Isolation versus quarantine and alternative measures to control emerging infectious diseases

In the past 25 years, the world has witnessed the emergence and re-emergence of many infectious diseases. In the early stages of their emergence, isolation and quarantine may be the only and last resort to effectively control infectious diseases when we are confronted with limited or no knowledge of a newly identified and previously unknown contagious disease, which causes a serious public health threat either locally or internationally. The article traces back the origins of isolation and quarantine; defines precisely the terms isolation and quarantine as they are currently used in the modern era; compare and contrast these terms; identifies some of the harmful consequences of applying quarantine measures; highlights considerations for the use of isolation and quarantine; and identifies alternative measures adopted by the world health community to respond to emerging and re-emerging health threats.     

The environment and the lung. Changing perspectives

The focus of public health concern and research in regard to environmental lung diseases has changed across the century. Illustrative agents include radon, indoor asbestos, environmental tobacco smoke, acidic aerosols, and oxidant gases. Tremendous progress has been made in understanding and preventing environmental lung diseases. However, we remain concerned about adverse consequences of breathing polluted outdoor and indoor air. In the persistent concerns about adverse effects of polluted air on the lung, a new emphasis is pervasive; the focus has shifted from avoiding clinical disease among highly exposed individuals to protecting the population from an unacceptable burden of risk. The technique of quantitative risk assessment has become increasingly important for characterizing the safety of environmental agents. The resulting emphasis on the final risk projection and attendant uncertainties may overly emphasize gaps in our knowledge.     

Ozone. The good, the bad, and the ugly

Sensitive individuals are at risk of adverse health effects from exposure to even modest levels of ozone. Such individuals are likely to develop respiratory symptoms and are more likely to be hospitalized when exposed to ozone at currently accepted levels. A review of scientific documents regarding the health effects of ozone has led the DHHS to agree with the EPA that the primary ambient air standard for ozone should be changed from 0.12 ppm (1-hour average) to 0.08 ppm (8-hour average). Achieving the proposed 0.08 ppm standard should decrease physician visits, hospitalization, and use of respiratory medications. In addition, because very susceptible healthy individuals may experience adverse health effects of the current standard, it is clear that the current standard provides little or no margin of safety, particularly for sensitive individuals. In order to avoid exposure to unhealthy levels of ozone, people should take precautions to minimize exposure from 2:00 to 6:00 pm on days when ozone levels are high. This is especially so for children, adults who are active outdoors, those with respiratory disease such as asthma, and people with unusual susceptibility to ozone.     

黄热病的再流行与世界卫生组织的消除黄热病流行战略

近年来,蚊虫传播的黄热病在非洲和南美洲地区大面积“再流行”,仅南美洲的巴西在一年时间就发现数千例黄热病确诊病例,黄热病已经在非洲和南美洲地区造成巨大的公共卫生负担。此外,在黄热病非流行国家和地区发现大量输入性病例,使得黄热病有可能在非洲和南美洲以外的地区成为“新发传染病”而在世界更大范围流行。为此,世界卫生组织制定了“消除黄热病流行（EYE）”战略,预计利用10年时间在黄热病流行地区接种13.8亿剂量黄热疫苗,以降低黄热病对国际公共卫生健康的危害。     

美国急性传染病的预防控制体系

急性传染病是美国死亡率最高的疾病之一.(Center for Disease Control and Prevention CDC)与联邦政府部门和其他机构合作,提供健康监视和预防体系,落实疾病预防计划和措施,管理全国健康统计数据,提供检疫指导、工作场地安全和环境疾病预防等服务,形成了较为有效和完善的急性传染病预防和控制体系.本文介绍了CDC在预防和控制急性传染病方面的主要做法,包括制定全面控制规划,建立监测体系,提高监测能力.开展应用研究,提高实验室检测能力.及时发布信息,开展全面指导.注重专业人员的培训,推广预防控制传染病的新技术、新方法.推行疫苗接种计划,改善医疗机构防治策略.加强国际合作,提供国际疾病传播监管服务.对医疗和生物恐怖紧急情况的快速反映是预防和控制体系的一个组成部分,包括制订医疗和生物恐怖紧急情况的全国反应计划,制定快速反应程序和规范,及时发布预警信息,协调快速反应力量及时反应,储备医疗物资,健全快速反应机制.CDC成功的预防措施和实践显示了其预防和控制体系的优势.     

