Review of FETP Training and Field Investigation
Taiwan FETPDonald D. Jiang, M.S., Ph.D.
FETP Alumni, 1999~
Review Outline
• FETP Training• Outbreak Investigation• Attendance of International Conference• Achievements of FETP Trainees
FETP Training• We recruit 10~12 trainees each year.• Training begins in August. All trainees are divided into
two teams. First team trainees stay in class from September to February and second team trainees return to their original units. Second team trainees come back to class for training from March to June and first team trainees return to their workplaces. In July, all trainees come together in class and prepare for their long term research project in second year training.
• Trainees will conduct outbreak investigation and study papers associated with their research projects in class.
Teaching Haiti Students, 2011~2012
FETP Training
• Core Courses• Journal Club• Instruction from Foreign Experts• Outbreak Investigation• Long Term Research
Core Courses• Mainly epidemiology and biostatistics.
Journal Club
• Once a week, reading SCI papers associated with epidemiological investigation of assorted outbreaks; producing power point files for presentation.
Instructions from Foreign Experts
Outbreak Investigation• Requests from county or city health bureaus.• Assignments from higher authority (CDC
director or deputy directors)• Responses to media report regarding outbreaks.
Long Term Research
• The second year assignment.
Thesis Oral Examination
Earning a FETP Certificate• Finish the first year course training.• Complete two outbreak investigations and
publish their findings.• Complete one long-term research project.
Graduation Ceremony
Outbreak Investigation
• Arrangement of outbreak investigation• Investigations of 224 outbreaks (1995~2009)• Two Important Outbreak Investigations– Outbreak of Enterovirus 71 (1999)– Outbreak of SARS (2003)
Risk Factors Associated with Mortality or Serious Clinical manifestations Induced by the Hand-Foot-and-Mouth
Disease: An 1:2 Matching Case-Control Study
• Purpose: to explore possible risk factors related to death or serious clinical manifestations induced by the hand-foot-and-mouth disease
• Study Design: an 1:2 matching case-control study
Study Subjects:• Cases: – children infected with hand-foot-and-mouth disease and
hospitalized or died with serious complications such as encephalitis, aseptic meningitis, pulmonary edema or hemorrhage, acute flaccid paralysis, and myocarditis during the period between February 1, 1998 and July 31, 1998
– 50 cases (32 males and 18 females), most of them expired
• Hospital-based controls: – children also infected with hand-foot-and-mouth disease,
but without above complications– selected from department of pediatric in 40 medical centers
and regional hospitals who reported cases– matched by reporting hospital, gender, age (+ 3 months),
and date of clinical visit (+ 1 week)
• Community-based controls:– children having no hand-foot-and-mouth disease– matched by residential area, gender, age (+ 3 months),
and date of clinical visit (+ 1 week)
• Investigation tool: – a semi-structure questionnaire contains demographic
information, birth information, medical history, vaccine history, breast/milk feeding history, nutrition, day/night care history, residential information, drinking water, pesticide, hygienic insects (mosquito, flea), family information, ... etc..
– person to person interview performed by trainees from the Field Epidemiology Training Program (FETP)
Results of analyzing risk factors associated with mortality or serious clinical manifestations induced by the hand-foot-and-mouth disease in the hospital-based case-control study
Variable Crude Odds Ratio (95% CI) Age-adjusted Odds ratio (95% CI) Clinical visits in recent one year 0.9422 (0.9146, 0.9708) * 0.9480 (0.9201, 0.9769) * Kindergarten/daycare center (yes/no) 5.7673 (0.5248, 63.3769) 9.7894 (1.0499, 91.2771) * No. of clinics visited before hospitalized 0.7383 (0.5712, 0.9542) * 0.7297 (0.5615, 0.9483) * Travel after having HFMD (yes/no) 5.0539 (2.4794, 10.3016) * 4.9121 (2.4033, 10.0402) * *statistically significant, p < 0.05, conditional logistic regression analysis.
