stations were reorganized.
The Korea Tuberculosis Association conducted the first national survey of tuberculosis in 1965 with the administrative support of the Korean government, WHO’s technical support, and equipment from UNICEF. The survey had been performed every 5 years since to identify trends and occurrences in tuberculosis. As the prevalence of tuberculosis decreased, the survey was discontinued in 2000, and the notification and reporting systems were improved.
An epidemiological investigation has been performed to prevent infectious diseases from spreading and promote early detection of the infection pathway. A web-based infectious disease surveillance system was also launched in 2007. Finally, the Infectious Disease Control and Prevention Act was newly enacted from existing laws in December 2010. The term “contagious disease” was also modified to the term “infectious disease” so that the term would include comprehensive diseases such as non-human-to-human transmitted infections. Additionally, the range of notifiable infectious diseases was enlarged.
There were various other institutional and organizational transitions, including the Early National Institute for Communicable Disease Prevention and Control, Korean Institute for Communicable Disease Prevention and Control, National Institute for Communicable
Disease Prevention and Control, and Korea Centers for Disease Control and Prevention.

In addition, a surveillance system of infectious diseases was adapted to these transitions.Moreover, the “Communicable Diseases Prevention Act” had been revised eight times until the “Infectious Disease Control and Prevention Act” was completed in 2000. A well-proven and effective surveillance system leads to a variety of surveillance systems to be developed. A surveillance system can be classified by reporting/notification criteria, for example, individual infected cases. If the system is classified by data collecting methods, it is either passive or active. If it is classified by range of monitoring, it is classified as a general surveillance system or a sentinel surveillance system.
A survey system is classified into (Field) Surveys and Epidemiological investigations.Korea has two representative field surveys, the Nationwide Survey of Intestinal Parasites and National Survey of Tuberculosis. The Nationwide Survey of intestinal parasites is a government project based on the Parasitic Diseases Prevention Act, which started in 1971. Since then, the survey has been performed every 5~8 years. The purpose of the survey is to identify the status of intestinal parasites in Korea. Through eight rounds of surveys, the status concerning the prevalence of intestinal parasites among the Korean population was determined. Enormous amounts of statistical data showed fluctuations and trends in the national health control system.
In addition, this research project is successfully decreasing the number of population who are infected with intestinal parasites up to almost the eradication level.
The National Tuberculosis Survey has conducted seven times at five-year intervals in order to understand and changes in and size of the tuberculosis issue from 1965 to 1995.The WHO and UNICEF supported this project. Free treatment was provided for patients and their families. Various tests and vaccinations were also carried out. In addition, to manage this illness at the national level, the government provided a department at the center currently under the Ministry of Health and Welfare. An epidemiological investigation should be performed to track the source of infection when the notifiable infectious diseases have been reported. The design of the study depends on the standard form of the KCDC with interviews of patients, parents, contacts,and attending physicians, collecting specimens and definitive diagnoses from diagnostic tests. To conduct these epidemiological studies, the KCDC organizes a central unit for epidemiological investigations. The metropolitan cities and provinces also have units with supporting city, country or district epidemiological investigation units. Each unit has its own role, and the timing of investigations differs.
A success factor of an infectious disease surveillance system in Korea is a balance among various elements: the monitoring system, related regulations and Acts, ICT, human capacity building and other elements. Infectious diseases are managed well by related regulations and legislations. Technology has also aided in this effort to distribute information in realtime to public health officers or the general public based on infectious disease web statistics.
The government is able to take appropriate measures against epidemics of infectious disease through the medium of training and education for practitioners, EIS officers and laboratory workers. Furthermore, the system’s reporting rate, timeliness, holistic approach and adaptability ensure a quality operation.

There are a few limitations. For example, information regarding infectious disease surveillance is not always used productively with less-than-optimal dissemination of the information despite the frequency of these weekly, monthly and annual reports. While the utilization of surveillance data has also been increasing recently, the system needs to develop more content for utilization. There are also general problems including past slow reporting rates. However, education and public relations activities have increased.
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