review of fetp training and field investigationhomepage.ntu.edu.tw/~ntuidrec/file/20141017/2... ·...

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



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


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



KCMH1475 RT 5/11 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)


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)


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)


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~~~

review of fetp training and field investigationhomepage.ntu.edu.tw/~ntuidrec/file/20141017/2... ·...

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