After SARS, better disease prevention
Q: Having seen SARS, H1N1 and H7N9, what progress and inadequacies have we seen in Taiwan’s disease prevention work?
A: In 2003 when SARS came to Taiwan, the epidemic spanned four months. We paid a painful cost due to insufficient government communication, a patient reporting and management system that needed strengthening, patient isolation and nosocomial infection control measures not yet implemented, inadequate personal protective equipment and other holes in the system.
The Department of Health has aggressively pushed disease prevention reform over the last decade, amending the Communicable Disease Control Act, boosting the effectiveness of epidemic monitoring systems, and building reserves of anti-virus preparations and vaccines.
The H1N1 epidemic of 2009 gave us the chance to test our defenses. At that time, the death rate of H1N1 novel influenza in Taiwan (1.8 per million) was just a third of the average of OECD member states, and a fifth that of the US, proving that Taiwan’s disease prevention system had improved greatly after the SARS scare.
Q: What are our disease prevention strategies for H7N9?
A: Immediately after gaining information from online channels on March 31, the CDC called an emergency meeting, instituting emergency measures and contacting their counterpart agency in mainland China that evening for verification. Then we put out a press release and contacted medical institutions to inform the public and medical personnel. On April 3, H7N9 was listed as a notifiable infectious disease, and we set up the Central Epidemic Command Center (CECC) as a communication platform for all bodies dealing with the H7N9 flu.
Five lines of defense
Regarding disease prevention, we’ve set five lines of defense. The first is virus monitoring. This includes the notifiable infectious disease monitoring system, National Health Insurance information combined with community virus monitoring, real-time monitoring of pneumonia and flu deaths, and a real-time emergency room disease monitoring and warning system. The purpose of all this is to gain a fuller understanding of developments in the flu epidemic.
People working in poultry farming are a high-risk group, so we inoculate them first with seasonal flu vaccine to reduce the chances of genetic exchange between different virus strains within their bodies.
We are also strengthening border quarantine controls by boosting quarantine measures in ports and airports. Anyone entering Taiwan from an infected area who displays signs of respiratory tract infection is to be taken to a hospital for a checkup and isolated until such time as an H7N9 infection is excluded.
The second line of defense is to control bird-to-bird and bird-to-human contact.
Nowadays Taiwan’s major poultry farms are surrounded by nets to prevent contact with wild birds. But with small farms and home-raised poultry, it’s near impossible to close all gaps.
Protecting our wetlands is vital for reducing direct contact between migratory birds and humans; it’s also needed in order to give migratory birds some living space.
More importantly, we must control bird-to-human contact effectively. The government has declared a prohibition on selling or slaughtering live poultry at traditional markets starting May 17. Over the past decade, the government has been constantly discouraging such practices with incentives and advertising, but has been unable to cut it off completely. This time, we must succeed.
The third line of defense is to stock antiviral medications. People confirmed as having H7N9 and those who have had close contact with them will be eligible for publicly funded antiviral medications until the CECC is disbanded.
The fourth line of defense is healthcare. The CECC has released a set of H7N9 clinical treatment protocols to clinicians to boost the treatment capacities of healthcare centers.
Development of vaccines
The fifth line of defense is vaccine R&D.
Two of the WHO’s national influenza centers—the US Centers for Disease Control and Japan’s National Institute of Infectious Diseases—have agreed to provide the Taiwan CDC with H7N9 flu vaccine strains for preparations for vaccine production. As for issues of vaccine mass production and purchasing, we need to make appropriate choices in accordance with the development of the disease.
Currently there’s no evidence indicating sustained human-to-human transmission of H7N9, and the epidemic has been maintained at Phase 3 on the WHO Phase scale (bird-to-human, or limited human-to-human), so the government hasn’t issued any recommendations to restrict travel or trade. There is no cause for public alarm.