The rapid containment of the Singapore severe acute respiratory syndrome (SARS) outbreak in 2003 involved the introduction of several stringent control measures. These measures had a profound impact on the healthcare system and community, and were associated with significant disruptions to normal life, business and social intercourse. An assessment of the relative effectiveness of the various control measures is critical in preparing for future outbreaks of a similar nature. The very "wide-net" surveillance, isolation and quarantine policy adopted was effective in ensuring progressively earlier isolation of probable SARS cases. However, it resulted in nearly 8000 contacts being put on home quarantine and 4300 on telephone surveillance, with 58 individuals eventually being diagnosed with probable SARS. A key challenge is to develop very rapid and highly sensitive tests for SARS infection, which would substantially reduce the numbers of individuals that need to be quarantined without decreasing the effectiveness of the measure. Daily temperature monitoring of all healthcare workers (HCWs) in hospitals was useful for early identification of HCWs with SARS. However, daily temperature screening of children in schools failed to pick up any SARS cases. Similarly, temperature screening at the airport and other points of entry did not yield any SARS cases. Nevertheless, the latter 2 measures probably helped to reassure the public that schools and the community were safe during the SARS outbreak. Strong political leadership and effective command, control and coordination of responses were critical factors for the containment of the outbreak.
Disease Outbreaks ; prevention & control ; Humans ; Quarantine ; organization & administration ; Severe Acute Respiratory Syndrome ; epidemiology ; Singapore ; epidemiology

OBJECTIVES: The pandemic of novel influenza A (H1N1) virus has required decision-makers to act in the face of the substantial uncertainties. In this study, we evaluated the potential impact of the pandemic response strategies in the Republic of Korea using a mathematical model. METHODS: We developed a deterministic model of a pandemic (H1N1) 2009 in a structured population using the demographic data from the Korean population and the epidemiological feature of the pandemic (H1N1) 2009. To estimate the parameter values for the deterministic model, we used the available data from the previous studies on pandemic influenza. The pandemic response strategies of the Republic of Korea for novel influenza A (H1N1) virus such as school closure, mass vaccination (70% of population in 30 days), and a policy for anti-viral drug (treatment or prophylaxis) were applied to the deterministic model. RESULTS: The effect of two-week school closure on the attack rate was low regardless of the timing of the intervention. The earlier vaccination showed the effect of greater delays in reaching the peak of outbreaks. When it was no vaccination, vaccination at initiation of outbreak, vaccination 90 days after the initiation of outbreak and vaccination at the epidemic peak point, the total number of clinical cases for 400 days were 20.8 million, 4.4 million, 4.7 million and 12.6 million, respectively. The pandemic response strategies of the Republic of Korea delayed the peak of outbreaks (about 40 days) and decreased the number of cumulative clinical cases (8 million). CONCLUSIONS: Rapid vaccination was the most important factor to control the spread of pandemic influenza, and the response strategies of the Republic of Korea were shown to delay the spread of pandemic influenza in this deterministic model.
Antiviral Agents/therapeutic use ; Disaster Planning/*organization & administration ; *Disease Outbreaks ; Health Policy ; Humans ; Immunization Programs/organization & administration ; *Influenza A Virus, H1N1 Subtype ; Influenza, Human/drug therapy/*epidemiology/prevention & control ; *Models, Theoretical ; Quarantine/organization & administration ; Republic of Korea/epidemiology

