http://0rz.tw/a433H
這是在2005年IHR時的相關討論，可以了解到印尼、土耳其、羅馬尼亞所面臨的困境
在禽流感及剛過的SARS問題上，疾病流行的爆發所存在的經濟損失。
Calls for more money as the threat looms ever larger
Nov 11th 2005
From Economist.com
At a meeting in Geneva, development banks and health agencies have called for much more money to respond to the outbreak of bird flu and the threat of a human pandemic. Rich countries are working on their own plans in case the co-ordinated global response fails
IN RECENT weeks, the world’s public health officials have been afflicted with a sort of pandemic of meetings about bird flu. Much of this culminated, this week, in a meeting of officials from nations around the world at the headquarters of the World Health Organisation (WHO) in Geneva. Plans were hatched for how best to respond to the threat from a virus that is threatening poultry around the world and which, it is feared, may trigger a pandemic of human flu. And money was discussed. Lots of it.
The meeting revealed a broad consensus that the best short-term strategy was to tackle and eliminate the animal disease. Already, 150m birds have been culled around the world. Countries such as Japan and Malaysia have reacted quickly to eliminate outbreaks of highly pathogenic bird flu and have now been declared free from virus. However, poor countries in Asia such as Vietnam, Cambodia, Thailand and Laos have neither the veterinary facilities for surveillance, the laboratories to test samples, nor the ability to respond swiftly to eradicate outbreaks. It is increasingly clear that the world’s richer nations will have to pay for these countries to raise their capacity in these areas.
While everyone seems to agree that the best strategy for dealing with the threat of a human pandemic is to control flu in birds, little clarity emerged in Geneva on how money would be allocated. The World Bank said it would create a programme to make $500m available to countries in South-East Asia struggling to contain the outbreak; overall, the bank believes that up to $1 billion will be needed over the next three years to handle the poultry crisis. In addition, the Asian Development Bank said it could commit at least $470m (as a mixture of grants and loans) to support Asia’s response—a sum that also includes money to help countries stockpile drugs.
In the short term, international agencies such as the WHO, the Food and Agriculture Organisation (FAO) and the World Organisation for Animal Health (OIE) say they need about $35m to respond. They are worried that some countries appear to be overwhelmed by the disease. There is also great concern that flu might be carried to poor African nations by migrating birds. It has already spread to the edges of the European Union: last month, the deadly H5N1 strain of the virus was confirmed in poultry in Turkey and Romania. And on Friday, Kuwait announced the first confirmed case in the Middle East.
There is likely to be more clarity in January as to how all this money would be allocated, at yet another bird-flu meeting. However, some overlapping requirements are already emerging. The FAO and OIE have for some time had a largely unfunded global strategy for fighting avian flu. As the disease spreads to new countries, the costs of this plan are spiralling—from $100m earlier this year to $500m now. So far, less than a tenth of this has been made available. Instead, much of the money being discussed by the big international lenders will go directly to individual countries.
More information also emerged this week on the cost-effectiveness of such spending. Milan Brahmbhatt, lead economist for the East Asia and Pacific region at the World Bank, pointed out that while there were huge uncertainties over the severity of any future flu pandemic, the disruption caused by the SARS virus in 2003 led to $200 billion of economic losses in one three-month period. Because a human pandemic could easily cause disruption lasting a year, reports suggest it would cost some $800 billion in global losses; America alone could suffer losses of $100 billion-200 billion from a pandemic that made 50m people ill and killed between 100,000 and 200,000. The Asian Development Bank reckons that a demand shock from a severe outbreak would cause up to $283 billion in damage to Asia’s economies and could tip the world economy into recession.
Although the disease is currently a threat mainly to poultry, many are worried about the supply of anti-viral drugs and vaccines for a human pandemic. Some countries are reported to be stockpiling enough anti-virals for 25% of the population, while others have little or no access to such medicines because of their high costs or shortage of stocks.
So far, 50 countries have placed orders with Roche, a Swiss company, for its drug Tamiflu, which is one of two anti-viral treatments thought to be effective in protecting humans from bird flu. Margaret Chan, assistant director-general of communicable diseases at the WHO, hinted on Wednesday that further funding for new stockpiles of anti-virals was likely to be announced soon, including additional money from the World Bank.
Although the supply of Tamiflu currently outstrips demand, Roche is ramping up production in anticipation of a sharp rise in orders. This year, the company plans to produce 55m doses, a tenfold increase on its capacity in 1999; this is expected to rise to 150m in 2006 and 300m in 2007. Although Roche is delivering the drug on a first-come-first-served basis, there have been some notable exceptions to this rule: the company was quick to send tens of thousands of packs to Indonesia, Turkey and Romania during their recent outbreaks.
So far, Roche has been approached by 150 companies and countries that are interested in working with the firm to produce Tamiflu. Most, though, only have the capability to put the active ingredient into capsules, as opposed to making it themselves. Although there have been reports that Roche will supply ingredients and know-how to allow Vietnam to manufacture the drug, in fact the ongoing negotiations are only about encapsulation. Of the 64 people who have so far died of bird flu, 42 were infected in Vietnam.
