Taipei's use of a multi-channel mass risk communication program to rapidly reverse an epidemic of highly communicable disease.
BACKGROUND
In September 2007, an outbreak of acute hemorrhagic conjunctivitis (AHC) occurred in Keelung City and spread to Taipei City. In response to the epidemic, a new crisis management program was implemented and tested in Taipei.


RESULTS
Having noticed that transmission surged on weekends during the Keelung epidemic, Taipei City launched a multi-channel mass risk communications program that included short message service (SMS) messages sent directly to approximately 2.2 million Taipei residents on Friday, October 12th, 2007. The public was told to keep symptomatic students from schools and was provided guidelines for preventing the spread of the disease at home. Epidemiological characteristics of Taipei's outbreak were analyzed from 461 sampled AHC cases. Median time from exposure to onset of the disease was 1 day. This was significantly shorter for cases occurring in family clusters than in class clusters (mean+/-SD: 2.6+/-3.2 vs. 4.39+/-4.82 days, p = 0.03), as well as for cases occurring in larger family clusters as opposed to smaller ones (1.2+/-1.7 days vs. 3.9+/-4.0 days, p<0.01). Taipei's program had a significant impact on patient compliance. Home confinement of symptomatic children increased from 10% to 60% (p<0.05) and helped curb the spread of AHC. Taipei experienced a rapid decrease in AHC cases between the Friday of the SMS announcement and the following Monday, October 15, (0.70% vs. 0.36%). By October 26, AHC cases reduced to 0.01%. The success of this risk communication program in Taipei (as compared to Keelung) is further reflected through rapid improvements in three epidemic indicators: (1) significantly lower crude attack rates (1.95% vs. 14.92%, p<0.001), (2) a short epidemic period of AHC (13 vs. 34 days), and (3) a quick drop in risk level (1 approximately 2 weeks) in Taipei districts that border Keelung (the original domestic epicenter).


CONCLUSIONS
The timely launch of this systematic, communication-based intervention proved effective at preventing a dangerous spike in AHC and was able to bring this high-risk disease under control. We recommend that public health officials incorporate similar methods into existing guidelines for preventing pandemic influenza and other emerging infectious diseases.
Yen
Muh-Yong
MY
Department of Disease Control and Prevention, Taipei City Hospital, Taipei City Government, Taipei, Taiwan. myyen1121@gmail.com
Wu
Tsung-Shu Joseph
TS
Chiu
Allen Wen-Hsiang
AW
Wong
Wing-Wai
WW
Wang
Po-En
PE
Chan
Ta-Chien
TC
King
Chwan-Chuen
CC
D000293:Adolescent; D002648:Child; D003140:Communicable Disease Control; D003142:Communication; D003232:Conjunctivitis, Acute Hemorrhagic / Q000453:epidemiology / Q000517:prevention & control*; D004189:Disaster Planning; D004196:Disease Outbreaks / Q000517:prevention & control*; D006266:Health Education; D006801:Humans; D010353:Patient Education as Topic; D011634:Public Health; D012306:Risk; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors