In order to reach viewers in the south and center of Taiwan, the Environmental Protection Administration has gotten Taiwanese Opera stars Yang Li-hwa and Yeh Ching to make public service announcements. Wearing their costumes and using Taiwanese, they politely and sincerely admonish people not to "breed mosquitoes" and to eradicate dengue fever. The Ming Hwa Garden Taiwanese opera troupe, in their "Dragon King" vignette they perform for the same series of public service ads on TV, presses the message that "the Dragon King fears neither Heaven nor Earth--he only fears dengue fever," and expresses the hope that everyone will take precautions to prevent it.

Infectious Diseases in the News: In fact, it isn't just dengue fever. Since May and June of this year, information that the number of cases of many communicable illnesses like AIDS, food poisoning, and German measles have increased extraordinarily has continually appeared in the media.

According to statistics of the Department of Health, there has been a definite increase in the incidence of illnesses defined by law as infectious in the Taiwan area as of the end of July of this year in comparison with the same time period last year. For example, this year there have been 1,414 cases of Geman measles; there were only 254 cases last year. This year there have been seven cases of amoebic dysentery, there were three last year. The combined number of cases of acute hepatitis has been119 this year, and was only 51 last year. This year there have been eight cases of AIDS, three last year. As of the end of September of this year, there have been 124 cases of dengue fever, with only three last year.And although cholera, long exterminated, has not yet reappeared, recently disease prevention agencies have discovered non-viral cholera bacteria in aquatic products from Kaohsiung and Hualien. Coming just as the shadow of cholera is touching many countries in the world, and as stories emerge of people getting sick at the famous seafood emporium Hai Pa Wang,this information really is startling.

"Epidemic" Depends on Where You Are: Is it true as some say that the incidence of these diseases has already spread, and that in the near future they will spread explosively?

Because of such speculation, Li Kuang-yu, who works in Taipei's Eastern District, always feels stymied whenever it's time to go out to lunch; she's really fearful that if she's not careful, she'll "hit the jackpot."

Others have chosen "rational" positive action. Wang Chun-wei, who hails from Changhwa and now works in a shipping company in Taipei, after seeing in the paper that "the indicators for the number of infectious mosquitoes which carry dengue fever in Changhwa County have already reached the epidemic warning level," immediately decided to take advantage of the October 10 National Day holiday to head back and do a thorough housecleaning.

However, vis-a-vis the media's "bold assumptions," scholars and public health units have offered both supportive views and reservations.

Wu Chao-hsin, director of the Institute of Preventive Medicine at the Department of Health, indicates that although there has been an increase in most infectious illnesses in the country this year, besides the concentration of dengue fever in the San Min district of Kaohsiung and the concentration of German measles in military camps in central and southern Taiwan, the other cases of communicable illnesses have been mainly "scattered." These should simply be seen as individual cases occurring in several different locations, without any clear indication of infecting others, much less an "epidemic."

Chin Chuan-chun, an associate professor in the Graduate School of Public Health at National Taiwan University, says on the other hand that the methods for determining whether or not an infectious disease is "epidemic" are mainly comparisons with the incidence of illness the previous year. "From this point of view, dengue fever could be considered epidemic; it's just not as serious an epidemic as 1988," concludes Chin.

She explains that according to the accepted definitions of Public Health Studies, an epidemic means that the number of cases in a given district exceeds the normal "anticipated volume." The anticipated volume varies according to time, place, and the illness in question; there is no fixed standard.

For example, in the US in 1986, small pox prevention was already comprehensive, but it was not in India. Thus, the one case that year in the US was enough to meet the standard for "epidemic," while if India had had 100 cases the same year, this would not be called epidemic because their had been no significant increase over the level of the previous year.

