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Response: Strategies to Counter SARS 4. Emergency Response System Develop Integrated infectious disease information system Establish Emergency Operation Center (EOC ) Establish Incident Command System Establish Taiwan Area’s first-ever Disease Prevention Consulting Committee 5. Enhance Health Education Host 2004 Asia-Pacific Anti-bioterrorism Symposium 380 participants including medical professionals, hospital administrators, college personnel, fire service, police, professional and general public Flow Chart for Reporting Individual Cases with Infectious Diseases to Department of Health of Taipei City Government Taipei City-area hospitals report potential infectious disease cases Department of Health (DOH) receives information about infectious disease cases DOH faxes other municipal & county health departments, who confirm receipt via telephone Case closed 1.Samples (or virus contracts) are collected and sent to Kunyang lab for exams (including data sheet) 2.Recall case report on disease progress of deceased patients and patients with serious entrovirus-associated symptoms or new, emerging infectious symptoms Northern Region Branch of Center for Disease Control, Department of Health, Executive Yuan Epidemic Situation Evaluation in Taipei City Hospitals Inspection(Including Individual Cases, Family Members, Relatives, Friends, Coworkers, Hospital Staff and other people who might be affected, as well as travel histories and medical records) Cluster Infection Confirmed Information integration Follow up for 2 theoretical latent periods (No add case) Yes No Mobile Disease Prevention teams on mission Members of FETP training class Cases are closed Epidemic Investigation Taipei City Emergency Response System Incident Commander [Mayor] Main Contact [Deputy Mayor] Communication [Personnel Office] Evaluation [Research and Planning Division] Safety Inspection [Government Ethics Office] Public news release [Information Office] Media Execution [Department of Health] Planning [Research and Planning Division] Financing [Finance Department] Logistics [Administrative Services] Public opinion survey Resource Distribution [Chief Secretary, Department of Health] Epidemic Investigation [Division for Disease Control and Prevention ] Medical Care Prior Admission to Hospitals [Medical Affairs Division] Medical Care [Medical Affairs Division] Psychiatry [Medical Affairs Division] Hazard Control [Division for Disease Control and Prevention ] Deceased Patient Affairs [Personnel Office] Emergency Response [Government Ethics Office] New & Emerging Infectious Disease Prevention 1. Avian influenza was announced as a legally defined infectious disease on Dec. 29th, 2004 2. Epidemic Watch: (1) Monitor body temperatures of workers with direct contact with poultry/livestock business and pet bird business (2) Monitor human-contagious avian influenza infections and report to responsible authorities 3. Joint Prevention Task Force supported by different Agencies: Establish Taipei City’s Joint Prevention Task Force for Avian Influenza Provide assistance and consultation for individuals involved in poultry/livestock/domestic pet business and closely monitor all incidents of avian influenza New & Emerging Infectious Disease Prevention Avian Influenza Prevention & Control Exercises 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 then evacuated from danger zones and are sprayed thoroughly with disinfectant solution by the cleaning staff (especially armpit, groin areas and feet) New & Emerging Infectious Disease Prevention Joint Prevention Task Force for Avian Influenza of Taipei City Composed of experts from Departments of Health, Economic Development, Environmental Protection and Education to provide assistance, education and consultation specifically to Zoos, Guandu Nature Park, Poultry/Domestic 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 Enterovirus Epidemic Trend Plot of Reported Enterovirus Cases from Campus 1 2065 1959 2100 500 450 1800 School Reporting System Accumulative (Left Axis) 1697 392 400 Weekly (Right Axis) 1500 1382 350 315 297 2,065 Patients were reported being infected with enterovirus by child care facilities (this pioneering model • Emergency Care facilities reported 5,172 patients as being infected with enterovirus. • 397 patients were Taipei City residents. • 13 patients had complications from severe enterovirus symptoms --7 patients were excluded to be infected with enterovirus. --6 patients were confirmed infected. until June 30th, 2005 262 990 250 207 900 200 693 600 150 129 106 357486 was first established in Taipei City) Hospital Reporting System 300 1200 300 0 100 291 238261 193210 36 124127127132143153159165171175 30 66 115 28 23 17 58 9 3 0 5 11 10 6 6 6 4 18 94 21 58 1. 1 1. 2 A c c umul a t i ve (L e ft A xi s ) 58 94 W e e kl y ( Ri ght A xi s ) 58 36 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 50 5. 2 5. 3 5. 4 6. 1 6. 2 6. 3 6. 4 6. 5 115 124 127 127 132 143 153 159 165 171 175 193 210 238 261 291 357 486 693 990 138 169 195 206 21 9 3 0 5 11 10 6 6 6 4 18 17 28 23 30 66 0 月週 129 207 297 392 315 262 106 Trend Plot of Reported Enterovirus Cases from Emergency Care 5,172 5000 4,748 4500 4000 3500 1000 500 0 700 635 625 600 2,751 481 2500 1500 800 737 3,488 623 Weekly (Right Axis) 3000 2000 900 4,113 Accumulative (Left Axis) 1,647 1,331 1,168 1,062 969 903 163 742 785 830 118 121 604 638 691 93 106 106 480 526 564 73 66 419 46 38 40 34 53 51 43 45 239 345 118 74 61 424 2,128 316 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 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) 1000 118 121 106 74 61 46 38 40 34 53 51 43 45 73 66 93 106 163 316 481 623 737 625 635 424 500 400 300 200 100 0 月週