Roche says it wants to select partners by the end of November to help it speed up its own processes and add production capacity. Some countries and companies have said they will reverse-engineer and produce Tamiflu without help from Roche; it emerged this week that Chinese government scientists are trying to develop their own version of the drug. A Roche spokesperson said on Wednesday it would do everything it can to avoid this, and that it was “not on a collision course with any government in the world”. The company currently charges governments in rich countries €15 ($18) per course of ten Tamiflu tablets, and those in poor countries €12. It says this is well below its normal price, and rules out further reductions.
The big question, though, is how prepared the world’s governments want to be. The level of 25% (of population covered by stockpiles) is based on previous pandemics that suggest about a quarter of all people would get sick. Some countries have ordered more than this so that emergency workers can take the drug continuously to prevent them catching the virus.
Last week, the United States revealed that it would spend $7.1 billion preparing for a flu pandemic. Much of this money will be spent on buying drugs, while only $250m will be made available for foreign assistance. Such a wide disparity between the finance available for national and international programmes is by no means unique. While the most rational way to tackle the problem is to focus resources on stamping out highly contagious bird flu in a co-ordinated global way, rich countries are obliged to draw up their own fall-back plans in case such a strategy fails. However, the costs of responding at home are far higher than elimination at source.
2007年9月7日 星期五
How Dr Chan intends to defend the planet from pandemics
關於這次SEAR會議，我想要負責處理SEAR會員國的印尼針對辛布宣言裡面所重視的部份進行探討它的因素！
光狐
http://0rz.tw/a931U
The World Health Organisation
基本上講述印尼為什麼不提供禽流感病毒樣本的原因來自於窮國雖然提供疾病的樣本，但是卻無法拿到足夠的疫苗來預防疾病，而這些國家卻也是最有可能爆發流行的國家。所以這就是現在的WHO秘書長陳馮富珍所以想辦法解決的問題。
How Dr Chan intends to defend the planet from pandemics
Jun 14th 2007 | GENEVA
From The Economist print edition
The new powers vested in a UN agency's boss should, in theory, cut the risk of killer diseases raging round the world
WITH its big electronic screens and global satellite links, the command centre feels like the heart of a vast military campaign. Every morning, there are strategy sessions to mull the latest intelligence, and rapid-response teams are sent to remote places at the commander's bidding.
In this case, the control room answers not to any general, but to the World Health Organisation (WHO)—the Geneva-based United Nations agency whose job is to monitor and respond to infectious diseases. In recent years, it has nipped in the bud over six dozen outbreaks that could have led to global crises. Unless outbreaks are spotted early, and virus strains shared with researchers worldwide, there is a recurring risk of a pandemic similar to the strains of influenza which caused havoc over the past century (see table).
That may sound obvious, but in practice, countries don't always help the WHO. In 2002, when the respiratory disease dubbed SARS emerged in China, the authorities hid the early signs for fear of hurting trade and tourism. More recently, Indonesia has been mired in a more intractable dispute—raising hard questions about the balance of economic power in the world.
Last year, the Indonesians stopped giving the WHO samples of the H5 virus which is responsible for avian flu, a disease that has forced a mass slaughter of poultry in many countries and could, if it mutates, cause a deadly epidemic among humans. Indonesia won some sympathy for its complaint that it was giving away precious intellectual property, while it might well be unable to afford the vaccines which are then developed. There was little the WHO could do in response.
However the agency's hand will be strengthened by a treaty that enters force on June 15th. The new “international health regulations” (IHRs) oblige governments to co-operate with Margaret Chan, the WHO's director-general, and report potential pandemics at once. If it succeeds, this could lead to a “good-governance revolution” in disease prevention, says David Fidler of Indiana University.
But will it work? Sceptics are not short of arguments. The new system requires countries to do a lot of things to improve public health, but provides no money. Implementing the treaty could prove hard in federal states like Canada and the United States, adds Kumanan Wilson of the University of Toronto; some of the actions required by the IHRs are handled at state or provincial level. Even so, the IHRs have one advantage over treaties like the Kyoto protocol on climate change. At least in the short term, Kyoto imposes heavy costs on some countries that are hard to explain to voters. But every country has an immediate, obvious interest in avoiding pandemics. That, in principle, could put a great deal of power in Dr Chan's hands.
The new treaty commits countries to tell her within 24 hours of any emerging global health threat, something they have often failed to do. In a break with normal UN practice, the WHO will no longer be required only to rely on data from member governments: it can now use non-government sources, including the press and the internet, in its surveillance. If a country tries to hide vital data about a potential pandemic, Dr Chan can override national sensitivities and ring the alarm bells.
That sounds promising, but it does not quite deal with the problem raised by Indonesia. Poor countries, where most potential pandemics start, rarely have the health facilities or vaccine-making capacity to combat a serious outbreak on their own; they rely on external help and vaccine imports. They complain that big firms in rich countries are exploiting their vulnerability. Indonesian officials put it bluntly: why should they hand over precious virus strains when the resultant vaccine may never benefit their people?