Results of analyzing risk factors associated with mortality or serious clinical manifestations induced by the hand-foot-and-mouth disease in the community-based case-control study
Variable Crude Odds Ratio (95% CI) Age-adjusted Odds ratio (95% CI) Allergic history (yes/no) 6.4186 (2.0782, 19.8241) * 8.8357 (2.1460, 36.3757) * Skin symptoms (yes/no) 10.1787 (2.1102, 49.1020) * 8.7111 (1.8254, 41.5750) * Children care (parent/non-parent) 0.3825 (0.1618, 0.9047) * 0.3969 (0.1590, 0.9907) * No. of clinics visited before hospitalized 0.2482 (0.2154, 0.2859) * 0.2618 (0.2264, 0.3028) * *statistically significant, p < 0.05, conditional logistic regression analysis.
18
SARS Reported Cases (3,581)
Probable Cases (664)
PCR or Antibody +346 (52.1%)
PCR and Antibody -317 (47.8%)
Survive273
Dead73 (21.1%)
Survive210
Dead107 (33.8%)
Die in SARS37 (10.7%)
Link to SARS36 (10.4%)
D d S i D d
SARS Li k t
FETP Responsibility for SARS Outbreaks
• Field investigation of reported cases • Hospital SARS outbreak investigation• Inspections of hospital nosocomial infection
control for SARS• Inspections of fever surveillance for nursing
homes, veterans homes, long-term care centers…
Field Investigation of Reported Cases
• To verify media report cases.• Complete field investigation of 104 reported cases. • For each reported case, we need to provide:–Results of field investigation (contact history)–Clinical history–Chest X-ray film/scan imagefor daily afternoon task meeting.
Hospital SARS Outbreak Investigation
• National Taiwan University Hosp.
• Taipei Veterans General Hosp.
• Tri-Service General Hosp.• Kaohsiung Chang Gung
Memorial Hosp.• MacKay Memorial Hosp. • Far Eastern Memorial
Hosp.
• Penghu Hosp., DOH• Taipei City Hoping Hosp.• Taipei City Zhongxing
Hosp.• Taipei City Gandau Hosp.• Taipei City Yangming
Hosp.
SARS in Hospital Emergency Room
5 14 12
Source: Emerg Infect Dis. 2004 May;10(5):782-8.
Epidemiological links of SARS probable and suspected cases in X ward area of One Medical Center in Southern Taiwan
KCMH581 4/17, 4/25 JCH 4/26 Ward X02 4/28 fever 5/18 expired
KCMH1331 4/21~4/28 Ward X01 4/28 fever 5/8 expired
KCMH1355 4/8~5/8 Ward X03 5/8 expired
KCMH1271 2/13 Ward X05 5/8 fever 5/11 expired
KCMH1574 4/7~5/6 Ward X08 5/13 fever 5/15 expired
KCMH600 Daughter of KCMH609 4/28 fever 4/17~4/25 Roommate of CMH581
KCMH609 4/30 fever CGMH(Linkou) 4/17, 4/25 took KCMH581 to JCH
KCMH1235 Brother of KCMH581 4/26 took KCMH581 to CGMH 5/4 fever 5/19 expired
KCMH738 Nurse 5/2 fever
KCMH788 Doctor 5/3 fever
KCMH1236 Doctor 5/3 fever 5/16 expired
KCMH969 Patient of KCMH1236 4/25~5/2admitted 5/8 expired
KCMH1274 4/23 fever Ward X02 5/8 fever
KCMH1564 4/27-5/7 Ward X01 5/7~5/14 PH 5/14 fever 5/23 expired
KCMH1332 Doctor 5/9 fever
KCMH1334 Doctor 5/11 fever
KCMH1590 Son of KCMH2088 4/27~30 and 5/2~3 took care KCMH1590 5/13 fever
