Analysis on District Medical Resources and Preparedness Gap on the Health Outcomes of the 2009 H1N1 Influenza Pandemic in Taiwan
Yu-Chen Hsu1, Yi-Ta Yang1, Shih-Yan Yang1, Shu-Mei Chou2, Jen-Hsiang Chuang3
2011 Vol.27 NO.22
Correspondence Author： Yu-Chen Hsu
To examine and revise the pandemic influenza preparedness and response plan , and to help policy makers decide how to distribute medical resources, we analyzed the relationship between the clinical outcomes of the 2009 H1N1 pandemic, including the proportion of patients with severe complications and deaths, and the distribution of medical resources and the level of pandemic preparedness during the H1N1 epidemic between 2009 and 2010 in Taiwan. Questionnaires were distributed to hospitals and health authorities in all 25 counties and cities in Taiwan, evaluating the healthcare services, laboratory testing results, and distribution of medical resources between March and May, 2009. The preparedness in response to pandemic influenza of the 25 county and city governments was reviewed by the Taiwan Centers for Diseases Control (Taiwan CDC) using a structured evaluation in October, 2008. The numbers of severe influenza-related complications and deaths notified through the Communicable Disease Reporting System between July 1, 2009 and
June 30, 2010 were analyzed using regression model. As a result, 264 questionnaires from local health bureaus and 226 questionnaires from hospitals and clinics were returned; the response rates were 71% and 46% respectively. The number of severe influenza-related complications was 939, and 44 patients died. Increasing antiviral stockpile to cover additional 0.01% of our population can statistically decrease 1% of the risk of severe flu-associated complication (p=0.001). Increasing 1% of preparedness also can statistically decrease 1.6% of the risk of severe flu-associated complication (p<0.001). Although not statistically significant, increasing 1% of preparedness can decrease 2% of the risk of flu mortality. According to this study, medical resources and preparedness were associated with severe influenza-related complications but not associated with death, which might be due to the fact that the 2009 H1N1 pandemic was moderate in severity, and the convenience and proximity of medical care facilities in areas with sufficient medical resources. The relatively low number of deaths (44) probably associated with the vaccination campaign may also result in the insignificant analysis result. The number of flu clinics was highly associated with the antiviral stockpile and the antiviral successfully lowered the risk of severe influenza-related complications. Although there were differences in the distribution of medical resources and the level of preparedness among counties and cities, the distribution of medical resources was planned and controlled by a central command center during the pandemic, and the influence of the minimal geographic difference was insignificant. However, because the difference in the level of preparedness in different counties and cities did affect the risk of severe influenza-related complications and death, maintaining the same level of preparedness is of great importance. We recommended that evaluation of preparedness should be taken into consideration when making policies in response to communicable diseases.