The World Health Organization (WHO) announced the emergence of a novel influenza on April 24, 2009, and they declared pandemic on June 11. In Korea, the proportion of influenza-like illness and the consumption of antiviral agents peaked in early November. The government established the Central Headquarters for Influenza Control and operated the emergency response system. In the quarantine stations, we checked the body temperature and collected quarantine questionnaires from all the arrivals from infected countries. We also isolated the confirmed cases in the national isolation hospitals. However, as the community outbreaks were reported, we changed strategy from containment to mitigation. We changed the antiviral agent prescription guideline so that doctors could prescribe antiviral agents to all patients with acute febrile respiratory illness, without a laboratory diagnosis. Also the 470 designated hospitals were activated to enhance the efficacy of treatment. We vaccinated about 12 million people and manage the adverse event following the immunization management system. In 2010, we will establish additional national isolation wards and support hospitals to establish fever clinics and isolation intensive care unit (ICU) beds. We will also make a computer program for managing the national isolation hospitals and designated hospitals. We will establish isolation rooms and expand the laboratory in quarantine stations and we will construct a bio-safety level 3 laboratory in each province. In addition, we plan to construct a bio-safety level 4 laboratory at a new Korea Centers for Disease Control and Prevention (KCDC) facilities in Ossong.
Antiviral Agents/therapeutic use ; Disaster Planning/*organization & administration ; *Disease Outbreaks ; Humans ; *Influenza A Virus, H1N1 Subtype ; Influenza, Human/drug therapy/*epidemiology ; Quarantine/organization & administration ; Republic of Korea/epidemiology ; World Health Organization

The development of transport is being easily shared with people all over the world. It is necessary to appropriately and effectively revise the domestic quarantine law because the fatal infectious diseases are at risk of being easily shared. Today, Korea has an advanced quarantine system approved by World Health Organization, but it maintains partnerships with related ministries (Ministry of Foreign Affairs, Ministry of Justice, local medical institutions) and to introduce new medical technology (electronic quarantine) is important. And since the prevention of quarantine infectious diseases and prevention of the spread, in order to maintain international cooperation with the International Health Regulations, the quarantine law and the system should be amended and improved effectively and it is also a way to prepare for the outbreak of new quarantine infectious diseases. In the past, Korea has experienced great confusion during the past outbreak of swine flu and Middle East respiratory syndrome coronavirus. To prevent similar cases from recurring in the past, the revision of the quarantine law and the improvement of the system should be done to cope with the changing environment (new infections, increased number of overseas travelers, etc.).
Communicable Diseases ; International Cooperation ; Jurisprudence ; Korea ; Middle East Respiratory Syndrome Coronavirus ; Quarantine ; Social Control, Formal ; Social Justice ; Swine ; World Health Organization

Avian influenza A H5N1 continues to be a major threat to global public health as it is a likely candidate for the next influenza pandemic. To protect public health and avert potential disruption to the economy, the Hong Kong Special Administrative Region Government has committed substantial effort in preparedness for avian and pandemic influenza. Public health infrastructures for emerging infectious diseases have been developed to enhance command, control and coordination of emergency response. Strategies against avian and pandemic influenza are formulated to reduce opportunities for human infection, detect pandemic influenza timely, and enhance emergency preparedness and response capacity. Key components of the pandemic response include strengthening disease surveillance systems, updating legislation on infectious disease prevention and control, enhancing traveller health measures, building surge capacity, maintaining adequate pharmaceutical stockpiles, and ensuring business continuity during crisis. Challenges from avian and pandemic influenza are not to be underestimated. Implementing quarantine and social distancing measures to contain or mitigate the spread of pandemic influenza is problematic in a highly urbanised city like Hong Kong as they involved complex operational and ethical issues. Sustaining effective risk communication campaigns during interpandemic times is another challenge. Being a member of the global village, Hong Kong is committed to contributing its share of efforts and collaborating with health authorities internationally in combating our common public health enemy.
Animals ; Birds ; Communicable Disease Control ; methods ; organization & administration ; Disease Outbreaks ; prevention & control ; statistics & numerical data ; Hong Kong ; epidemiology ; Humans ; Influenza A Virus, H5N1 Subtype ; isolation & purification ; Influenza in Birds ; epidemiology ; Population Surveillance ; Quarantine ; Risk Factors ; Time Factors ; World Health Organization

OBJECTIVEAn epidemic of severe acute respiratory syndrome (SARS) hit Beijing, China, between March and July 2003 with an attack rate of 1.9 per 10 thousand. (2,521 cases). To control the epidemic of SARS, a total of 30,173 residents were quarantined either in their residence or in quarantine sites. In order to understand the personal need of being quarantined and to estimate the risk of developing SARS during the quarantine period, a survey on the quarantined residents of Haidian District, Beijing, China was carried out.