KCMH1943 Son of KCMH1590 5/17 fever
KCMH2212 Daughter of KCMH2088 5/19 fever
KCMH2088 4/27 fever 4/29 Ward X14 5/9 expired
KCMH2284 Daughter of KCMH1590 5/21 fever
KCMH2285 Daughter-in-law of KCMH2088 5/21 fever
KCMH2570 Wife of KCMH1590 5/23 fever
KCMH2724 Grandson of KCMH2088 5/23 fever
KCMH1047 4/27 fever Daughter-in-law of KCMH1355 4/25~4/27 took care KCMH1355
KCMH1048 Daughter of KCMH1047 4/25~4/27 took care KCMH1355 5/2 fever
KCMH1002 Daughter of KCMH1355 4/29~30 took care KCMH1355 5/2 fever
KCMH1207 Son of KCMH1355 Beginning 4/8, to care KCMH1355 5/6 fever
KCMH1356 4/8 ward X03 4/30 fever 5/5 expired
KCMH1273 4/28-5/8 Ward X03 5/8 fever
KCMH1428 Daughter of KCMH1271 5/12 fever5/19 expired
KCMH1319 Wife of KCMH1271 5/11 fever
KCMH1270 Nurse aide for KCMH1271 5/7 fever 5/11 expired
KCMH1272 5/8 fever(Husband lived in ward X05, no symptoms) 4/28 discharge
KCMH1619 Wife of KCMH1574 5/10 fever 5/18 expired
KCMH1081 4/30 fever Ward X18 4/30 discharge
KCMH1407 4/22~5/1 Ward X11 5/2-5/9 Ward X21 5/13 fever 5/16 expired
KCMH1828 4/24~26 Ward X04 5/13 fever 6/11 expired
KCMH1617 4/21-28 Ward X03 5/7 fever
KCMH1624 5/5~5/8 contact with KCMH1356 and KCMH1355 5/14 fever 5/27 expired
KCMH2373 5/5 5/8 5/11-15 contact with CMH1356 KCMH1355 and KCMH2373 5/22 fever
KCMH1399 Nurse 5/11 fever
KCMH1474 Nurse 5/11 fever
KCMH1475 RT 5/11 fever
KCMH1476 Nurse 5/10 fever
KCMH1565 Wife of KCMH1564 5/14 fever
Patients
Patient families
Medical personnel
Funeral service workers
25
SARS Outbreak in an Hospital Emergency Room(Person-Time-Place link)
medical personnel patient
Case 1311 5/7 fever Case 1494 5/13 fever
5/1 dinning together
Case 2523 Wife of #1494
5/10 fever
Case 892 peddler
4/27 fever 5/4ER 5/5 died
Case 1287 5/4ER adjacent bed 5/10 fever 5/21 died
Case 2000 5/4ER adjacent bed 5/16 fever
Case 381 Hoping Hosp.
MI22 ward 4/26 fever 5/7 died
Case 1340 Brother of #1340 5/12 fever
Case 1583 Dr. Chou 5/4 5/9 fever
Case 1582 staff 5/4 ER 5/11 fever
Nurse Chao Night shift 5/4 ER, 5/9 fever Nurse Chang Midnight shift 5/4 ER, 5/10 fever
Case 1119 4/28 MI22 ward 5/7 fever
Case 974 4/28 MI22 ward 5/4 fever
Case 1604 Mother of #892
5/16 fever
# 974
nurse
nurse
Attendance of Prevention and Control of Natural Disasters
• National– the Chi-Chi Earthquake (1999.9.21.)– Typhoon Mindulle.(2004.7.)
• International–South Asia's tsunami (2004.12.26.)
Achievements of FETP Trainees
• Job performance• Academic performance• Presentations in Domestic Conference• Presentations in International Conference• Published papers
Presentations in Domestic Conference
• Taiwan Public Health Association• 1998 (4 oral), 2001 (6 oral), 2002 (6 oral, 2
poster)• Chinese Microbiology and Immunology
Association• The Infectious Diseases Society of Taiwan
Presentations in International Conference
The 3rd TEPHINET Global Scientific Conference 8-12 November 2004, Beijing, China.
