Social support and response to AIDS and severe acute respiratory syndrome

Negative public reactions to emerging infectious diseases can adversely affect population health. We assessed whether social support was associated with knowledge of, worry about, and attitudes towards AIDS and severe acute respiratory syndrome. Our findings suggest that social support may be central to our understanding of public responses to emerging infectious diseases.     

CDC's strategic plan for bioterrorism preparedness and response

The Department of Health and Human Services (DHHS) has played a critical lead role over the past two years in fostering activities associated with the medical and public health response to bioterrorism. Based on a charge from Secretary Donna Shalala in 1998, the Centers for Disease Control and Prevention (CDC) is leading public health efforts to strengthen the nation's capacity to detect and respond to a bioterrorist event. As a result of our efforts, federal, state, and local communities are improving their public health capacities to respond to these types of emergencies. For many of us in public health, developing plans and capacities to respond to acts of bioterrorism is an extension of our long-standing roles and responsibilities. These are stated in the CDC Mission Statement: to promote health and quality of life by preventing and controlling disease, injury, and disability, and the Bioterrorism Mission: to lead the public health effort in enhancing readiness to detect and respond to bioterrorism. CDC's infectious diseases control efforts are summarized below: --Initially formed to address malaria control in 1946; --Established the epidemic Intelligence Service in 1951; --Participated in global smallpox eradication and other immunization programs; --Estimated 800-1,000 + field investigations/year since late 1990s; --New diseases: Legionnaire's Disease, toxic shock syndrome, Lyme disease, HIV, hantavirus pulmonary syndrome, West Nile, etc. -- Today: focus on emerging infections and bioterrorism. Over the past 50 years, CDC has seen a decline in the incidence of some infectious diseases and an increase in some, whereas others continue to present on a more unpredictable basis (i.e., hantavirus). Outbreak identification, investigation, and control have been an integral part of what we do for more than 50 years. We estimate that 800 to 1,000 field investigations have occurred every year since the late 1990s. Today, however, we have a new focus on emerging infectious diseases and bioterrorism.     

Taiwan's traffic control bundle and the elimination of nosocomial severe acute respiratory syndrome among healthcare workers

The traffic control bundle consists of procedures designed to help prevent epidemic nosocomial infection. We retrospectively studied the serial infection control measures to determine factors most effective in preventing nosocomial infections of healthcare workers (HCWs) during the 2003 Taiwanese severe acute respiratory syndrome (SARS) epidemic. Fever screening stations, triage of fever patients, separating SARS patients from other patients, separation of entrances and passageways between patients and HCWs, and increasing hand-washing facilities all demonstrated a protective effect for HCWs (univariate analysis; P<0.05). By multiple logistic regression: (i) checkpoint alcohol dispensers for glove-on hand rubbing between zones of risk, and (ii) fever screening at the fever screen station outside the emergency department, were the significant methods effectively minimising nosocomial SARS infection of HCWs (P<0.05). The traffic control bundle should be implemented in future epidemics as a tool to achieve strict infection control measures.     

Impact of severe acute respiratory syndrome care on the general health status of healthcare workers in taiwan.

BACKGROUND: The impact of the outbreak of severe acute respiratory syndrome (SARS) was enormous, but few studies have focused on the infectious and general health status of healthcare workers (HCWs) who treated patients with SARS. DESIGN: We prospectively evaluated the general health status of HCWs during the SARS epidemic.The Medical Outcome Study Short-Form 36 Survey was given to all HCWs immediately after caring for patients with SARS and 4 weeks after self-quarantine and off-duty shifts. Tests for detection of SARS coronavirus antibody were performed for HCWs at these 2 time points and for control subjects during the SARS epidemic. SETTING: Tertiary care referral center in Taipei, Taiwan. SUBJECTS: Ninety SARS-care task force members (SARS HCWs) and 82 control subjects. RESULTS: All serum specimens tested negative for SARS antibody. Survey scores for SARS HCWs immediately after care were significantly lower than those for the control group (P<.05 by the t test) in 6 categories. Vitality, social functioning, and mental health immediately after care and vitality and mental health after self-quarantine and off-duty shifts were among the worst subscales. The social functioning, role emotional, and role physical subscales significantly improved after self-quarantine and off-duty shifts (P<.05, by paired t test). The length of contact time (mean number of contact-hours per day) with patients with SARS was associated with some subscales (role emotional, role physical, and mental health) to a mild extent. The total number of contact-hours with symptomatic patients with SARS was a borderline predictor (adjusted R2=0.069; P=.038) of mental health score. CONCLUSIONS: The impact of the SARS outbreak on SARS HCWs was significant in many dimensions of general health. The vitality and mental health status of SARS HCWs 1 month after self-quarantine and off-duty shifts remained inferior to those of the control group.     

Protecting healthcare staff from severe acute respiratory syndrome: filtration capacity of multiple surgical masks

Guidelines issued by the Centers for Disease Control and Prevention and the World Health Organisation state that healthcare workers should wear N95 masks or higher-level protection during all contact with suspected severe acute respiratory syndrome (SARS). In areas where N95 masks are not available, multiple layers of surgical masks have been tried to prevent transmission of SARS. The in vivo filtration capacity of a single surgical mask is known to be poor. However, the filtration capacity of a combination of masks is unknown. This was a crossover trial of one, two, three and five surgical masks in six volunteers to determine the in vivo filtration efficiency of wearing more than one surgical mask. We used a Portacount to measure the difference in ambient particle counts inside and outside the masks. The best combination of five surgical masks scored a fit factor of 13.7, which is well below the minimum level of 100 required for a half face respirator. Multiple surgical masks filter ambient particles poorly. They should not be used as a substitute for N95 masks unless there is no alternative.     