The Indonesians have a point. It is true that most of the factories that make pandemic vaccines are located in rich countries, and those plants cannot make enough to cover even the rich world's needs. And in previous global health panics, it has been obvious that rich states think of their own voters first. So at a WHO assembly in May, rich countries agreed that the poor must have access to life-saving vaccines in the event of a pandemic; Indonesia duly agreed to share its virus samples again. On June 13th Dr Chan announced plans to create a global stockpile of avian flu vaccine with the help of donations from GlaxoSmithKline, a British drugs firm, and others.
Fine, but how exactly any strategic stockpile will be split up during a global pandemic remains a mystery. The new rules do not offer much help on that front.
What Indonesia and other poor states really want is to have vaccine-making units within their borders. The WHO has helped a few poor countries to start such plants, but the technology involved is tricky. Not every country in the world can expect to have such factories; and those that do may well resist the idea of helping rival states. As Laurie Garrett of America's Council on Foreign Relations notes, Indonesian politicians would balk at sharing vaccines with Papua New Guinea. That explains why stockpiling and building new factories are partial answers at best to the global challenge.
Perhaps the best reason to take the IHRs seriously is that by making it harder for governments to hide pandemic data, they make innovation more likely. And innovation is desperately needed: today's vaccines cannot be made in the volume needed for the whole world, and they cannot keep up with the evolution of some virus strains. But as Joseph Hogan of GE, an industrial firm with a health division, points out, smarter vaccines and more efficient manufacturing may solve that problem. Vijay Samant of Vical—one of several firms now investing heavily in a new generation of pandemic technology—also welcomes the increased powers for Dr Chan and her agency. “Without access to the latest strains, researchers can't come up with new vaccines,” he argues. Dr Chan faces a big job, and big expectations.
光狐
http://0rz.tw/a931U
The World Health Organisation
基本上講述印尼為什麼不提供禽流感病毒樣本的原因來自於窮國雖然提供疾病的樣本，但是卻無法拿到足夠的疫苗來預防疾病，而這些國家卻也是最有可能爆發流行的國家。所以這就是現在的WHO秘書長陳馮富珍所以想辦法解決的問題。
How Dr Chan intends to defend the planet from pandemics
Jun 14th 2007 | GENEVA
From The Economist print edition
The new powers vested in a UN agency's boss should, in theory, cut the risk of killer diseases raging round the world
WITH its big electronic screens and global satellite links, the command centre feels like the heart of a vast military campaign. Every morning, there are strategy sessions to mull the latest intelligence, and rapid-response teams are sent to remote places at the commander's bidding.
In this case, the control room answers not to any general, but to the World Health Organisation (WHO)—the Geneva-based United Nations agency whose job is to monitor and respond to infectious diseases. In recent years, it has nipped in the bud over six dozen outbreaks that could have led to global crises. Unless outbreaks are spotted early, and virus strains shared with researchers worldwide, there is a recurring risk of a pandemic similar to the strains of influenza which caused havoc over the past century (see table).
That may sound obvious, but in practice, countries don't always help the WHO. In 2002, when the respiratory disease dubbed SARS emerged in China, the authorities hid the early signs for fear of hurting trade and tourism. More recently, Indonesia has been mired in a more intractable dispute—raising hard questions about the balance of economic power in the world.
Last year, the Indonesians stopped giving the WHO samples of the H5 virus which is responsible for avian flu, a disease that has forced a mass slaughter of poultry in many countries and could, if it mutates, cause a deadly epidemic among humans. Indonesia won some sympathy for its complaint that it was giving away precious intellectual property, while it might well be unable to afford the vaccines which are then developed. There was little the WHO could do in response.
However the agency's hand will be strengthened by a treaty that enters force on June 15th. The new “international health regulations” (IHRs) oblige governments to co-operate with Margaret Chan, the WHO's director-general, and report potential pandemics at once. If it succeeds, this could lead to a “good-governance revolution” in disease prevention, says David Fidler of Indiana University.
But will it work? Sceptics are not short of arguments. The new system requires countries to do a lot of things to improve public health, but provides no money. Implementing the treaty could prove hard in federal states like Canada and the United States, adds Kumanan Wilson of the University of Toronto; some of the actions required by the IHRs are handled at state or provincial level. Even so, the IHRs have one advantage over treaties like the Kyoto protocol on climate change. At least in the short term, Kyoto imposes heavy costs on some countries that are hard to explain to voters. But every country has an immediate, obvious interest in avoiding pandemics. That, in principle, could put a great deal of power in Dr Chan's hands.
The new treaty commits countries to tell her within 24 hours of any emerging global health threat, something they have often failed to do. In a break with normal UN practice, the WHO will no longer be required only to rely on data from member governments: it can now use non-government sources, including the press and the internet, in its surveillance. If a country tries to hide vital data about a potential pandemic, Dr Chan can override national sensitivities and ring the alarm bells.