• Su Li-Mei, Chiao LM, Yang SS, et al.: A Viral Gastroenteritis Outbreak Associated with Person-to-person Transmission in Respiratory Care Wards.(poster)
• Lee Wang-Ping, Hung CJ, Ou CL , et al.: Imported Shigellosis in Connection with Travelers from Bali Island, Indonesia (poster)
Presentations in International Conference
The 3rd Biregional TEPHINET Scientific Conference 9-12 January 2006, Chennai, India
• Shiou-Hwa Wang, Chen YC, Jiang DD, et al: Development of Fever or Diarrhea Risk Without Taking Preventive Measures in Healthcare Workers Caring for SARS Patients. (oral)
• Shih Hsiu, Hsu YH, Jiang DD: Outbreak of gastroenteritis due to norovirus infection in a training institution, 2005.(oral)
Presentations in International Conference
The 4th TEPHINET Global Scientific 12-17 November 2006, Brasilia, Brazil.
• Lai Chaochih, Jiang DD, Wu FT, et al.:Detectingpathogens and risk factors for sporadic gastroenteritis in an ED-based matched case-control study. (poster)
• Tsai Yi-Chen, Lai C, Jiang DD: A Gastroenteritis Outbreak Due to Norovirus Infection in a Long-Term Care Hospital.(poster)
Presentations in International ConferenceThe 4th TEPHINET Southeast Asia/Western Pacific Bi-Regional Scientific Conference
26-30 November, Taipei, Taiwan.• Yang Chin-Hui : The efficacy of universal prenatal HIV screening and the effect of
perinatal prophylaxis to prevent maternal-to-child HIV transmission in Taiwan, 2005-2006. (oral)
• Liu Yu-Lun: The Timely Disease Monitoring By Using Real-Time Outbreak and Disease Surveillance (RODS) System in Taiwan: Preliminary Results. (oral)
• Chan Pei-I Chun: Extrapulmonary TB in children, did we do enough contact tracing? (oral)
• Chen Ju-Hsin: An analysis of Coxsackie B3 enterovirus outbreaks in Taiwan in 2005.(poster)
• Peng Mei-Chen: The Effect of Pneumococcal Vaccination in the Elderly, NantouCounty, Taiwan, 2006. (oral)
• Yeh Hui-Chu: An Outbreak Investigation of Unknown Cause Respiratory or GI Symptoms at a Secondary School Located in Hualien City. (oral)
• Kao Chuan-Yin: Imported measles cases from Japan in Taiwan, MayXJune 2007. (oral)
• Lee Tsuey-Fomg: Confirmation of Homologous Strains as the Cause of Bacillary Dysentery Outbreaks in Nanjhuang Township of Miaoli County and HepingTownship of Taichung County by Molecular Epidemiology - Taiwan, 2005-2006.(poster)
Presentations in International ConferenceThe 5th TEPHINET Global Scientific Conference,
November 1~6, 2008, Kuala Lumpur, Malaysia.• Pinhui Lee, D. Jiang. A Tuna Spaghetti Induced
Outbreak of Norovirus Gastroenteritis at A High School —Yun-Lin County, Taiwan, March 2008. (oral)
• Shih-Chuan Wang, Song-En Huang, Donald Jiang, et al. Nosocomial Measles Outbreak following an Imported Case, January - March 2009 in Northern Taiwan. (oral)
• Chin-Mei Lu, Donald Jiang. Histamine-Induced Food Poisoning Outbreak in among Junior/ Senior High School Students - A Case-Control Study. (poster)
Presentations in International Conference
The 5th TEPHINET Southeast Asia and Western Pacific Bi-Regional Scientific Conference, November 2~6, 2009. Seoul, Korea.
• Chiao-Wen Lin, Song-En Huang, Donald Jiang. Evaluation of Timeliness, Representativeness, and Positive Predictive Value National NotifiableDiseases Surveillance System in Detecting Dengue Fever between 2004 and 2008 in Taiwan. (oral)
Research Projects and Published Papers
• 52 long term projects (1995~2006).• 97 published papers (Chinese 48, English 31,
SCI 8) (2000~2011).
Salute to Dr. Malison
FETP, We Are a Family
Goodbye~~ I miss you all~~~
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