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Early detection a vital weapon against an epidemic

Early detection a vital weapon against an epidemic

In recent years, people's lives constantly change with technology advance. More and more people travel around the world and so do communicable diseases. Information spreads as fast as misinformation. To correctly grasp the latest news, DOH has endeavored to improve its surveillance systems.
"First we have to know that there are thousands of epidemic diseases in the world," said Tseng Shu-hui (曾淑慧), Deputy Director of CDC's 5th Division. "So we have designated certain communicable diseases as notifiable diseases that anyone who finds these diseases is obliged to report them to the health bureaus, whereas for non-notifiable diseases, reporting is at the doctor's discretion. Among the notifiable diseases, CDC has further categorized them into many different levels to represent the epidemic situations and the possible threats to society. Emerging infectious diseases and appointed infectious diseases are two of these categories. Notifiable diseases are infectious diseases that can cause serious impact on society, such as AIDS, cholera, plague and hydrophobia. Non- notifiable diseases are those relatively minor diseases such as enterogastritis and dermatosis.
Multi-surveillance System
Center for Disease Control (CDC) is at the frontline of epidemic surveillance and control. It constructed the Notifiable Diseases Surveillance System in July 2001 to gather disease information through Internet and cell phone. By using the online reporting system and text messaging, even the remote countryside can inform the medical workers to take timely action. According to a survey by the Ministry of Transportation, the mobile phone ownership in Taiwan has reached 96.6%, the 2nd highest in the world, which makes sending text messages via cell phone an efficient way of exchanging information."The difference between the enhanced reporting system and the old one is that in the past, it was a point-to-point report," said Dr. Tseng. But now, it is a point-to-dimension report. For instance, in a remote village in Nantou, once a case is reported, the local health bureau and CDC will immediately be notified simultaneously."
CDC also plans to work with other government divisions; for instance, the Bureau of National Health Insurance, the Immigration Office and the National Policy Agency to track the medical history of people entering from high-risk countries.
"We found that Taiwanese are apt to visit doctors especially after traveling abroad out of Taiwanese's medication habits," said Dr. Tseng. "So we think a web-based surveillance system might be a good way to grasp the epidemic diseases."
When doctors find their patients infected by infectious diseases, they go online, check the box, and click sending to finish the report. But for emerging infectious diseases that have no clear pictures to ascertain, CDC creates a Syndromic Surveillance System to monitor them. What the physician needs to do is describe the patients' symptoms as well as their travel and contact histories, and CDC will be in charge of integrating the information, examining specimens and taking further actions.
"Humans' knowledge of those diseases is limited," said Dr. Tseng. "We already know some of them but there are much more to be discovered. SARS taught us a great lesson that we should stay vigilant all the time."
So far, since doctors provide about 99% of the surveillance information, CDC cooperates with 700 to 800 doctors in Taiwan's 319 townships. This system was established in 1989 in which doctors regularly provided case numbers for chicken pox, diarrhea, flu, hand- foot-and mouth diseases and measles. CDC also reminds doctors to pay attention to patients' clinical symptoms, contact history, travel history and occupations. The system contributes to public health in several ways. First of all, through this system, CDC can appraise the damage caused to society by the given disease; secondly, DOH can appraise the effects of its infectious disease prevention plan; thirdly, through this system the Health Bureaus will be able to build up the Taiwan's epidemiological database; finally, CDC can forecast the magnitude of emerging infectious diseases.
Even though most people would choose to visit a doctor when they have discomfort, it doesn't make the School Surveillance System less important. "The surveillance system has to be multidimensional," said Dr. Tseng. "We don't expect schools to discover emerging infectious diseases but we do need school surveillance system to regularly report the numbers of sick students so that CDC can keep an eye on the abnormal."
For densely-populated organizations such as long-term care facilities, elderly apartments, institutions for disability, protectories, veterans' homes, prisons, nursing homes and day-care centers for mental recovery, infectious diseases can spread rapidly and lead to lethal consequences. The nurses in these organizations have been asked to report on the cluster infections within 24 hours since September 2004, particularly clusters of respiratory tract diseases and gastric diseases.
"From the SARS experience, we realized that outbreaks of epidemic diseases in densely- populated institutions could be irreparable," said Dr. Tseng. "These people's immune systems are particularly vulnerable to communicable diseases."
To update the latest information, CDC actively monitors the epidemic situations worldwide on the website of World Health Organization (WHO), other countries' health departments, new reports as well as international public health organizations. Although Taiwan is not yet a member of WHO, Taiwan is a signatory country of the International Health Regulations. (IHR) Every department of CDC has a focal point for direct communication with equivalent health organizations in other countries.
Finally, CDC has set up a 24- hour toll-free line 1922 for any people who have questions about their symptoms. The phone operators can provide people with advice on the initial steps to handle a possible pandemic. "Taiwan is a small country where any incident can be rapidly reported to the central government," said Dr. Tseng. "Since the information transmits so fast, so should our reaction. What really notable is that most of the existing surveillance systems were built up before the 2003 SARS outbreak. What we need most desperately is alertness."


Updated : 2021-10-18 05:25 GMT+08:00