post-SARS Era Research Articles

Epidemiologic changes of infectious diseases in the post-SARS era in China, 2004–2018

ObjectivesTo outline 44 major infectious diseases in the post-SARS (severe acute respiratory syndrome) in China and describe their long-term trends and changes by age, sex, epidemic season, and province.BackgroundAfter the outbreak of severe acute respiratory syndrome (SARS) in 2003, with the change of infectious disease prevention and control system and the improvement of residents’ quality of life, the incidence and mortality of infectious diseases have undergone major changes.MethodsThe data of 44 major infectious diseases in China from 2004 to 2018 were obtained from the monthly analysis report of the China Information System for Disease Control and Prevention (CISDCP) and the Public Health Science Data Center. Joinpoint r regression models were used to examine trends in incidence and mortality for 44 major and important infectious diseases from 2004 to 2018.ResultsFrom 2004 to 2018, 20,105, 500, 772 patients (10, 306, 546, 523 males and 9, 798, 954, 249 females) were diagnosed with 44 major infectious diseases. The overall incidence of 44 infectious diseases increased significantly from 294.6 per 100,000 people in 2004 to 479.1 per 100,000 people in 2010, with 7.9% APC (95% CI 5.2% -10.7%, P < 0.001), then slowed, and then increased to 561.2 per 100,000 people in 2018, with 1.5% APC (-0.1%—3.2%, P = 0.070). The overall mortality rose significantly, from 0.49 to 1.13 per 100,000 people between 2004 and 2011, with an APC increase of 11.6% (7.7% -15.6%, P < 0.001), and then remained stable until 2018. Among these, the prevalence of vaccine-preventable diseases and gastrointestinal & enteroviral diseases remained high and increased year by year. Patients with zoonotic diseases have the greatest risk of death, while patients with sexually transmitted and blood-borne diseases have the greatest number of deaths. Incidence rates vary considerably across geographic regions. Western China has a disproportionate burden of infectious diseases compared with eastern regions.ConclusionsAfter the event of SARS in 2003, infectious disease preventing and controlling model has undergone major changes in China, and certain achievements have been made in this field. Although overall morbidity and case fatality rates are still rising, they have leveled off. In reducing the disproportionate disease burden in the western region, expanding vaccination programs, preventing further increases in rates of sexually transmitted diseases, renewing efforts for emerging and persistent infectious diseases, and addressing seasonal and unpredictable outbreaks (such as the COVID-19 pandemic), there are still remain many challenges.

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Beyond the anti-racist reason: a postcolonial perspective on pandemic politics

ABSTRACT This article interrogates the politics of the COVID-19 pandemic from a postcolonial perspective. One alarming concern during the pandemic is the rise of racism against Asians all over the world. However, little explored behind media reports are the legacies, tensions and challenges left by imperial domination inherited from the past, especially within the postcolonial regimes in Asia, such as Hong Kong and China. Drawing upon postcolonialism as a critical lens, this article makes perceptible the intractable issues of health politics. Postcolonial challenges shown by COVID-19 include immigration, changing politico-juridical definitions of identity, the legacy left by the Soviet era which poses an obstacle to modernising China's healthcare system, and the boom of birth tourism welcomed by the marketised turn of health and tourism policy in Hong Kong in the post-SARS era. A postcolonial perspective invites health sociologists to scratch beneath the surface of political problems such as racism, and attend to the complex heterogeneity of health politics in the pandemic.

Changing epidemiological patterns of HIV and AIDS in China in the post-SARS era identified by the nationwide surveillance system

BackgroundChina has made substantial progress in tackling its HIV and AIDS epidemic. But the changing patterns of HIV and AIDS incidence based on the longitudinal observation data were rarely studied.MethodsThe reporting incidence (RI) and mortality data on HIV and AIDS in China covering 31 provinces from 2004 to 2014 were collected from the Chinese Public Health Science Data Center. To decompose the time-series data, Empirical Mode Decomposition (EMD) was applied to properly describe the trends of HIV and AIDS incidence. A mathematical model was used to estimate the relative change of incidence among provinces and age groups.ResultsA total of 483,010 newly HIV infections and 214,205 AIDS cases were reported between 2004 and 2014 nationwide. HIV infection increased from 13,258 in 2004 (RI 1.02 per 100,000 person years) to 74,048 in 2014 (RI 5.46 per 100,000). The number of AIDS cases increased from 3054 in 2004 (RI 0.23 per 100,000) to 45,145 in 2014 (RI 3.33 per 100,000). The overall relative changes for HIV infection and AIDS incidence were 1.11 (95% confidence interval [CI] 1.10–1.13) and 1.28 (95% CI 1.23–1.33), respectively. The relative increase for HIV and AIDS RI was higher in northwest provinces while lower in Henan, Xinjiang, Guangxi and Yunnan. The overall relative changes for HIV infection were 1.12 (95% CI 1.11–1.14) in males and 1.10 (95% CI 1.06–1.13) in females. For AIDS RI, the relative increases were 1.31 (95% CI 1.26–1.36) in males and 1.22 (95% CI 1.17–1.28) in females. The lowest relative increase was detected among young adults, while the largest relative increase (odds ratio [OR] > 1.30) was detected in people aged 55 years or above.ConclusionsHIV and AIDS showed an increasing trend in China from 2004 to 2014, respectively, but the epidemic tended to be under control among provinces and young people that used to have a high HIV and AIDS incidence. Northwest China and older people could be new “hop-spots” for HIV and AIDS risk.