METHODS33 precincts in Haidian District divided into five groups (7 in north, 6 in south, 7 in west, 6 in east and 7 in central of Haidian District) according to the location of the precincts were involved. The director of Center of Disease Control and Prevention of Haidian District was asked to select 1 precinct from each group according to the workload of the precinct quarantine officers. From those 5 precincts we obtained lists of all quarantined persons from the precinct quarantine officers. All quarantinees were asked to complete a self-administered questionnaire. The SARS patients were diagnosed and verified according to the diagnosis criteria released by Chinese Ministry of Health which was equivalent to the SARS 'probable case' definition of WHO. All SARS cases had been reported to the relative authorities.

RESULTSBy May 23, 2003, 5,186 persons had been quarantined in Haidian district, accounting for 0.23% of all residents. 1,028 of sampled quarantined residents completed the questionnaire. Of those who completed the questionnaire, 2.3% (95% CI: 1.5% - 3.5%) developed SARS while under quarantine. The median quarantine period was 14 days (range 1 day to 28 days). 61% of the quarantinees had a direct contact history with SARS patients, and all secondary SARS patients developed through contact to these quarantinees. The remaining 39% quarantinees who did not have a direct contact history with SARS patients had not developed SARS during the period under quarantine. 37% of the quarantees had direct contact during original patients' symptomatic period with an AR of 6.3%. Persons who looked after the illed SARS patient(s) during their symptomatic period, had an highest attack rate of 31% (95% CI: 20% - 44%). 63% (95% CI: 60% - 66%) of the total quarantined persons did not have direct contact with a SARS patient during his/her symptomatic period, with an attack rate of 0% (95% CI: 0% - 0.73%).

CONCLUSIONOnly those persons having direct contact with ill SARS patients need to be under quarantine. The overall cost for quarantine on SARS prevention could be reduced by as much as 63% if the quarantine program was limited to this group. No evidence was found that SARS patient was infective during the incubation period.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; China ; epidemiology ; Disease Outbreaks ; prevention & control ; Female ; Humans ; Infant ; Male ; Middle Aged ; Quarantine ; methods ; organization & administration ; psychology ; Risk Factors ; Severe Acute Respiratory Syndrome ; epidemiology ; prevention & control ; psychology ; Time Factors

OBJECTIVETo investigate the psychosocial status and related factors among university students during severe acute respiratory syndrome (SARS) epidemic in Beijing.

METHODSBy means of stratified cluster sampling, symptom checklist-90 (SCL-90) and questionnaire on general information were applied among 6800 students in three universities in Beijing.

RESULTSThere were 6280 valid questionnaires gathered. In order to control and prevent SARS, strict management was conducted in three universities which providing various social supports. Out of the 6280 students, 460 had SCL-90 positive symptoms with a rate of 7.3%. Risk factors of SCL-90 positive symptom were found as follows: major in arts (OR = 2.00), misconception on the control and prevention of SARS (OR = 1.91), considering measures non-effective (OR = 2.25), and do not believe that SARS can be under control (OR = 3.57). Protective factors of SCL-90 positive symptom would include as: being female (OR = 0.77), being graduate students (OR = 0.38), and being not much influenced on study and daily life during the period of strict management (OR = 0.54).

CONCLUSIONPsychosocial status of students was influenced by their knowledge and attitude on SARS. Various social supports might keep the university students to having a healthy psychosocial status.

Adolescent ; Adult ; Awareness ; China ; epidemiology ; Disease Outbreaks ; prevention & control ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Quarantine ; methods ; organization & administration ; psychology ; Risk Factors ; Sampling Studies ; Severe Acute Respiratory Syndrome ; epidemiology ; prevention & control ; psychology ; Surveys and Questionnaires ; Time Factors ; Universities