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.

Toward a collaborative model of pandemic preparedness and response: Taiwan's changing approach to pandemics

“…As a result, TCB has been expanded across Taiwan's hospital system and has been deployed in outbreaks that have occurred since then. 30 In addition to the microapplication of TCB to hospitals, TCB has also been applied nationally, drawing on the six regional communicable disease control centers. The network facilitates communication and integrates response efforts (including sharing training and surge capacity) among the national and local level governments while also incorporating input from hospitals, infection control units and local health departments.…”

“…In addition, hotel administrators are required to distribute notices to guests explaining epidemic risks and the various measures to be taken to avoid infection. 30 This same approach has been adopted in other cities across Taiwan. Kaohsiung city government implemented similar collaboration with its hotels when, while hosting the 2009 World Games, the city was struck by the 2009 H1N1 outbreak.…”

2019 novel coronavirus disease (COVID-19) in Taiwan: Reports of two cases from Wuhan, China

“…After 17 years, physicians in Taiwan face another novel coronavirus outbreak originating in China. 1 With the past experience of severe acute respiratory syndrome (SARS), 2,3 we respond quickly this time. However, a new pathogen inevitably raises new challenges.…”

Interrupting COVID-19 transmission by implementing enhanced traffic control bundling: Implications for global prevention and control efforts

“…2 Fomites are important because while populations generally protect themselves from clearly observable droplet transmissions (coughing, sneezing), being invisible, fomite transmission is regularly overlooked both in hospitals and communities. [3][4][5] Consequently, during the community saturation phase, fomite transmission may play a larger role than droplet transmission as a mechanism in emergent infectious diseases. [3][4][5][6] In this paper we argue that by implementing enhanced Traffic Control Bundling (eTCB), 6 to transmission by the index case via droplets and contact with exposed people in the same care zone.…”

“…[3][4][5] Consequently, during the community saturation phase, fomite transmission may play a larger role than droplet transmission as a mechanism in emergent infectious diseases. [3][4][5][6] In this paper we argue that by implementing enhanced Traffic Control Bundling (eTCB), 6 to transmission by the index case via droplets and contact with exposed people in the same care zone. However, later analysis found that those without contact history with the index case were likely infected by fomites on bed curtains and/or public restroom fixtures touched by the index case who had been suffering from walking pneumonia and diarrhea.…”