Is Our City Livable and Healthy in the Post-SARS Era? Re-designing Healthy Cities – a Lesson from Hong Kong

The paper draws an attention on the academic debate on the pros and cons of compact city, onethat embraces a high-density and high-rise, mixed land-use urban form. The paper supports compact cityas a candidate for sustainable urban form by reviewing and discussing recent new initiatives from HongKong in the post-SARS era that includes research and development efforts by academia and governmentson the evaluation and derivation of guidelines for design implementation and building management operationsat the urban design and building design levels. Similarly, innovative initiatives are also found in thecollective efforts by statutory bodies, developers and professionals to improve the standard and quality ofthe habitable environment. The discussion is based on selected case studies from recently realized projectsin the residential market; as well as applied research programs undertaken by universities and government.The summary is that recent efforts in Hong Kong show that there is confidence for a high density compactcity to be a livable and healthy city. In the paper, the reference to ‘health,’ ‘hygiene’ or ‘healthy buildings’is a causal usage. The three terms project a layperson’s perception of the quality of the physical environment.In this way, the terms have no specific medical connections.

Infectious diseases in China in the post-SARS era

The epidemiology and comparative burden of communicable diseases determines which diseases warrant public health resources and intervention. In a country as large as China, identification of the communicable diseases causing the greatest burden and the population groups most affected by specific diseases is a massive, and very important, undertaking. In The Lancet Infectious Diseases, Shigui Yang and colleagues report surveillance data for communicable diseases in China over a 10-year period (2004–13), covering a population of 1·3 billion people and incorporating nearly 55 million notified cases of 45 infectious diseases.

Risk and Outbreak Communication: Lessons from Taiwan's Experiences in the Post-SARS Era.

In addition to the impact of a disease itself, public reaction could be considered another outbreak to be controlled during an epidemic. Taiwan's experience with SARS in 2003 highlighted the critical role played by the media during crisis communication. After the SARS outbreak, Taiwan's Centers for Disease Control (Taiwan CDC) followed the WHO outbreak communication guidelines on trust, early announcements, transparency, informing the public, and planning, in order to reform its risk communication systems. This article describes the risk communication framework in Taiwan, which has been used to respond to the 2009-2016 influenza epidemics, Ebola in West Africa (2014-16), and MERS-CoV in South Korea (2015) during the post-SARS era. Many communication strategies, ranging from traditional media to social and new media, have been implemented to improve transparency in public communication and promote civic engagement. Taiwan CDC will continue to maintain the strengths of its risk communication systems and resolve challenges as they emerge through active evaluation and monitoring of public opinion to advance Taiwan's capacity in outbreak communication and control. Moreover, Taiwan CDC will continue to implement the IHR (2005) and to promote a global community working together to fight shared risks and to reach the goal of “One World, One Health.”

Transnationality and Nationalism: Shared and Contested Memories of Wu Lien-Teh across East and Southeast Asia in Post-SARS Era

Transnationality and Nationalism: Shared and Contested Memories of Wu Lien-Teh across East and Southeast Asia in Post-SARS Era

Qualitative study on the shifting sociocultural meanings of the facemask in Hong Kong since the severe acute respiratory syndrome (SARS) outbreak: implications for infection control in the post-SARS era.

BackgroundThe clinical importance and efficacy of facemasks in infection prevention have been documented in the international literature. Past studies have shown that the perceived susceptibility, the perceived severity of being afflicted with life-threatening diseases, and the perceived benefits of using a facemask are predictors of a person’s use of a facemask. However, I argue that people wear a facemask not merely for infection prevention, and various sociocultural reasons have been motivating people to wear (and not wear) a facemask. Facemasks thus have sociocultural implications for people. Research on the sociocultural meanings of facemasks is scant, and even less is known on how the shifting sociocultural meanings of facemasks are related to the changing social environment, which, I argue, serve as remarkable underlying factors for people using (and not using) facemasks. As new infectious diseases such as avian influenza and Middle East Respiratory Syndrome have been emerging, threatening people’s health worldwide, and because facemasks have been documented to have substantial efficacy in the prevention of infection transmission, understanding the sociocultural meanings of facemasks has significant implications for public health policymakers and health care providers in designing a socially and culturally responsive public health and infection control policy for the community.MethodsA qualitative research design involving the use of 40 individual, in-depth semistructured interviews and a phenomenological analysis approach were adopted.ResultsThe sociocultural meanings of the facemask have been undergoing constant change, from positive to negative, which resulted in the participants displaying hesitation in using a facemask in the post-SARS era. Because it represents a violation of societal ideologies and traditional Chinese cultural beliefs, the meanings of the facemask that had developed during the SARS outbreak failed to be sustained in the post-SARS era.ConclusionThe changes in meaning not only influenced the participants’ perceptions of the facemask but also influenced their perceptions of people who use facemasks, which ultimately influenced their health behavior, preventing them from using facemasks in the post-SARS era. These findings have critical implications for designing a culturally responsive infection prevention and facemask usage policy in the future.