That sounds promising, but it does not quite deal with the problem raised by Indonesia. Poor countries, where most potential pandemics start, rarely have the health facilities or vaccine-making capacity to combat a serious outbreak on their own; they rely on external help and vaccine imports. They complain that big firms in rich countries are exploiting their vulnerability. Indonesian officials put it bluntly: why should they hand over precious virus strains when the resultant vaccine may never benefit their people?
The Indonesians have a point. It is true that most of the factories that make pandemic vaccines are located in rich countries, and those plants cannot make enough to cover even the rich world's needs. And in previous global health panics, it has been obvious that rich states think of their own voters first. So at a WHO assembly in May, rich countries agreed that the poor must have access to life-saving vaccines in the event of a pandemic; Indonesia duly agreed to share its virus samples again. On June 13th Dr Chan announced plans to create a global stockpile of avian flu vaccine with the help of donations from GlaxoSmithKline, a British drugs firm, and others.
Fine, but how exactly any strategic stockpile will be split up during a global pandemic remains a mystery. The new rules do not offer much help on that front.
What Indonesia and other poor states really want is to have vaccine-making units within their borders. The WHO has helped a few poor countries to start such plants, but the technology involved is tricky. Not every country in the world can expect to have such factories; and those that do may well resist the idea of helping rival states. As Laurie Garrett of America's Council on Foreign Relations notes, Indonesian politicians would balk at sharing vaccines with Papua New Guinea. That explains why stockpiling and building new factories are partial answers at best to the global challenge.
Perhaps the best reason to take the IHRs seriously is that by making it harder for governments to hide pandemic data, they make innovation more likely. And innovation is desperately needed: today's vaccines cannot be made in the volume needed for the whole world, and they cannot keep up with the evolution of some virus strains. But as Joseph Hogan of GE, an industrial firm with a health division, points out, smarter vaccines and more efficient manufacturing may solve that problem. Vijay Samant of Vical—one of several firms now investing heavily in a new generation of pandemic technology—also welcomes the increased powers for Dr Chan and her agency. “Without access to the latest strains, researchers can't come up with new vaccines,” he argues. Dr Chan faces a big job, and big expectations.
2007年9月6日 星期四
WHO’s Regional Committee for South-East Asia calls for continued solidarity to tackle the health challenges
這篇大致上是在描述東南亞國家面臨的一些問題
裡面有提到一個基金
還有提到下次(61屆)會在印度新德里舉辦
Thimphu, Bhutan, 3 September, 2007: The 60th session of WHO’s Regional Committee for South-East Asia concluded here today with a call for continued solidarity and joint endeavours for health development by Member countries. It noted with satisfaction the progress in the implementation of WHO’s collaborative programmes and activities in the Region.
The session took several momentous decisions and would be viewed, “As the session where regional solidarity and togetherness were further strengthened”, said Dr Samlee Plianbangchang, Regional Director for WHO South-East Asia Region.
Member countries of WHO’s South East Asia Region account for approximately 25% of the world population. However, they bear 40% of the world’s disease burden. The Region has the largest number of children missed by immunization, the highest number of deaths from measles, and from complications of pregnancy and childbirth.
Notably, the Committee adopted a resolution to establish the South-East Asia Regional Health Emergency Fund (SEARHEF). The Region is vulnerable to natural and man-made emergencies which impact human health, and accounted for 58% of deaths due to disasters worldwide. This Fund would provide financial support to Member Countries in the first three months after the onset of an emergency. It would be an instrument to tide over affected Member countries in the face of an emergency. The Fund is not meant to finance bulk relief, recovery, reconstruction and rehabilitation which are funded by established mechanisms like Flash Appeals, Consolidated Appeals Process (CAP) and Central Emergency Response Fund (CERF) The Fund would build a corpus from within countries and by raising voluntary contributions. Thailand announced a contribution of US $100,000 for the Fund, during the Regional Committee session.
The Committee deliberated on several issues of regional priority including: i)Nutrition and food safety, ii)Scaling up prevention and control of chronic noncommunicable diseases, iii) TB control iv)Revised malaria control strategy, v)Avian and pandemic influenza preparedness, vi) Public health, innovation and intellectual property rights, and vii) WHO and reforms of the UN system.
The Regional Committee decided that the Technical discussions in 2008 would be on the subject of “Revitalising Primary Health”.
The Regional Committee decided that its 61st session would be held at the SEARO office in New Delhi.
For any clarification or additional information, please contact Ms Vismita Gupta-Smith, the Public Information and Advocacy officer, phone: 91-11-23370971 and mobile: 91- 9871329861 Email: guptasmithv@searo.who.int and Ms Harsaran Pandey, STP-Information Officer, at telephone: 011 23309 465; mobile: 9811021001, email pandeyh@searo.who.int.
All press releases, fact sheets and other WHO media material may be found at: www.searo.who.int.
http://www.searo.who.int/en/Section316/Section503/Section2358_13505.htm
裡面有提到一個基金
還有提到下次(61屆)會在印度新德里舉辦
Thimphu, Bhutan, 3 September, 2007: The 60th session of WHO’s Regional Committee for South-East Asia concluded here today with a call for continued solidarity and joint endeavours for health development by Member countries. It noted with satisfaction the progress in the implementation of WHO’s collaborative programmes and activities in the Region.
