Objectives: We investigated the German system for managing patients with viral hemorrhagic fever (VHF) in comparing with the current Japanese system.
Methods: In Germany, we visited the Robert Koch Institute and the isolation centers in Berlin and Leipzig. In Japan, we visited the isolation wards in the Narita Red Cross Hospital and the Rinku General Medical Center in Izumi-Sano, Osaka, to allow determination of differences in the systems. In terms of the "WHO program on emerging virus diseases, 1994", we then evaluated the two countries' systems.
Results: In Germany, the finding of a suspected case with VHF is promptly reported to the competent authorities at the local level. Public health physicians on 24-hour duty declare a quarantine alert and the case is transferred to one of five isolation centers not by plane but by ambulance car. The isolation rooms in Berlin, constructed some 20 years ago, are enclosed with plastic film and kept under negative pressure and this hinders it difficult to perform intensive care in the small space available. In contrast, intensive care and routine clinical tests can be readily conducted in the isolation facilities in Leipzig installed in 2000, since the rooms are spacious and kept under negative pressure. It is also noteworthy that the same ward is utilized for patients with drug-resistant infectious diseases to train medical staff. With 3 of the 4 goals in the WHO program, establishing efficient surveillance of infectious diseases, provision of a qualified national laboratory and performance on practical research on infectious diseases, there are no large differences, between the two countries, in continuous efforts in line with recently-modified infectious disease laws. However, we found differences with regard to an effective strategy to circumvent VHF, 1) local government has a main role against VHF and control team is promptly designated in Germany, 2) only 10 beds are equipped to deal with VHF in Germany, 3) management of air-droplet infection seems insufficient in Japan, 4) highly-equipped isolation rooms are not utilized for patients other than those with VHF in Japan.
Conclusions: These findings require urgent discussion among Japanese experts concerning; 1) operation of BSL4 facilities in national laboratories; 2) collaboration among quarantine stations, local government and national reference laboratories; 3) the appropriate number of isolation wards; 4) practical procedures to run of isolation wards efficiently; 5) the possibility of utilizing isolation wards for non-VHF.