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Evaluation of Taiwan's Syndromic Surveillance System after
the Severe Acute Respiratory Syndrome --- Taiwan, 2003
Frank Fuh-Yuan Shih,1,2 M-Y.
Yen,3 F-K. Chang,4 L-W. Lin,4 J-S. Wu,4 C-A. Hsiung,5 M-S. Ho,6 I. Su,3 M. Marx,7 H. Sobel,8 C-C. King1
1College of Public Health, National Taiwan University, Taipei, Taiwan; 2National Taiwan University Hospital, Taipei, Taiwan;
3Jen-Ai Municipal Hospital, Taipei, Taiwan; 4Center for Disease Control, Taipei, Taiwan; 5National Health Research Institute, Taipei, Taiwan;
6Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; 7New York City Department of Health and Mental Hygiene, New York, New York; 8World Health Organization, Geneva, Switzerland
Corresponding author: Chwan-Chuen King, Institute of Epidemiology, College of Public Health, National Taiwan University, 1 Jen-Ai Road, Section 1, Taipei, Taiwan (100). E-mail: a1234567@ccms.ntu.edu.tw.
Abstract
Introduction: Taiwan's clinical syndromic surveillance system faced substantial challenges during the 2003
outbreak of severe acute respiratory syndrome (SARS).
Objectives: This study aimed to evaluate the feasibility of syndromic surveillance for health-care workers
and delineate obstacles to the reporting process.
Methods: Six months after the SARS outbreak, self-administered, structured questionnaires were mailed to
270 Taiwan health-care workers at medical centers, community hospitals, and other health-care facilities.
The questionnaire gathered information about demographics, difficulties in reporting, reasons for delayed reporting or underreporting, and types of information health-care workers expected for feedback. Chi-square and paired t-tests were used for data analysis.
Results: A total of 229 completed questionnaires (84.8%) were analyzed. Respondents cited the following
problems in reporting SARS cases: waiting for laboratory data (48%), ambiguous clinical presentations (45%), and protection of patient privacy (45%). Health-care workers in medical centers expressed greater concern about rigorous control from hospital authorities but had less difficulty in arranging consultations and were less influenced by mass media.
By contrast, health-care workers in community hospitals waited longer for treatment responses, had
more consultation regarding confusing laboratory results, and experienced more pressure from patients and their relatives not to report their illnesses. Respondents cited a need for improved guidelines, recommendations,
standard operating procedures, and the effectiveness of prevention and control measures.
Conclusions: Future SARS surveillance in Taiwan requires simplified case definitions with different levels
of confirmation, built-in mechanisms to prevent release of confidential information, enhanced
infection-control training, timely communication of appropriate feedback information; and enhanced use of information
technology to simplify the reporting process and integrate different data sets.
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