The session took several momentous decisions and would be viewed, “As the session where regional solidarity and togetherness were further strengthened”, said Dr Samlee Plianbangchang, Regional Director for WHO South-East Asia Region.
Member countries of WHO’s South East Asia Region account for approximately 25% of the world population. However, they bear 40% of the world’s disease burden. The Region has the largest number of children missed by immunization, the highest number of deaths from measles, and from complications of pregnancy and childbirth.
Notably, the Committee adopted a resolution to establish the South-East Asia Regional Health Emergency Fund (SEARHEF). The Region is vulnerable to natural and man-made emergencies which impact human health, and accounted for 58% of deaths due to disasters worldwide. This Fund would provide financial support to Member Countries in the first three months after the onset of an emergency. It would be an instrument to tide over affected Member countries in the face of an emergency. The Fund is not meant to finance bulk relief, recovery, reconstruction and rehabilitation which are funded by established mechanisms like Flash Appeals, Consolidated Appeals Process (CAP) and Central Emergency Response Fund (CERF) The Fund would build a corpus from within countries and by raising voluntary contributions. Thailand announced a contribution of US $100,000 for the Fund, during the Regional Committee session.
The Committee deliberated on several issues of regional priority including: i)Nutrition and food safety, ii)Scaling up prevention and control of chronic noncommunicable diseases, iii) TB control iv)Revised malaria control strategy, v)Avian and pandemic influenza preparedness, vi) Public health, innovation and intellectual property rights, and vii) WHO and reforms of the UN system.
The Regional Committee decided that the Technical discussions in 2008 would be on the subject of “Revitalising Primary Health”.
The Regional Committee decided that its 61st session would be held at the SEARO office in New Delhi.
For any clarification or additional information, please contact Ms Vismita Gupta-Smith, the Public Information and Advocacy officer, phone: 91-11-23370971 and mobile: 91- 9871329861 Email: guptasmithv@searo.who.int and Ms Harsaran Pandey, STP-Information Officer, at telephone: 011 23309 465; mobile: 9811021001, email pandeyh@searo.who.int.
All press releases, fact sheets and other WHO media material may be found at: www.searo.who.int.
http://www.searo.who.int/en/Section316/Section503/Section2358_13505.htm
Something interesting
By Bush,
I searched google by "辛布+宣言+台灣",
and our blog came out in the first place of the search list.
Haahhh...
I searched google by "辛布+宣言+台灣",
and our blog came out in the first place of the search list.
Haahhh...
2007年9月4日 星期二
International Health Regulations (IHR) 2005
這個在這期的資訊中應該會常常看到，大家可以參考
http://www.who.int/csr/ihr/en/
International Health Regulations (2005)
The successful implementation of the International Health Regulations (2005) or IHR (2005), with the technical support of WHO, by all the countries who committed themselves to meet the new requirements of the Regulations will contribute significantly to enhancing national, regional and international public health security.
The entry into force of the IHR (2005) on 15 June 2007 is a public health landmark for the World Health Organization (WHO) and its Member States. The global community has a new legal framework to better manage its collective defences against acute public health risks that can spread internationally and have devastating impacts on human health as well as unnecessary negative interference on trade and travel.
連結裡面還有相關文件下載，關於辛布宣言中的東西可以延伸到這邊來查詢
http://www.who.int/csr/ihr/en/
International Health Regulations (2005)
The successful implementation of the International Health Regulations (2005) or IHR (2005), with the technical support of WHO, by all the countries who committed themselves to meet the new requirements of the Regulations will contribute significantly to enhancing national, regional and international public health security.
The entry into force of the IHR (2005) on 15 June 2007 is a public health landmark for the World Health Organization (WHO) and its Member States. The global community has a new legal framework to better manage its collective defences against acute public health risks that can spread internationally and have devastating impacts on human health as well as unnecessary negative interference on trade and travel.
連結裡面還有相關文件下載，關於辛布宣言中的東西可以延伸到這邊來查詢
辛布宣言
http://www.searo.who.int/en/Section316/Section503/Section2358_13502.htm
本次的東南亞衛生部長級會議對於本宣言相當有關係，大家可以從這邊尋找相關的議題
25th Meeting of Ministers of Health
Thimphu, Bhutan, 31 August – 1 September 2007
Thimphu Declaration on International Health Security in the South-East Asia Region
We, the Health Ministers of Member States of the World Health Organization’s South-East Asia Region participating in the Twenty-fifth Health Ministers’ Meeting in Thimphu, Bhutan, recognize that in the concept of International Health Security lies the realization that there is a need to reduce the vulnerability of people around the world to the escalation of existing, new, acute or rapidly spreading risks to health, particularly those that threaten to transcend international borders.
We also recognize that rapid globalization with easy, frequent travel, as well as large-scale trade, give an ample opportunity for communicable diseases to spread across borders quickly and with ease.
