防疫體系之因應

Measures Taken by the Disaster Control System

涂醒哲 ； 陳為堅 ； 陳國東 ； 林頂 ； 鄭家榮 ； 蕭清郎 ； 劉祥瑞 ； 林嘉明 ； 姚振文 ； 蕭孟芳 ； 宋鴻樟

《中華公共衛生雜誌》 19卷3S期 (2000/06) Pp. 18-26

https://doi.org/10.6288/CJPH2000-19-3S-03

摘要

天然災害發生時，對災區居民除了生命財產的損失，最大的衝擊來自於居住環境的改變，可能增加環境的致病因子，同時居民必須改變原來的生活習慣以因應重大的環境變遷，飲食匱乏，基本健康醫療服務亦可能因此中斷，而使病原有可乘之機，如果平時的防疫體系未能在災害發生時，立即有效的因應，則災區居民即使面臨天然災害的當時得以倖存，卻可能遭受傳染病所帶來的健康危害。台灣地區歷經每年颱風的威脅，一九九九年的九二一地震更是天然災害中史無前例的衝擊，每次天然災害均賴醫療、環保與防疫體系等單位的密切合作，使台灣地區從未因天然災害而導致嚴重的傳染病爆發流行，這讓我們對民眾所提供最基本的保障，本次的「衛生醫療體系因應重大災難國際研討會」有關防疫體系主題之探討，更著重在未來如何讓我們的傳淅病監視作業、疫苗與消毒藥品之儲備與供應、災區環境衛生之維護、與藉助大眾傳媒之衛生教育宣導等防疫措施能執行的更具效率，如：（1）善用災區的醫療資源，讓醫師的通報作業更簡化而通暢，也讓傳染病的通報作業（主動監測與被動監測）更具備正確性、完整性與及時性。（2）疫苗及消毒藥品之儲備、調配、供應與採購的每一個環節更具時效性。（3）環境衛生服務提供兼具量與質，包括災區之垃圾清理、環境消毒、飲用水質監測與流動廁所等各項工作，不但每一個收容所能獲得充分供應，且提昇服務的品質。（4）發揮大眾傳播媒體的正向功能，報導正確疫情，提供完整衛生教育相關訊息。

關鍵字

天然災害 ； 防疫 ； 疫情監視 ； 疫苗 ； 環境衛生 ； 衛生教育

並列摘要

With both the numbers of disasters and their victims increasing, disasters constitute a major public health problem. Sudden-impact natural disasters such as earthquakes may result in a large number of injured persons, many of whom are handicapped for the rest of their lives. The natural disasters including typhoons, floods, earthquakes, and volcano eruptions might lead to different extend of damages, which ties to the preparedness and measures against crisis. 1 As mentioned by WHO, there is no direct causality between epidemic diseases and natural disasters. 2 The disease outbreak occurs only under the worse conditions of the water distribution and sewage system infrastructure, over-crowding, insufficient medical supply and blockage of communication. Being well prepared and trained, Taiwan, unlike those underdeveloped countries, had overcome from multitudinous destruction of typhoons and floods and no epidemic occurred. 3,4 This phenomenon was proven by the aftermath of 921 earthquake. Infectious disease outbreak has been one of the health concerns for survivors from disasters such as storms, floods and earthquakes. This paper reported the strategies used for communicable disease prevention in the early period after the 921 earthquake of 1999, and examined the strategies for better responses toward such natural disasters in the future. Taiwan is located in an area where multiple typhoons and floods occurred annually, but no disaster can be compared with the recent earthquake that caused the loss of 2300 lives and the collapse of transportation, communication and basic health services. However, no outbreak was reported during the post-earthquake period. Several adequate strategies that had contributed to the prevention of outbreaks should be considered:(1) The Center of Disease Control (CDC) was able to establish an outbreak prevention task force immediately. Front-line EIS officers were assigned to the disaster areas within 24 hours and other CDC officers were assigned to the townships within a week to assist in disease patterns monitoring. Immunization materials were transported to the sites within a week. (2) Experiences established from previous typhoons provided sufficient emergency response system collaborations and experience for this earthquake. Environmental Protection Administration, military, and civilian groups were able to collaborate immediately in providing essential environmental control in refugees camps, including clean water, mobile sanitation units, refuse collection and insect controls. (3) Provision of adequate water and food supplies. Charity teams of religious organizations including Buddhists, Christians, Catholics, etc. had established food services to provide hot meals all over the refugee camps. (4) Provision of ambulance clinics. University medical centers, hospitals and veteran medical system were able to respond immediately under the request of the Department of Health. Emergency ambulance care units were adapted at acute areas for health services to replace collapsed basic health services. Also, the government was able to provide sufficient immunization materials and medicine. (5) CDC was able to monitor the endemic communicable disease cases. Collaboration with schools of public health, an emergency system for communicable diseases surveillance was established within 72 hours. The ambulance care units were able to participate in active disease surveillance using a simplified mutual medical chart for each patient visit. These charts were collected daily and analyzed for excess morbidity estimation. The CDC was thus able to timely monitor diseases. By using mass media, CDC was able to provide disease information and educate the public.

並列關鍵字

natural disaster ； disease control ； disease surveillance ； vaccines ； environmental sanitation ； health education