Rabies prevention in Hawaii

The scientific basis of Hawaii's public health rabies prevention program is discussed, as is a proposed minor modification offered to assist Hawaii residents who use guide dogs and who want to travel out of state. Hawaii's current quarantine program has successfully prevented the introduction of the disease. Alternative programs involve risks that are not easily evaluated.     

The medico-legal prerequisite for initiating quarantine and isolation practices in public health emergency management in hospitals in Ghana

Hospitals and other health facilities in Ghana do not appear to have standardized practices for quarantine and isolation in public health emergency management. This paper reviews the legislative framework governing the medico-legal prerequisites for initiating quarantine and isolation procedures as articulated in the Infectious Disease Act (Cap 78) 1908 amended, 1935, the Quarantine Act (Cap 77) 1915 amended, 1938, the Emergency Powers Act of 1994, (Act 472), and the National Disaster Management Act, 1996, (Act 517) in consonance with the 1992 Constitution of Ghana. The findings provide that (1) The legislative framework outlines systematic standards and protocols to be followed in the committal of person or persons in quarantine and isolation during public health emergencies. (2) These standards and protocols consider as imperative, the creation of standardized national templates for the initiation of quarantine and isolation measures. (3) The non-compliance of the standards and protocols renders vulnerable medical facilities and hospitals with their personnel to the threat of medical malpractice suits and breach of professional ethics. This paper provides suggestions to hospital administrators and medical personnel of how to develop administrative templates in compliance with the law in managing public health emergencies. It also provides examples of such templates for possible adoption by hospitals and other health administrators.     

长期职业暴露于市政固体垃圾与中毒性神经病的进展：营养补充与补充替代医学在化学预防中的前景

Achieving effective municipal solid waste （MSW） management remains a major challenge and waste generation and accumulation continue to constitute important environmental and public health concern, particularly in most developing countries. Although the general population is at risk of adverse health consequences and hazards associated with exposure to MSW, the waste management workers （WMWs） are the most vulnerable because of their direct involvement in the disposal of waste, with increasing evidence of work-related health and safety risks among these individuals. Among the numerous work-related health hazards prevalent in WMWs, development of toxic neuropathies following chronic occupational exposure remains poorly recognized. However, the risk or predisposition to toxic neuropathies is becoming evident considering the increasing recognition of large amount of neurotoxic heavy metals and hazardous industrial materials present in MSW in mostparts of the world. The present review seeks to draw attention to the continuous vulnerability of the WMWs to developing toxic neuropathies. This is aimed at facilitating conscious efforts by relevant governmental and non- governmental agencies towards promoting risk reduction and ensuring adequate protection against possible toxic polyneuropathies associated with occupational exposure to solid wastes. While continuous education of the WMWs on the need for adequate compliance to safety regulations and practice remains sacrosanct towards achieving significant reduction in toxic neuropathies and related adverse health consequences of waste handling, it is also our intention in this review to underscore the possible relevance of nutrient supplementation and alternative medicines in chemoprevention.     

Potential health effects of greenhouse effect and ozone layer depletion in Australia.

OBJECTIVE: To identify potential health effects of the greenhouse effect and ozone layer depletion in Australia. DATA SOURCES: Data were derived from a number of sources: (i) published articles accessed from relevant databases in the disciplines of health, public health and climatology over the past 20 years; (ii) published conference proceedings, review monographs and government reports covering the topic; (iii) a survey of experts in public health and climatology/geography (150 individuals were surveyed in the first phase with a 63% response rate); and (iv) a consensus conference in which 22 invited experts reviewed the results of the literature review and survey and a second conference in which 18 senior members of the health bureaucracy and public health profession considered the implications of the findings. STUDY SELECTION: Over 200 published articles or monographs were reviewed. Criteria for selection were whether the papers contributed information to the objectives of the review. DATA EXTRACTION: Because of the nature of the problem under investigation, predictions based on reasonable scientific assumptions were the major content of the review rather than conclusions based on scientific research. DATA SYNTHESIS: The major predicted health effects of long-term climatic change in Australia are skin and eye damage from increased ultraviolet radiation exposure, increased incidence of some respiratory diseases, vector-borne and water-borne diseases, and the social and physical effects of natural hazards and social and economic restructuring. The most vulnerable groups include the aged, the very young, the chronically ill, those living in poorly designed neighbourhoods and those working in outdoor occupations or heavy industry. CONCLUSIONS: The potential effects on health of long-term climatic change cover the broad spectrum of public health concerns. Detailed predictions of likely problems in specific geographic areas are not yet possible, but progressive development of such predictive capability is a high priority. Doctors will have an increasingly important role in monitoring local health status and participating in disease prevention and surveillance programmes.     

