Outbreak 雖然不是隨時會發生，但是我們都應該隨時做好準備！但是，究竟什麼是 Outbreak 呢？當一個 outbreak 發生後，我們又該如何面對挑戰？以下，我們將從定義出發，討論一個 outbreak 的管控需要考量的不同面向，並提供一個 10 steps 的處理方式給大家參考！大家可要細細研讀，我們 table training 再見啦！
Principle of Outbreak Investigation
- Definition:
- Outbreak/Epidemic: The occurrence of cases or other health-related events clearly in excess of normal expectancy. （只要疾病的發生率超出預期即可稱為outbreak，一例也可稱作outbreak）
- Example1: SARS (2003): 8422 cases with 916 deaths (CFR=10.9%) in 29 countries
- Example2: Middle East Respiratory Syndrome (2012-2013): 80 cases with 25 deaths (CFR 56%)
- Cluster: An aggregation of cases in a give place & time
- Sporadic: A disease that sometimes occurs in an area
- Endemic: A disease that normally occurs in an area
- Pandemic: The epidemic that spreads over many countries (2 or more regions) of the world
- Objectives of the outbreak investigation
- Control the current outbreak
- Prevent future outbreaks
- Evaluate disease prevention programs
- Evaluate effectiveness of the existing surveillance
- Research for more knowledge of the disease
- Respond to public or political concern
- Surveillance in Taiwan
- Emergency Operating Center （緊急醫療應變中心）
- Disaster Management Assistant Team （國災隊）
- Ten steps of an outbreak investigation 以下分項列出Outbreak因應的十個步驟內容，並說明可行的方式。
- Confirm the existence of the outbreak. （確認疫情的存在）: Determine the expected number of cases before deciding if the observed number exceeds the expected.
- Verify the diagnosis and determine the etiology of the disease. （找出病因）: Obtain medical records and lab reports and Conduct clinical testing if needed.
- Develop a case definition, start case-finding, and collect information on cases. （解釋這個疾病並開始尋找資料）: An acute illness involving jaundice or elevated liver function tests occurring after visiting or residing in District A during May-August 2010
- Describe persons, places, and times, and generate hypotheses. （設定一個假說）: Descriptive epidemiology: epi-curve, spot map, exposure
- Test the hypotheses using an analytic study. （運用分析去測試假說）: Case-control study, cohort study
- Carry out necessary environmental or other studies to supplement the epidemiological study. （去地區做實地研究）: Survey the surrounding. Find more cases
- Draw conclusions to explain the causes or the determinants of the outbreak, based on clinical, laboratory, epidemiological, and environmental studies. （舉出結論）: The most possible source of an outbreak is a water supply
- Report and recommend appropriate control measures to concerned authorities at the local, national, and if appropriate, international levels. （對政府機關做出建議）: Quarantine and isolation of individuals to reduce spread
- Communicate the findings to educate other public health professionals and the general public. （把發現跟醫療團體與大眾做說明）: Response to media attention important to address public concerns about outbreak
- Follow up the recommendations to ensure implementation of control measures. （事後做追蹤去確保防範措施）: Check the result!!!
- 行前小練習：瞭解一個曾經發生過的outbreak案例，嘗試以10 steps進行推演。
參考資料：ACTION Thailand 2013講義