We are aware that the world climate is changing. Temperatures are rising; tropical storms are increasing in frequency and intensity; polar ice caps and permafrost regions are melting. The acute impact of climate change–related events may be local, but their causes are global.
We are also concerned that no single institution, sector or country has all the capacities needed to respond to international public health emergencies caused by epidemics, natural disasters and humanitarian or environmental emergencies.
We are of the view that the impact of the above threats on human health has serious implications for morbidity and mortality, and will delay internationally agreed upon development goals.
We reiterate our commitment to the World Health Assembly Resolutions related to Emergency Preparedness and Response and International Health Regulations (IHR) 2005.
We note the efforts of WHO’s Regional Office for South-East Asia to:
1)Systematize and measure emergency preparedness and response in health systems through benchmarks, standards and indicators;
2)Systematically support countries in the full implementation of the International Health Regulations (IHR) 2005 strengthening core capacities;
3)Support short-term strategies in stockpiling anti-virals, personal protective devices and pre-pandemic vaccines, as well as long-term strategies to increase influenza vaccine production capacity in the Region; and
4)To mobilize adequate resources to support these activities.
To achieve effective solutions to address issues related to International Health Security, we are committed to:
1.Take further action to improve emergency preparedness and response in line with the World Health Assembly and Regional Committee Resolutions WHA 58.1, WHA 59.20, SEA/RC 57/3, and SEA/RC 58/3;
2.Take further action to implement the International Health Regulations (IHR) 2005 in line with World Health Assembly and Regional Committee Resolutions WHA 58.3 and WHA 59.2, and SEA/RC 58/7;
3.Develop and systematically implement National Emergency Preparedness Plans, taking into account the significant role of private health providers based on country-specific priority benchmarks and indicators within one year and to revisit the plans regularly;
4.Develop and implement action plans towards strengthening core capacities for countries for International Health Regulations (IHR) 2005;
5.Develop and implement national action plans for mitigation and adaptation to address the health impacts of global warming and climate change.
6.Mobilize adequate resources for these initiatives and participate actively in developing and maintaining partnerships related to improving these areas of health.
We, the Health Ministers of WHO’s South-East Asia Region, fully support the establishment of the South-East Asia Regional Health Emergency Fund and commit to the function of the Working Group as well as efforts towards resource mobilization.
We, the Health Ministers of WHO’s South-East Asia Region, urge all Member States as well as the WHO Director-General and the Regional Director for the South-East Asia Region to continue to provide leadership and technical support in building partnerships between governments, United Nations and bilateral agencies, members of academia, professional bodies, NGOs, the private sector and the media and civil society, and to jointly advocate effective follow-up on all aspects of this Thimphu Declaration on International Health Security in the South-East Asia Region.
本次的東南亞衛生部長級會議對於本宣言相當有關係，大家可以從這邊尋找相關的議題
25th Meeting of Ministers of Health
Thimphu, Bhutan, 31 August – 1 September 2007
Thimphu Declaration on International Health Security in the South-East Asia Region
We, the Health Ministers of Member States of the World Health Organization’s South-East Asia Region participating in the Twenty-fifth Health Ministers’ Meeting in Thimphu, Bhutan, recognize that in the concept of International Health Security lies the realization that there is a need to reduce the vulnerability of people around the world to the escalation of existing, new, acute or rapidly spreading risks to health, particularly those that threaten to transcend international borders.
We also recognize that rapid globalization with easy, frequent travel, as well as large-scale trade, give an ample opportunity for communicable diseases to spread across borders quickly and with ease.
We are aware that the world climate is changing. Temperatures are rising; tropical storms are increasing in frequency and intensity; polar ice caps and permafrost regions are melting. The acute impact of climate change–related events may be local, but their causes are global.
We are also concerned that no single institution, sector or country has all the capacities needed to respond to international public health emergencies caused by epidemics, natural disasters and humanitarian or environmental emergencies.
We are of the view that the impact of the above threats on human health has serious implications for morbidity and mortality, and will delay internationally agreed upon development goals.
We reiterate our commitment to the World Health Assembly Resolutions related to Emergency Preparedness and Response and International Health Regulations (IHR) 2005.
We note the efforts of WHO’s Regional Office for South-East Asia to:
1)Systematize and measure emergency preparedness and response in health systems through benchmarks, standards and indicators;
2)Systematically support countries in the full implementation of the International Health Regulations (IHR) 2005 strengthening core capacities;
3)Support short-term strategies in stockpiling anti-virals, personal protective devices and pre-pandemic vaccines, as well as long-term strategies to increase influenza vaccine production capacity in the Region; and
4)To mobilize adequate resources to support these activities.
