2009年8月14日

[知識分享站] 八八水災特稿（一）：預防災害擴大第一步－落實公共衛生監測

八月八日的莫拉克颱風來襲造成了台灣50年來未見的嚴重水災，洪水與土石流的重創帶走了摯愛的家人以及賴以為生的家園，更嚴重的阻礙了災後搜救的腳步。即使返回積水退去的家園，後續的環境清理、災民身心健康照護、家園重建、國土重新規劃等等，還有非常多的事項需要我們長期積極的關心與注意。尤其是這次水災重創南台灣，農損超過九十億，大量死亡的家禽家畜泡在水中腫脹發臭，再加上水災後可能爆發的皮膚病和傳染病的流行，必須趕快展開相關公共衛生的處置措施。為了避免進一步疫病的爆發，最重要的是必須提供乾淨安全的水來清理環境，並且透過煮沸的程序來加強飲用水的安全，以避免在水災過後另一波疾病的侵襲。

這幾年由於氣候變遷的影響，極端氣候在全球各地不斷發生，長久的酷熱天氣與短時間的大量降雨，全球各地的旱災與水災不斷的交替發生，而且規模越來越大。水災過後的疫病爆發也成為公共衛生的熱門課題。以公共衛生資料庫Global Health來查閱相關文獻資料可以發現，與洪水或水災相關的公共衛生文獻資料超過1000篇。(使用關鍵字：Flood 或 Flooding）

在檢視這些文獻資料的主題分布後，我們再加上人類疾病與疾病預防兩個主題以及文獻相關度作深入的資料篩選，先行篩選出2000年至今的相關文獻如下。
  1. Bansal, R. K., Tripathi, V. S., Desai, V. K., & Singh, A. (2007). Concerted health efforts prevent and contain diseases after floods disaster in Varachha Zone of Surat. [Correspondence]. Indian Journal of Community Medicine, 32(3), 232-233.
  2. Brandt, M., Brown, C., Burkhart, J., Burton, N., Cox-Ganser, J., Damon, S., et al. (2006). Mold prevention strategies and possible health effects in the aftermath of hurricanes and major floods. (Mold Prevention Strategies and Possible Health Effects in the Aftermath of Hurricanes and Major Floods). [Journal issue]. Morbidity and Mortality Weekly Report, 55(RR-8), 1-27.
  3. Campanella, N., & Tarantini, F. (2000). Incidence of some infectious diseases in an area of Nicaragua seriously affected by Hurricane Mitch. Igiene Moderna, 113(3), 209-223.
  4. Conly, J. M., & Johnston, B. L. (2005). Natural disasters, corpses and the risk of infectious diseases. Canadian Journal of Infectious Diseases & Medical Microbiology, 16(5), 269-270.
  5. Connolly, M. A. (2005). Communicable disease control in emergencies: a field manual. [Book]. Communicable disease control in emergencies: a field manual, 295.
  6. Cummings, K. J., Cox-Ganser, J., Riggs, M. A., Edwards, N., & Kreiss, K. (2007). Respirator donning in post-hurricane New Orleans. Emerging Infectious Diseases, 13(5), 700-707.
  7. Flooding and communicable diseases fact sheet. (2005). Weekly Epidemiological Record, 80(3), 21-28.
  8. Federal Emergency Management Agency. (2009, 04 August 2009). Disaster Preparation and Recovery. Retrieved 14 August 2009.
  9. Goyet, C. d. V. d., Marti, R. Z., & Osorio, C. (2006). Natural disaster mitigation and relief. [Book chapter]. Disease control priorities in developing countries, 39.
  10. Kanbara, H., & Moji, K. (2007). Proceedings of the 47th Annual Meeting of Japanese Society of Tropical Medicine and the 21st Annual Meeting of Japan Association for International Health, Nagasaki, Japan, 11-13 October 2006. [Journal issue; Conference proceedings]. Tropical Medicine and Health, 35(2), 65-237.
  11. Kario, K., Shimada, K., & Takaku, F. (2005). Management of cardiovascular risk in disaster: Jichi Medical School (JMS) Proposal 2004. JMAJ - Japan Medical Association Journal, 48(7), 363-376.
  12. Kshirsagar, N. A., Shinde, R. R., & Mehta, S. (2006). Floods in Mumbai: impact of public health service by hospital staff and medical students. Journal of Postgraduate Medicine, 52(4), 312-314.
  13. Linscott, A. J. (2007). Natural disasters - a microbe's paradise. Clinical Microbiology Newsletter, 29(8), 57-62.
  14. Merlin-Scholtes, J., Narain, J., Chunsuttiwat, S., Hyde-Price, C., Dubois, P. F., & Sorensen, E. (2005). Health protection and disease prevention: a critical review of experience. [Conference paper]. Prehospital and Disaster Medicine, 20(6), 385-388.
  15. Morgan, O. (2004). Infectious disease risks from dead bodies following natural disasters. Revista Panamericana de Salud Publica/Pan American Journal of Public Health, 15(5), 307-312.
  16. Qi, Z. (2008). Infectious disease-related pathogens and their prevention and control strategies after earthquakes. Academic Journal of Second Military Medical University, 29(6), 590-593.
  17. Reba, K., Shashikala, Karunasagar, I., Srinivasan, S., Devi, S., Venkatesh, K., et al. (2007). Contamination of community water sources by potentially pathogenic vibrios following sea water inundation. Journal of Communicable Diseases, 39(4), 229-232.
  18. Shen, J. (2009). An investigation of disease surveillance in a disaster area caused by the typhoon "Saomai". Journal of Tropical Medicine (Guangzhou), 9(3), 326-328.
  19. Shi, L. Y., Tsai, J., & Kao, S. (2009). Public health, social determinants of health, and public policy. Journal of Medical Sciences, 29(2), 43-59.
  20. Zhang, L., & Chen, C. (2007). Evaluation of results of health education and promotion during emergent disasters and disease prevention in Linhai City. China Tropical Medicine, 7(3), 485-486.
  21. World Health Organization. (2006). Communicable disease following natural disasters - Risk assessment and priority interventions.

綜合數篇文獻我們可以發現幾個重點：
  1. 腹瀉與發燒是監測水災過後是否會爆發另一波疾病高峰的重要指標
  2. 世界衛生組織於2005年即針對水災後的風險評估與公共衛生監測提出了一個完整的說明文件可供參考。（7,21）
  3. 美國國會醫學圖書館的線上資源MedlinePlus從公衛的角度，從天災前的準備與復原提供了一套非常完整的資訊。（8）
透過完整的文獻搜尋與整理，可以幫助我們在現有的救災實務經驗中再加上理論依據，加快在災後對於公共衛生監測的速度和廣度，讓災民可以儘快回復原來的生活。
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