Optimizing severe acute respiratory syndrome response strategies: lessons learned from quarantine

Taiwan used quarantine as 1 of numerous interventions implemented to control the outbreak of severe acute respiratory syndrome in 2003. From March 18 to July 31, 2003, 147,526 persons were placed under quarantine. Quarantining only persons with known exposure to people infected with severe acute respiratory syndrome could have reduced the number of persons quarantined by approximately 64%. Focusing quarantine efforts on persons with known or suspected exposure can greatly decrease the number of persons placed under quarantine, without substantially compromising its yield and effectiveness.     

严重急性呼吸综合征（SARS）调查分析

目的 了解严重急性呼吸综合征(SARS)流行病学的特点，提出相应的预防和控制措施。方法 采取现场调查、网上电子病历审查、电话询问等方法。结果 认真贯彻落实消毒隔离制度，医院内无任何人员感染发病。SARS住院病人治愈率为89．2％，病死率5．4％，有接触史患占37．8％。结论 SARS病例在年龄上以青壮年为主，职业以商业餐饮服务人员为多。     

Factors associated with critical-care healthcare workers' adherence to recommended barrier precautions during the Toronto severe acute respiratory syndrome outbreak.

OBJECTIVE: To assess factors associated with adherence to recommended barrier precautions among healthcare workers (HCWs) providing care to critically ill patients with severe acute respiratory syndrome (SARS). SETTING: Fifteen acute care hospitals in Ontario, Canada. DESIGN: Retrospective cohort study. PATIENTS: All patients with SARS who required intubation during the Toronto SARS outbreak in 2003. PARTICIPANTS: HCWs who provided care to or entered the room of a SARS patient during the period from 24 hours before intubation until 4 hours after intubation. METHODS: Standardized interviews were conducted with eligible HCWs to assess their interactions with the SARS patient, their use of barrier precautions, their practices for removing personal protective equipment, and the infection control training they received. RESULTS: Of 879 eligible HCWs, 795 (90%) participated. In multivariate analysis, the following predictors of consistent adherence to recommended barrier precautions were identified: recognition of the patient as a SARS case (odds ratio [OR], 2.5 [95% confidence interval {CI}, 1.5-4.5); recent infection control training (OR for interactive training, 2.7 [95% CI, 1.7-4.4]; OR for passive training, 1.7 [95% CI, 1.0-3.0]), and working in a SARS unit (OR, 4.0 [95% CI, 1.8-8.9]) or intensive care unit (OR, 4.3 [95% CI, 2.0-9.0]). Two factors were associated with significantly lower rates of consistent adherence: the provision of care for patients with higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (OR for score APACHE II of 20 or greater, 0.4 [95% CI, 0.28-0.68]) and work on shifts that required more frequent room entry (OR for 6 or more entries per shift, 0.5 [95% CI, 0.32-0.86]). CONCLUSIONS: There were significant deficits in knowledge about self-protection that were partially corrected by education programs during the SARS outbreak. HCWs' adherence to self-protection guidelines was most closely associated with whether they provided care to patients who had received a definite diagnosis of SARS.     

Disaster planning and response: guidance for healthcare facilities

The widespread devastation and massive disruptions caused in the last few weeks by Hurricanes Katrina and Rita--in New Orleans and numerous other communities along the U.S. Gulf Coast--showed just how difficult it can be for communities to function in the face of large-scale disasters. In the wake of these storms, healthcare facilities throughout the world will undoubtedly be examining their emergency management plans to assess whether they are prepared to handle similar events.     

Severe acute respiratory syndrome (SARS) and healthcare workers

The recent outbreak of severe acute respiratory synt drome (SARS) was spread by international air travel, a direct result of globalization. The disease is caused by a novel coronavirus, transmitted from human to human by droplets or by direct contact. Healthcare workers (HCWs) were at high risk and accounted for a fifth of all cases globally. Risk factors for infection in HCWs included lack of awareness and preparedness when the disease first struck, poor institutional infection control measures, lack of training in infection control procedures, poor compliance with the use of personal protection equipment (PPE), exposure to high-risk procedures such as intubation and nebulization, and exposure to unsuspected SARS patients. Measures to prevent nosocomial infection included establishing isolation wards for triage, SARS patients, and step-down; training and monitoring hospital staff in infection-control procedures; active and passive screening of HCWs; enforcement of droplet and contact precautions; and compliance with the use of PPE.     

The strategic plan for preparedness and response to bioterrorism in Korea

Following the Anthrax bioterrorism attacks in the US in 2001, the Korean government established comprehensive countermeasures against bioterrorism. These measures included the government assuming management of all infectious agents that cause diseases, including smallpox, anthrax, plaque, botulism, and the causative agents of viral hemorrhagic fevers (ebola fever, marburg fever, and lassa fever) for national security. In addition, the Korean government is reinforcing the ability to prepare and respond to bioterrorism. Some of the measures being implemented include revising the laws and guidelines that apply to the use of infectious agents, the construction and operation of dual surveillance systems for bioterrorism, stockpiling and managing products necessary to respond to an emergency (smallpox vaccine, antibiotics, etc.) and vigorously training emergency room staff and heath workers to ensure they can respond appropriately. In addition, the government's measures include improved public relations, building and maintaining international cooperation, and developing new vaccines and drugs for treatments of infectious agents used to create bioweapons.     

严重急性呼吸综合征的现场调查和控制

严重急性呼吸综合征 (severeacuterespiratorysyndrome,SARS)是指由新型冠状病毒引起的以肺炎为主要表现的呼吸道传染病。近距离飞沫传播为主要传播途径 ,在一定的条件下 ,传染性很强。SARS作为 2 1世纪全球第一个新发的广泛传播的传染病 ,其特点和流行规律尚有许多方面不清楚