Other Factors Involved: As for the fact that "the number of cases of many types of communicable illnesses have already greatly surpassed last year's," the Bureau of Communicable Disease Control suggests that "there are other factors involved which are not immediately evident." They believe that besides the possibility that this situation is due to unusual weather--there were frequent afternoon thunder showers in the Taipei area in June of this year and water accumulated in many places, which permitted the rapid breeding of the mosquito which carries encephalitis; there was a widespread drought in central and south Taiwan for the first half of the year, and there was a shortage of running water, so many people turned to well water or spring water which had not been purified, which might be the origin of amoebic dysentery --" the immunization network is increasingly tightly woven, which is an even more important factor that makes it look like the number of cases of communicable diseases has increased," argues Chang Yao-hsiung, director of the Office of DiseasePrevention.

The complete eradication of bubonic plague, smallpox, rabies, and malaria, previously rampant in the Taiwan area was announced in 1947, 1954, 1956, and 1965 respectively. Although hepatitis B and tuberculosis have not yet been wiped out, they have been severely restricted by widespread preventive measures.

An official of a prevention agency points out that most developing nations, for their national image, are unwilling to make a big deal out of cases of communicable illnesses, in order to avoid the possible effects of being listed as an epidemic area, which can create obstacles to the export of agricultural products, make foreign tourists unwilling to come, and even create panic in their own societies. "We are now very confident about our disease prevention work, and other considerations have become secondary. What's important is to get a grip on the situation of the communicable illness as quickly as possible, in order to protect the health of the nation's citizens."

In order to build a tight prevention network, the Department of Health has even gone so far as to use "the profit motive."

For example, in order to meticulously achieve the World Health Organization's plan to eradicate German measles, measles, polio in children, and tetanus by the year 2000, starting from July 1 of this year, practicing doctors in any area need only discover a case, move on their own to inform health agencies, and have the case confirmed by the Institute of Preventive Medicine, and besides getting an award of NT$200 per case of the measles, a doctor can get NT$2,000 per report for the other illnesses.

It's "Fine" If You Don't Report: Besides the carrot, there is also a "stick" to strengthen the prevention network.

In June of this year, the Executive Yuan passed the "Amended Draft Regulations for Infectious Disease Prevention." The existing list of infectious illnesses to be combated was expanded from 11 to 34. It also stipulates that if a doctor discovers a case of a communicable disease and does not report it to health agencies within a set amount of time, the doctor will be fined anything from NT$6,000 to $30,000.

"We're not at all surprised that, under supervision from a tight prevention network, the number of reported cases of all kinds of communicable diseases increased this year," says Chang Yao-hsiung.

Despite this, the "neither large nor small" numbers of cases of these illnesses still leave people a little non-plussed when they see them. The threats to life and health from modern industrial society come from stress and environmental pollution--cancer, heart disease, asthma, infertility, and other "diseases of modern civilization" caused by chemical or biological agents. Haven't these acute communicable illnesses transmitted by bacteria or viruses already been eradicated? Why is it that new diseases from biological to psychological are constantly appearing for modern people, yet the old illnesses show signs of rekindling and becoming rampant again?

"Mankind already understands how to control the vast majority of epidemic diseases. But knowing is not the same as doing. For example, many Third World nations don't have the money to buy immunization, or have poor public hygiene, so it is easy to have large-scale epidemics. Moreover," says Chin Chuen-chun, drawing an analogy, "the spread of an epidemic is like crime. No matter how tight the net gets, it is hard to avoid having the odd fish slip through. In particular, with population increasingly packed into urban areas, this creates new opportunities for communicable diseases to spread."

2,000 Dead from Influenza: Looking back at the history of epidemic illnesses, in the era when medicines were still undeveloped and public hygiene was poor, all kinds of diseases spread by bacteria or virus posed an enormous threat to human life. From 1918 to 1920, a Type A influenza epidemic took over 20 million lives.

