From SARS in 2003 to H1N1 in 2009: lessons learned from Taiwan in preparation for the next pandemic

Abstract

In anticipation of a future pandemic potentially arising from H5N1, H7N9 avian influenza or Middle East Respiratory Syndrome, and in large part in response to severe acute respiratory syndrome (SARS) in 2003, the city of Taipei, Taiwan, has developed extensive new strategies to manage pandemics. These strategies were tested during the 2009 H1N1 outbreak. This article assesses pandemic preparedness in Taipei in the wake of recent pandemic experiences in order to draw lessons relevant to the broader international public health community. Drawing on Taiwan and Taipei Centers for Disease Control data on pandemic response and control, we evaluated the effectiveness of the changes in pandemic response policies developed by these governments over time, emphasizing hospital and medical interventions with particular attention paid to Traffic Control Bundling. SARS and H1N1 2009 catalysed the Taiwan and Taipei CDCs to continuously improve and adjust their strategies for a future pandemic. These new strategies for pandemic response and control have been largely effective at providing interim pandemic containment and control, while development and implementation of an effective vaccination programme is underway. As Taipei's experiences with these cases illustrate, in mitigating moderate or severe pandemic influenza, a graduated process including Traffic Control Bundles accompanied by hospital and medical interventions, as well as school- and community-focused interventions, provides an effective interim response while awaiting vaccine development. Once a vaccine is developed, to maximize pandemic control effectiveness, it should be allocated with priority given to vulnerable groups, healthcare workers and school children.

Keywords: H1N1; Pandemic preparedness; Severe acute respiratory syndrome; Six Sigma; Traffic Control Bundles; Vaccination campaigns.

Figure 1

Conceptual scheme of traffic control bundle included triaging patients before admission to the hospitals, included cohorting the patients, separating the space and routes from the emergency department entrance through the hallways and the elevators to the negative pressure isolation rooms for patients and healthcare workers (HCWs). Patients were thus confined in the contamination zone. HCWs and patients were separated by zones of risk, with decontamination and handwashing with 75% alcohol disinfectant at checkpoints positioned in between zones of risk. PPE, personal protective equipment. (Adapted with permission from Yen et al.²³)

Figure 2

Epicurve of automated chief-complaint-based syndromic surveillance system for influenza-like illness (ILI) from emergency departments of five general hospitals of Taipei City in 2009. The epidemic signal (red traingles) at the beginning of 2009 were caused by seasonal influenza A H1N1. Red-encircled signals of 30 July, 8 August, 11 August, and 17 August, which were concordant with the first hospital cluster on 13 August, indicate the early warning signal of a community outbreak starting on 6 September.

Figure 3

Conceptual scheme of expandable task forces of special isolation hospital groups for surge capacity in mitigating novel pandemics. Each working group comprised one designated communicable disease isolation hospital (red ovals) with five alternative care sites (yellow circles) transformed from recruited schools. Other general hospitals (green ovals) should prioritize strict infection control to remain free from nosocomial outbreaks of novel pandemic and maintain the integrity of the healthcare system.