Epistemic paternalism in public health

Receiving information about threats to one's health can contribute to anxiety and depression. In contemporary medical ethics there is considerable consensus that patient autonomy, or the patient's right to know, in most cases outweighs these negative effects of information. Worry about the detrimental effects of information has, however, been voiced in relation to public health more generally. In particular, information about uncertain threats to public health, from-for example, chemicals-are said to entail social costs that have not been given due consideration. This criticism implies a consequentialist argument for withholding such information from the public in their own best interest. In evaluating the argument for this kind of epistemic paternalism, the consequences of making information available must be compared to the consequences of withholding it. Consequences that should be considered include epistemic effects, psychological effects, effects on private decisions, and effects on political decisions. After giving due consideration to the possible uses of uncertain information and rebutting the claims that uncertainties imply small risks and that they are especially prone to entail misunderstandings and anxiety, it is concluded that there is a strong case against withholding of information about uncertain threats to public health.     

大型活动期间举办地外围地区突发传染病事件公共卫生风险评估

目的: 识别和评估第十一次二十国集团（G20）峰会期间杭州市外围地区潜在的突发传染病类公共卫生风险及其可能给G20峰会带来的公共卫生影响。方法: 收集浙江省传染病相关事件公共卫生本底信息,采用文献检索、头脑风暴法和专家会商法制订突发传染病事件公共卫生风险准则和杭州市外围地区（宁波、温州、嘉兴、湖州、绍兴、金华、衢州、舟山、台州、丽水）公共卫生风险对G20峰会影响的风险准则,进行风险评估并提出风险管控建议。结果: 制订了杭州市外围地区突发传染病事件公共卫生风险评估准则和各市风险对杭州G20峰会影响的风险准则,依据制订的风险准则共梳理出外围地区最有可能发生的四类27项突发传染病类公共卫生风险,这些风险对举办地杭州市产生的影响主要是高风险1项,中等风险12项,低风险14项。根据风险评估的结果,针对呼吸道传染病、肠道传染病、中东呼吸综合征等输入性传染病和其他传染病分别制订了风险管控建议。未发现在G20峰会期间报告中东呼吸综合征等高风险传染病,各种中、低风险传染病的疫情与往年疫情水平接近。结论: G20峰会期间,杭州市外围地区突发传染病类事件对杭州市的影响主要以中、低风险为主。针对这些风险提出的管控措施为减少突发传染病事件公共卫生风险的不良后果提供了行动依据,避免了外围地区的各种风险因素对G20峰会的影响。     

国际化背景下新型卫生检验与检疫专业人才培养探讨

在高等教育国际化背景下,我校根据新型卫生检验与检疫人才培养要求,在教学理念、课程设置、教学方式、实践应用以及师资培养方面进行了探索与实践。率先提出夯实化学基础、拓展检疫能力、凸显医检优势、强化外语应用能力的四项原则;通过优化课程结构、积极利用社会资源、推动国际化教育,以培养具备多学科知识、多方面能力、较强适应力的卫生检验与检疫人才。     

Antibiotic resistance—consequences for animal health,welfare, and food production

Most of the literature on the consequences of emergence and spread of bacteria resistant to antibiotics among animals relate to the potential impact on public health. But antibiotics are used to treat sick animals, and resistance in animal pathogens may lead to therapy failure. This has received little scientific attention, and therefore, in this article, we discuss examples that illustrate the possible impact of resistance on animal health and consequences thereof. For all animals, there may be a negative effect on health and welfare when diseases cannot be treated. Other consequences will vary depending on why and how different animal species are kept. Animals kept as companions or for sports often receive advanced care, and antibiotic resistance can lead to negative social and economic consequences for the owners. Further, spread of hospital-acquired infections can have an economic impact on the affected premises. As to animals kept for food production, antibiotics are not needed to promote growth, but, if infectious diseases cannot be treated when they occur, this can have a negative effect on the productivity and economy of affected businesses. Antibiotic resistance in animal bacteria can also have positive consequences by creating incentives for adoption of alternative regimes for treatment and prevention. It is probable that new antibiotic classes placed on the market in the future will not reach veterinary medicine, which further emphasizes the need to preserve the efficacy of currently available antibiotics through antibiotic stewardship. A cornerstone in this work is prevention, as healthy animals do not need antibiotics.     

