台灣社會政治環境變遷、防治策略與登革熱流行及未來展望

The Relationships among Socio-political/Environmental Changes, Prevention and Control Strategies, and Epidemics of Dengue Fever in Taiwan-Future Prospects

董宗華(Tsung-Hua Tung) ； 蔡坤憲(Kun-Hsien Tsai) ； 金傳蓬(Chwan-Pong King) ； 黃彥彰(Scott Yan-Jang Huang) ； 金傳春(Chwan-Chuen King)

《台灣公共衛生雜誌》 30卷6期 (2011/12) Pp. 517-532

https://doi.org/10.6288/TJPH2011-30-06-01

摘要

台灣登革流行史，自南洋戰爭、戒嚴、環境整治至今日防疫，恰是台灣社會變遷最速期。而交通發展、都市化加速疾病傳播效率，政治民主化與媒體致防治困難，消費型態改變增病媒蚊滋生處，尤其全球氣候變遷更對病媒蚊生長與傳播影響深遠。本文以大尺度社會與政治變遷為背景溯析與登革流行相關的外在變化，進而由組織架構更替、登革偵測系統、防治作為與全球氣候變遷的面向，嘗試探索其對流行的影響。中央／地方政府、基層衛生人員與民眾合作無間為台灣登革防治成功的重要關鍵。因選舉年基層動員及空窗期而無暇防疫，致使2002、2006及2010年平均本土病例數較往年為高[平均±標準差：1526.3±928.1（在2002、2006、2010的三選舉年）] vs 156.9±181.6[在非選舉年（1999～2001、2003～2005、2007～2009）, p＝0.004）]。台灣近年在偵測系統與實驗診斷有長足的進步，是目前登革防治的最大優勢，但基層公共衛生功能與防疫人才流失為兩大隱憂，尤其過去與民眾關係最密切的里長及衛生所防疫功能漸失。全球暖化後，登革防治為全球衛生的重要議題，因此系統化跨年檢討台灣登革流行，期能鑑往知來，對未來全球登革防治盡棉薄之力。（台灣衛誌2011；30（6）：517－532）

關鍵字

登革熱 ； 環境變遷 ； 防治策略 ； 傳染病偵測 ； 全球衛生

並列摘要

The history of dengue epidemics in Taiwan has spanned World War II, martial law, and environmental remediation. We are currently in a period of rapid social change with an emphasis on disease prevention. Urbanization and mass-transportation systems have facilitated viral transmission, while democratization, mass media, changing patterns of consumption, and global climate change have all created more difficulties in prevention and control. The aim of this article was to retrospectively examine the relationship between epidemics of dengue/dengue hemorrhagic fever and ”external changes,” and to explore important factors (organizational structure, surveillance systems and global/regional climate change) that may have had an impact on Taiwan's dengue epidemics. Collaborations among central/local government, public health professionals, and cooperative residents have been the key to success in prevention and control of dengue. The mean number of cases in the years of city-mayor elections (2002, 2006, and 2010) was significantly higher than in those years without an election (1526.3 ± 928.1 vs 156.9 ± 181.6, p = 0.004). This was possibly due to grassroots mobilization and the lack of effective implementation during the transition period. The major strengths in the control of dengue in Taiwan are advancements in the surveillance system and in laboratory diagnosis, however, the diminishing function of local public health agencies and the loss of infectious disease experts are two important problems. The assistance provided by district leaders and officials at local health centers that are closest to residents have gradually gone. Dengue is an important issue in global health in an era of global warming. Our systematic examination of the micro- and macro- factors in the success and failure of prevention and control of dengue over three decades will hopefully be helpful in the global control of dengue. (Taiwan J Public Health. 2011;30(6):517-532)

並列關鍵字

Dengue ； Environment change ； Control Strategies ； Infectious Diseases Surveillance ； Global Health

參考文獻

Kuno, G.(2007).Research on dengue and dengue-like illness in East Asia and the Western Pacific during the First Half of the 20th century.Rev Med Virol.17,327-41.

Guzmán, M.G.,Kourí, G.(2009).Dengue in Cuba: research strategy to support dengue control.Lancet.374,1660-1.

Halstead, S.B.(1988).Pathogenesis of dengue: challenges to molecular biology.Science.239,476-81.

Gubler, D.J.,Clark, G.G.(1995).Dengue/dengue hemorrhagic fever: the emergence of a global health problem.Emerg Infect Dis.1,55-7.

Orozco, J.(2007).Defeating dengue: a difficult task ahead.Bull World Health Organ.85,737-8.