To achieve effective solutions to address issues related to International Health Security, we are committed to:
1.Take further action to improve emergency preparedness and response in line with the World Health Assembly and Regional Committee Resolutions WHA 58.1, WHA 59.20, SEA/RC 57/3, and SEA/RC 58/3;
2.Take further action to implement the International Health Regulations (IHR) 2005 in line with World Health Assembly and Regional Committee Resolutions WHA 58.3 and WHA 59.2, and SEA/RC 58/7;
3.Develop and systematically implement National Emergency Preparedness Plans, taking into account the significant role of private health providers based on country-specific priority benchmarks and indicators within one year and to revisit the plans regularly;
4.Develop and implement action plans towards strengthening core capacities for countries for International Health Regulations (IHR) 2005;
5.Develop and implement national action plans for mitigation and adaptation to address the health impacts of global warming and climate change.
6.Mobilize adequate resources for these initiatives and participate actively in developing and maintaining partnerships related to improving these areas of health.
We, the Health Ministers of WHO’s South-East Asia Region, fully support the establishment of the South-East Asia Regional Health Emergency Fund and commit to the function of the Working Group as well as efforts towards resource mobilization.
We, the Health Ministers of WHO’s South-East Asia Region, urge all Member States as well as the WHO Director-General and the Regional Director for the South-East Asia Region to continue to provide leadership and technical support in building partnerships between governments, United Nations and bilateral agencies, members of academia, professional bodies, NGOs, the private sector and the media and civil society, and to jointly advocate effective follow-up on all aspects of this Thimphu Declaration on International Health Security in the South-East Asia Region.
2007年9月3日 星期一
Health Ministers adopt Thimphu declaration
這是這次主題的新聞稿，主要講述這次第60次東南亞區的衛生部長級會談，主要在不丹舉辦(不丹也有一些特殊的衛生成就)，然後一些各方要合作的議題等等！
http://www.searo.who.int/en/Section316/Section503/Section2358_13500.htm
Health Ministers adopt Thimphu declaration
Health Ministers of WHO’s South-East Asia region discuss important health issues
SEA/PR/1451
Thimphu, 1 September 2007: Today Health Ministers from 11 Member States of WHO’s South East Asia Region adopted the “Thimphu Declaration on International Health Security in the South-East Asia Region”. The Thimphu Declaration recognizes natural and manmade health emergencies, emerging infectious diseases and climate change as threats to international health security.
The Declaration focuses on commitment to the International Health Regulation (IHR 2005), systematic emergency preparedness and response. It supports the establishment of the South-East Asia Regional Health Emergency Fund. It also calls on countries to develop national mitigation and adaptation plans to address the health impact of global warming and climate change.
The meetings of the Health Ministers of the SEAR countries are an important forum for considering regional health issues, common approaches and development of inter country collaborations and strategies. Thimphu is hosting the 25th Health Ministers Meeting this year.
In his inaugural address, H.E. Lyonpo Kinzang Dorji, Prime Minister of Bhutan listed some of the key public health achievements in Bhutan. He noted that no polio case has been reported since 1986, and leprosy and Iodine deficiency disorders have been eliminated. Bhutan has achieved universal child immunization, nearly 90% of rural water supply coverage as well as basic health care services for all citizens. He said that the primary health approach had been instrumental in attaining these public health successes.
Dr Samlee Plianbangchang, WHO Regional Director for South-East Asia, in his address, said that the avian influenza outbreaks in the Region had shown the vulnerability of countries to cross- border disease outbreaks. Dr Samlee underlined the significance of the Thimphu Declaration and said it “Elaborates the threats posed to human health either by climate change or other international and interrelated factors and the need for regional solidarity to meet these threats”.
WHO Director-General Dr Margaret Chan recognized the commitment of the SEAR Member countries to poverty reduction and said, “Your commitment shows great political courage in the face of a challenge magnified many times in this most populous region in the world”. Dr Margaret Chan also commended Bhutan’s commitment to Gross National Happiness as the best measure of true progress in development. She said that this objective is closely aligned with the comprehensive definition of health set out in WHO’s Constitution.
For any clarification or additional information, please contact Ms Vismita Gupta-Smith, the Public Information and Advocacy officer, phone: 91-11-23370971 and mobile: 91- 9871329861 Email: guptasmithv@searo.who.int and Ms Harsaran Pandey, STP-Information Officer, at telephone: 011 23309 465; mobile: 9811021001, email pandeyh@searo.who.int
All press releases, fact sheets and other WHO media material may be found at: www.searo.who.int.
http://www.searo.who.int/en/Section316/Section503/Section2358_13500.htm
Health Ministers adopt Thimphu declaration
Health Ministers of WHO’s South-East Asia region discuss important health issues
SEA/PR/1451
Thimphu, 1 September 2007: Today Health Ministers from 11 Member States of WHO’s South East Asia Region adopted the “Thimphu Declaration on International Health Security in the South-East Asia Region”. The Thimphu Declaration recognizes natural and manmade health emergencies, emerging infectious diseases and climate change as threats to international health security.
The Declaration focuses on commitment to the International Health Regulation (IHR 2005), systematic emergency preparedness and response. It supports the establishment of the South-East Asia Regional Health Emergency Fund. It also calls on countries to develop national mitigation and adaptation plans to address the health impact of global warming and climate change.