With progress in medicine, the root cause of each type of communicable disease was discovered one after another. Mankind was also able to develop antibodies to all types of bacteria, so that we have long been able to prevent hepatitis B, tuberculosis, childhood polio, measles, and tetanus. Or, even after they are transmitted, antibiotics can be used to repress the disease and alleviate the threat of death. As for other diseases which there is still no way to effectively eradicate, at least we now know how they are transmitted and, if the channels of transmission can be controlled, then there will be no epidemic.

For example, the cholera vaccine has not been particularly effective. Often the rate of effectiveness is only 50%, and the period of effectiveness is only three to six months, so it is not widely used. But we already know that cholera is spread through food and water, and that cholera bacteria will die if cooked at 100 degrees Celsius for eight minutes. So if one takes care with the cleanliness of the immediate environment, and avoids eating raw food, the chance of infection is tiny. If the disease is transmitted, it is only necessary to immediately disinfect the matter and, by dealing with cases one at a time, eventually prevent its spread. This year there has already been a cholera epidemic in Peru, which has already killed more than 2,000 people; although the American medical community and public health agencies warned Americans to take special care, the "conditions" for the spread of cholera never materialized because the US water system and general public hygiene already are at a high level.

Even if it is AIDS, gonorrhea, or syphilis, although there are still no preventive vaccines, the methods of transmission are already defined. If you want to avoid being infected, you only have to follow the advice of the medical community and avoid sexual contact with a partner from a high risk group, or use a condom when having sexual intercourse to protect yourself.

Infectious ≠ Epidemic: "The only one that's relatively problematic is AIDS, because it can be passed along by blood transfusions, and it is often inevitable to suffer blood loss in medical procedures; further, there is a six to eight week 'window of risk' from the time the virus is transmitted to when we produce antibodies. In this period, it is impossible to detect whether or not one has been infected [since current tests detect the antibodies rather than the virus itself], so that precautions might be too late. That's the reason it is called the 'epidemic of the century,'" concludes Lin Hwa-chen, director of the Taipei City Institute for the Prevention of Sexually Transmitted Disease.

Viruses and bacteria are being constantly generated, and many diseases long pronounced extinct might reappear after several years, creating fear and panic.

"Today, communications and travel are so convenient, if there is only a single case in any corner of the world, it has the potential to infect the entire world," says Director Lin, "but what we can do is to not permit it to spread."

There's no point in worrying about communicable diseases as long as they can be kept from becoming epidemic. For infectious diseases which have been found in Taiwan, that's simply the only way to deal with them.

[Picture Caption]

The white-striped mosquitoes one of the carrier mosquitos for dengue fever. (photo courtesy of the Environmental Protection Administration)

Stagnant water is an ideal place for mosquitoes to proliferate, and is a neglected public health problem.

Public health agencies spray disinfectant in neighborhoods to block the spread of infectious illnesses. (photo courtesy of the Environmental Protection Administration)

Those who test negative for the tuberculosis bacteria must get a shot. (photo by Arthur Cheng)

In modern society there is greater contact between people, making it hard to prevent infectious disease from spreading. Thus it is even more important to have the correct outlook on hygiene.

"The epidemic of the century"--AIDS--has generated fear worldwide. Interested persons are sparing no effort at prevention education. The sign asks for donations to an AIDS foundation.

Raw fish is a hotbed for the cholera bacteria, so it's best to eat it as little as possible.

Stagnant water is an ideal place for mosquitoes to proliferate, and is a neglected public health problem.

Public health agencies spray disinfectant in neighborhoods to block the spread of infectious illnesses. （photo courtesy of the Environmental Protection Administration）

Those who test negative for the tuberculosis bacteria must get a shot. （photo by Arthur Cheng）

In modern society there is greater contact between people, making it hard to prevent infectious disease from spreading. Thus it is even more important to have the correct outlook on hygiene.

"The epidemic of the century"--AIDS--has generated fear worldwide. Interested persons are sparing no effort at prevention education. The sign asks for donations to an AIDS foundation.

Raw fish is a hotbed for the cholera bacteria, so it's best to eat it as little as possible.