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Taipei City Government1
Yen-Jen Sung, MD, PhDCommissioner
Department of HealthTaipei City Government
Infectious Disease: Prevention Strategies &
Emergency Response Procedures
Taipei City Government2
Taipei City SARS Epidemic of 2003 1The first case of SARS in Taiwan-Area:A China-based Taiwanese businessman, Mr. Chin, and his wife reported March 14, 2003, the first immigrated & local cases
April 24, 2004: Heping Hospital Sealed for Isolation
March-August, 2003: 1539 cases reported by hospitals & clinics in metro Taipei; 157 Taipei residents
June 17, 2003, Taiwan removed from WHO’s travel alert list
July 15, 2003, Taiwan removed from Epidemic Region list
Taipei City Government3
Residential quarantine
26,942 grade A quarantined persons
(direct contact with potential SARS patients)
13,358 grade B quarantined persons
(returning from epidemic regions)
Of all quarantined, 12 (≈ 0.030%) diagnosed as
potential or suspected SARS cases
Taipei City SARS Epidemic of 2003 2
Taipei City Government4
Preparedness to Counter SARS 11. Organization Overhaul
Division for Disease Control and PreventionDisease Control & Prevention BranchInfectious Disease Specialized (Heping) Branch & Research Center
2. Nosocomial Infection ControlFever screening stations for all incoming patientsTraining and education of hospital staffNosocomial infection preventionLife-saving equipment inventory system for tracking and distribution “Total care” nursing system: family members discouraged to stay
3. Surveillance & ReportingReporting/Sharing of notifiable disease surveillance dataMobile community-based infectious disease prevention teamsIntegrated disease control measures with CDC of central government
Taipei City Government5
Preparedness to Counter SARS 24. Emergency Response System
Integrated infectious disease information system
Emergency Operation Center (EOC )
Incident Command System (ICS)
Disease Prevention Consulting Committee (DPCC)
5. Health Education2004 Asia-Pacific Anti-bioterrorism Symposium -
380 participants including medical professionals, hospital administrators, college personnel, fire service, police, professional and general public
“General medicine” (PGY1) training course for all resident physicians
Taipei City Government6
Taipei City GovernmentTaipei City Government
Food and Drug DivisionFood and Drug Division
Medical Affairs DivisionMedical Affairs Division
Health Promotion DivisionHealth Promotion Division
Research and Planning DivisionResearch and Planning Division
System Administration OfficeSystem Administration Office
Statistics OfficeStatistics Office
Administrative ServicesAdministrative Services
Accounting OfficeAccounting Office
Personnel OfficePersonnel Office
Government Ethics OfficeGovernment Ethics Office
Zhongxing BranchZhongxing Branch
Renai BranchRenai Branch
Heping BranchHeping BranchYangming BranchYangming Branch
Zhongxiao BranchZhongxiao Branch
Chinese Medicine BranchChinese Medicine Branch
Songde BranchSongde Branch
Taipei Municipal Guandu Hospital Taipei Municipal Guandu Hospital Taipei Municipal Wanfang HospitalTaipei Municipal Wanfang Hospital
Department of HealthDepartment of Health
Disease Control and Prevention Division
Disease Control and Prevention Division
LaboratoryLaboratory
Disease Control and Prevention Branch
Disease Control and Prevention Branch
12 District Health Centers12 District Health Centers
Taipei City HospitalTaipei City Hospital
Women and Children BranchWomen and Children Branch
Taipei City Government7
Annual “Total Security” Drill (萬安演習)300 held hostage by 6 armed BIOterrorists from …
August 24, 2005
Taipei City Emergency Response System
Taipei City Government8
1. Avian influenza as a legally defined infectious disease: Dec. 29, 2004.
National security level of alert announced last month.