中医院校医学生社区实践的探索与思考

现代医学模式在不断转变,比如从过去生物医学模式到生物—心理—社会医学模式,从以疾病为中心到以健康为中心,从以单个患者管理为主到以人群管理为主,从以医疗为重点到以预防保健为重点,这些转变无不体现了社区卫生服务中心已成为现代临床教学基地不可或缺的重要教学资源。医学生的后期培养不应只局限于临床医学院的实习,更应深入社区卫生服务中心,从而加强其人文素质的教育,加强百姓家庭的感情体验。     

灾后防疫非朝夕之功，科学防疫是重中之重

地震灾后传染病的流行受基础设施被破坏的程度、地理和气候等自然因素和人为因素的影响.水源污染、病媒密度增加、环境卫生恶劣以及当地及输入性病原体是地震后消化道、虫媒和呼吸道传染病的主要危险因素.灾区防疫工作应针对传染源、传播途径和易感人群等3个关键环节展开.同时应重视过度"消杀灭"对生态环境的破坏.对灾民进行卫生教育和重建当地卫生防疫力量是长期控制疫病的关键.本文以映秀灾区防疫工作为基础,就目前灾后防疫工作存在的问题进行分析,并提出了10条建议,供后期防疫工作借鉴.     

Framework for monitoring equity in access and health systems issues in antiretroviral therapy Programmes in southern Africa

Universal provision of antiretroviral therapy (ART), while feasible, is expensive. In light of this limitation, the World Health Organisation (WHO) has launched the 3 × 5 initiative, to provide ART to 3 million people by the end of the year 2005. In Southern Africa, large-scale provision of ART will likely be achieved through fragile public health systems. ART programmes should therefore be developed and expanded in ways that will not aggravate inequities or result in the inappropriate withdrawal of resources from other health interventions or from other parts of the health system. This paper, proposes a framework for monitoring equity in access and health systems issues in ART programmes in Southern Africa. It proposes that an equity monitoring system should comprise seven thematic areas. These thematic areas encompass a national monitoring system which extends beyond one agency or single data collection method. Together with monitoring of targets in terms of numbers treated, there should also be monitoring of health systems impacts and issues in ART expansion, with reporting both nationally and to a regional body.     

Psittacosis in Hamilton: A case report and epidemiological study

A case report of a patient severely ill with psittacosis is presented, together with an epidemiological study of his fellow workers. This study illustrates the contagiousness of the disease and indicates that it is probably more prevalent than clinical experience suggests. Only three of the 83 persons studied who were exposed became ill enough to seek medical attention. It is important that both the physician and the public be made aware of this disease so that definitive treatment can be instituted as early as possible. Tetracycline is the drug of choice. Since this infection is widespread among many varieties of birds, and is not confined to those of the parrot family, this disease must be considered in any patient with an atypical pneumonia, especially when there has been contact with a bird. Since there is not likely to be a reinstitution of the ban on the importation of psittacine birds as domestic pets, the only alternative means of controlling outbreaks of this disease is public and physician awareness. Since some outbreaks appear to be spread from man to man, sometimes with high mortality, it is important that any patient suspected of having this disease be kept in strict isolation.     

Electromagnetic fields: biological and clinical aspects

Our entire biosphere is immersed in a sea of man-made electromagnetic fields (EMF). Occupational and public health data suggest that these fields may be a health hazard, possibly involving cancer and fetal loss. This paper reviews the history and pertinent physics of electromagnetic fields and presents evidence from the authors' work, and that of others, of biological interaction with living systems. Epidemiological data suggesting EMF hazards are reviewed including a discussion of possible risks associated with Hawaii's Lualualei transmitter site, TV and FM antennas in high-density population areas, fields surrounding electric power transmission and computer terminals, and the plan to route a major highway through the near-field of an operating Omega signal-source. In the face of current public fear and controversial research reports about long-term EMF exposure, suggestions are presented for public policy about these local sources of concern, as well as for the EMF risks common to any similarly developed areas.     

WHO的EMF规划和电磁场暴露的健康效应

对ＷＨＯ和ＥＭＦ规划和电磁场暴露的健康效应作一综述。