Objective: The Okinawa prefectural government conducted enhanced surveillance for the Sixth Worldwide Uchinanchu Festival, with participation of more than 5300 visitors from abroad, many of whom were Okinawan or of Okinawan descent, for early detection of Zika virus disease and other potential public health threat outbreaks. Method: Enhanced surveillance conducted from 12 October through 13 November involved four surveillance systems, (Nursery) School Absenteeism Surveillance system ((N)SASSy), Prescription Surveillance (PS), and Official Syndromic Surveillance (OSS), each of them operates routinely, in addition to case-based and sentinel surveillance under the Infectious Diseases Control Law as Official National Surveillance of Infectious Diseases (ONSID). This enhanced surveillance was conducted for analysis and evaluation, with intensive information sharing among concerned parties. Result: We performed the enhanced surveillance for 33 days from 12 October through 13 November. Information from enhanced surveillance was analyzed and evaluated, and eventually summarized as a daily report. There has been one rubella case at an elementary school in Okinawa City on 20 October and a measles case at an elementary school in Uruma City on 2 November. Those two cases were registered into (N)SASSy on a timely basis. The public health center investigated them quickly, and the measles case was denied later because symptoms did not satisfy with case definition. Discussion: How to cite this paper: Yamakawa, M., Yamauchi, M., Nidaira, M., Azuma, T., Nakasone, T., Ando, F., Hayamizu, T., Kinjo, S. and Nakamura, Y. We regard enhanced surveillance as useful to confirm events that might demand a public health response. Moreover, the related including public health centers or medical institutions confirmed the situation as valuable for the administrative structure. However, because almost all (nursery) schools or pharmacies are closed during successive holidays, outbreaks that occur on such days cannot be recognized on a timely basis. More sensitive surveillance for such days, with better preparations for ambulance transfer and at emergency departments in hospitals remains as a challenge for future work.
