| Summary: | 博士 === 臺灣大學 === 職業醫學與工業衛生研究所 === 98 === A diversity of programmes address the impact of global challenge on human health, but as yet no comprehensive framework or strategy has emerged to develop and implement policy and planning. Under the globalization of commercial trades, climatic change, and active international cultural exchanges among people, there is an urgent need to document and improve control on pathogens and emerging infectious diseases. Based on the lesson learned from the severe acute respiratory syndrome (SARS) in 2003 and the possibility of pandemic influenza H5N1 as well as other emerging infectious diseases, World health Organization (WHO) has urged the member nations to improve disease prevention, surveillance, and preparedness for future pandemic episode, under the guideline of International Health Regulations 2005 (IHR (2005)).The following algorithm showed the concept of continuous improvement of infectious control strategy and infrastructure, and international health regulation may assist international cooperation and strengthen the global infrastructure of infectious disease control.
Surveillance provides us the opportunity of identifying the risk factor and risk population. As a medical epidemiologist working in the Center for Diseases Control, I have the privilege of access to many data sources collected. This dissertation is a collection of studies proposing hypothesis and refuting hypothesis through analyzing these datasets to come up with useful recommendation to improve the control strategy and/or infrastructure:
The first paper is related to a retrospective evaluation of the effectiveness of different quarantine policies when SARS occurred, which revealed that restricting quarantine measures to only those persons with suspected exposure to SARS cases in hospitals, homes, communities, and airplanes could have reduced the number of persons quarantined by 64%, without compromising overall yield and efficiency. The second paper is to evaluate a national surveillance system of unexplained death if it has established the infrastructure needed for Taiwan to detect critical and fatal cases of unknown causes. The third study applied close monitoring system for 3 months and documented the significance of infection control staff on hospital acquired bacteremia of MRSA, which was designed for estimating the threat of Methicillin resistant staphylococcus aureus (MRSA) for Taiwan to scope the magnitude of its disease burden. The forth paper is related to the access of the risk factors from an institutional point of view, which could guide the appropriate resource allocation for the control of nosocomial infection of MRSA.
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