The SARS-Associated Stigma of SARS Victims in the Post-SARS Era of Hong Kong

This article explores the disease-associated stigma attached to the SARS victims in the post-SARS era of Hong Kong. I argue that the SARS-associated stigma did not decrease over time. Based on the ethnographic data obtained from 16 months of participant observation in a SARS victims' self-help group and semistructured interviews, I argue that the SARS-associated stigma was maintained, revived, and reconstructed by the biomedical encounters, government institutions, and public perception. I also provide new insight on how the SARS-associated stigma could create problems for public health development in Hong Kong. As communicable diseases will be a continuing threat for the human society, understanding how the disease-associated stigma affects the outcomes of epidemic control measures will be crucial in developing a more responsive public health policy as well as medical follow-up and social support service to the diseased social groups of future epidemic outbreaks.

Effect of Severe Acute Respiratory Syndrome on Bystander Willingness to Perform Cardiopulmonary Resuscitation (CPR)–Is Compression–Only Preferred to Standard CPR?

The effect of the severe acute respiratory syndrome (SARS) outbreak on the willingness of laypersons to provide bystander cardiopulmonary resuscitation (CPR) using standard CPR (SCPR) or compression-only CPR (CCPR) was evaluated. The preferred type of SCPR in the post-SARS era was assessed. A descriptive study was conducted through telephone interviews. Persons who attended a CPR course from January 2000 through February 2003 answered a structured questionnaire. The respondents' willingness to perform SCPR or CCPR during a witnessed cardiac arrest of an average adult stranger or that of a family member in the pre-SARS and the post-SARS era was surveyed. Data for 305 respondents were processed. For the scenario of cardiac arrest of an average stranger, more respondents would perform CCPR than SCPR in the pre-SARS era (83.6% vs. 61.3%, p <0.001) and in the post-SARS era (77.4% vs. 28.9%, p <0.001). In the scenario of the cardiac arrest of a family member, more would perform CCPR than SCPR in the pre-SARS era (92.8% vs. 87.2%, p <0.001) and in the post-SARS era (92.8% vs. 84.9%, p <0.001). After SARS, more respondents were unwilling to perform SCPR (p <0.001) and CCPR (p <0.001) on strangers. After SARS, more respondents were unwilling to perform SCPR on a family member (p = 0.039), but there was no difference in the preference to perform CCPR (p = 1.000). Concerns about SARS adversely affected the willingness of respondents to perform SCPR or CCPR on strangers and to perform SCPR on family members. Compression-only CPR was preferred to SCPR to resuscitate strangers experiencing cardiac arrest after the emergence of SARS.

Allied health infection control coordinators: A new link to infection control

BACKGROUND: Infection control (IC) was once considered to be related only to nursing, but IC problem have come to be seen as related to many healthcare issues inside the hospital. In the past, allied health professionals (AHPs) were overlooked when IC topics and issues arose. In the post-SARS era, however, such myths have been totally destroyed. Further training about basic IC concepts and advanced applications is absolutely necessary for allied health professionals, as they are among the most important mobile staff in Hong Kong. PROJECT: With the formation of the Allied Health Infection Control Coordinators Group, AHPs will be invited as representatives to hospital infection control teams, and their concerns related to IC can be addressed. AHPs come from various disciplines, including physiotherapists, occupational therapists, speech therapists, medical laboratory technologists, podiatrists, prosthetists and orthotists, dietitians, medical physicists, and radiographers. RESULTS: A structured IC training program was designed in consultation with hospitals' senior staff and representatives. A 4-day basic and advanced training was run with hospital visits and international consultations in between. A train-the-trainer format was adopted so that, after completing the course, participants could provide further training and could monitor the application of IC knowledge and practices in their own environments. Besides, during the training program, an effort was made to formulate, standardize, and align IC practice within the Hospital Authority with the aim of ensuring the future quality and standard of IC implementation. RESULTS: A total of 189 AHPs attended a 1-day basic IC training. Only 26.5% reported having attended a formal IC training program previously, and 88% stated that they were satisfied with the overall training program. From the overall pre-course and post-course assessment of their IC knowledge, between 54.8% and 73.4% scored significantly higher (by McNemar test, p < 0.05). Eighty of the attendees are being recruited for a 3-day advanced IC application training in 2005. CONCLUSION: Structured, train-the-trainer-format IC training proved to be significantly effective and satisfactory for participants, enhancing staff IC knowledge applications and concepts.