2. Epidemic Watch:
(1) Body temperature monitor for poultry/livestock/pet bird business
workers
(2) Human avian influenza infections and reporting
3. Joint Prevention Task Force supported by different agencies:
TCG Joint Prevention Task Force for Avian Flu
Assistance & consultation for poultry/livestock/pet business workers
Close monitor for all incidents of avian flu
4. Isolation, hospitalization, and treatment resource integration
New & Emerging Infectious Diseases1
Taipei City Government9
Avian Flu Prevention & Control Drills
Legend:Department of Health receives reports from animal inspection division of chickens possibly carrying avian influenza virus …
Staff dispatched to the scene pack euthanized chickens into plastic bags. Workers are evacuated from danger zones and sprayed thoroughly with disinfectant solution by the cleaning staff (esp. armpit, groin and feet)
New & Emerging Infectious Diseases2
Taipei City Government10
New & Emerging Infectious Diseases3
Joint Prevention Task Force for Bird Flu: Experts in Health, Animal Inspection & Education Departments provide assistance, education and consultation specifically to Zoos, Nature Parks, Poultry/Pet Businesses
Staff from Departments of Economic Development and Environment Protection visiting Guandu Nature Park for disease prevention education programs
Staff from Departments of Economic Development and Health were visiting Pet Bird/Poultry vendors for disease prevention education
Taipei City Government11
School Reporting System2,065 cases reported by child care facilities (pioneering model first established in Taipei)
Hospital Reporting SystemEmergency Care facilities reported 5,172
cases; 397 Taipei City residents
13 complicated with severe symptoms--7 excluded enteroviral infection--6 confirmed
(as of June 30, 2005)
School campus-reported enterovirus cases
Emergency care -reported enterovirus cases
Enterovirus Epidemic 1
58115124127127132143153159165171175193210238261291
357
990
1382
1697
1959
2065
693
486
94
106
262
03
315
9
392
36
21
58
5 11 10 6 6 6 4 18 17 28 2330 66
129
207
297
0
300
600
900
1200
1500
1800
2100
0
50
100
150
200
250
300
350
400
450
500
Accumulative (Left Axis)
Weekly (Right Axis)
A c c umul a t i ve (L e f t A x i s ) 58 94 115 124 127 127 132 143 153 159 165 171 175 193 210 238 261 291 357 486 693 99 0 138 169 195 206
We e kl y (Ri ght A xi s ) 58 36 21 9 3 0 5 11 10 6 6 6 4 18 17 28 23 30 66 129 207 297 392 315 262 106
1. 1 1. 2 1 . 3 1 . 4 2. 1 2. 2 2. 3 2. 4 3. 1 3. 2 3 . 3 3 . 4 4. 1 4. 2 4. 3 4. 4 4. 5 5. 1 5 . 2 5 . 3 5. 4 6. 1 6. 2 6. 3 6. 4 6. 5
月週
5,172
239118 345419
526480 564 604 638 691 742
4,748
4,113
3,488
2,751
2,1281,647
1,3311,1681,062969903830785
118 121
46 38 40 3453 51 43 45
73 6693 106
163
623
737
635
424481
61
316
106
74
625
0500
100015002000250030003500400045005000
01002003004005006007008009001000
Accumulative (Left Axis)
Weekly (Right Axis)
Accumulative (Left Axis) 118 239 345 419 480 526 564 604 638 691 742 785 830 903 969 1062 1168 1331 1647 2128 2751 3488 4113 4748 5172
Weekly (Right Axis) 118 121 106 74 61 46 38 40 34 53 51 43 45 73 66 93 106 163 316 481 623 737 625 635 424
1.1 1.2 1.3 1.4 2.1 2.2 2.3 2.4 3.1 3.2 3.3 3.4 4.1 4.2 4.3 4.4 5.1 5.2 5.3 5.4 6.1 6.2 6.3 6.4 6.5月週
Taipei City Government12
Strategies• Enhanced Health Education
• Advocate frequent hand washing and equipment cleaning (wet, rub, rinse, hold, wipe)
• Improve inter-agency cooperation
• Improve epidemic surveillance systems
• Establish bilingual reporting system
Enterovirus Epidemic2
Taipei City Government13
Taipei City Notifiable Disease Statistics Total Case of 2004 (ND Defined by Law)
TAIWAN TaipeiTuberculosis 10523 903HIV Infection 1570 210Scarlet Fever 759 130Dengue Fever 420 12AIDS 260 41Bacillary Dysentery 146 22Legionnaire's Disease 105 18Enterovirus (severe case)associated symptoms 49 4Typhoid 37 7Encephalitis B. 32 0Amoebic Dysentery 31 10Pertussis 21 3Influenza (servere case) 19 4Malaria 18 5Dengue Hemorrhagic Fever 7 0
Taipei City Government14
Future Efforts for for Disease Prevention
1. Professional mobile disease prevention teams
2. Efficiency of infectious disease reporting
3. Occurrence prevention & mortality reduction
4. Nosocomial infection prevention
5. Effective community surveillance & reporting
6. Efficient investigation of reported cases
7. International collaboration
Recommended