The meetings of the Health Ministers of the SEAR countries are an important forum for considering regional health issues, common approaches and development of inter country collaborations and strategies. Thimphu is hosting the 25th Health Ministers Meeting this year.
In his inaugural address, H.E. Lyonpo Kinzang Dorji, Prime Minister of Bhutan listed some of the key public health achievements in Bhutan. He noted that no polio case has been reported since 1986, and leprosy and Iodine deficiency disorders have been eliminated. Bhutan has achieved universal child immunization, nearly 90% of rural water supply coverage as well as basic health care services for all citizens. He said that the primary health approach had been instrumental in attaining these public health successes.
Dr Samlee Plianbangchang, WHO Regional Director for South-East Asia, in his address, said that the avian influenza outbreaks in the Region had shown the vulnerability of countries to cross- border disease outbreaks. Dr Samlee underlined the significance of the Thimphu Declaration and said it “Elaborates the threats posed to human health either by climate change or other international and interrelated factors and the need for regional solidarity to meet these threats”.
WHO Director-General Dr Margaret Chan recognized the commitment of the SEAR Member countries to poverty reduction and said, “Your commitment shows great political courage in the face of a challenge magnified many times in this most populous region in the world”. Dr Margaret Chan also commended Bhutan’s commitment to Gross National Happiness as the best measure of true progress in development. She said that this objective is closely aligned with the comprehensive definition of health set out in WHO’s Constitution.
For any clarification or additional information, please contact Ms Vismita Gupta-Smith, the Public Information and Advocacy officer, phone: 91-11-23370971 and mobile: 91- 9871329861 Email: guptasmithv@searo.who.int and Ms Harsaran Pandey, STP-Information Officer, at telephone: 011 23309 465; mobile: 9811021001, email pandeyh@searo.who.int
All press releases, fact sheets and other WHO media material may be found at: www.searo.who.int.
本期主題與工作分配9/3
本次工作期間為
9/4-9/15
9/8日以前盡可能完成資料搜尋的工作(因有多數人會參加9/8-12的畢業旅行)
9/15交稿
本期主題為：WHO Regional Committee for South-East Asia meets in Bhutan
31 August 2007 -- The 60th session of the WHO Regional Committee for South-East Asia begins today in Thimphu, Bhutan. Avian and pandemic influenza preparedness and a revised malaria control strategy are among the topics to be discussed.
本次工作分配：
主題撰寫：浩哥
國際議題：民浩、光狐、芳盈
國內議題：豪哥、佳真
麻煩有疑問或是需要幫助請儘速提出！感謝！
9/4-9/15
9/8日以前盡可能完成資料搜尋的工作(因有多數人會參加9/8-12的畢業旅行)
9/15交稿
本期主題為：WHO Regional Committee for South-East Asia meets in Bhutan
31 August 2007 -- The 60th session of the WHO Regional Committee for South-East Asia begins today in Thimphu, Bhutan. Avian and pandemic influenza preparedness and a revised malaria control strategy are among the topics to be discussed.
本次工作分配：
主題撰寫：浩哥
國際議題：民浩、光狐、芳盈
國內議題：豪哥、佳真
麻煩有疑問或是需要幫助請儘速提出！感謝！
本期新聞稿
世界狂犬病日警醒世界 ‧陳治平
今年的九月八日世界狂犬病日，WHO響應Harris County Public Health and Environmental Services(HCPHES)、World Organization for Animal Health (OIE)、Pan American Health Organization (PAHO)以提醒大家目前世界現有的狂犬病流行狀況以及是可以藉由疫苗所避免的。
狂犬病的傳染是從患有狂犬病的動物或病患，因其唾液中含有病毒，狂犬病病毒即從已感染者的唾液中隨著抓、咬而進入人體（偶而經由皮膚的傷口、黏膜）。故被感染狂犬病的動物的爪子抓傷也是危險的，其原因是動物會舔牠們的腳。狂犬病會感染任何一種哺乳類動物，但多半會傳染人類的主要動物則是：貓、狗、浣熊及蝙蝠。這些動物多半與人類有較多的機會接觸到(尤其是貓狗，而浣熊與蝙蝠則是在野外活動時容易接觸)。
世界上現今每十分鐘即有一人因狂犬病而死亡，這樣的情況主要發生在亞洲及非洲(尤其是印度及中國大陸)，這些人其實有很大的機會不需要面對死亡，因為就現在的醫療技術，狂犬病疫苗可以有極高的效用防止疾病的發生。另一方面，針對相同會受到感染的哺乳類而言，也有開發出類似的口服疫苗，對於一些會受到狂犬病威脅而瀕臨絕種的野生動物來說，這或許是另一條活路。
雖然狂犬病是有辦法可以治療的，但是世界上仍然有這麼多人因為狂犬病而死亡(並且多數是孩童)。這樣的問題可能不完全是醫療的問題，反而是有沒有辦法讓每一個可能受感染的對象得到治療。這樣的原因可能歸咎於疫苗不夠和藥物價格過高的問題。另外，像在中國則是在快速發展寵物快速增加，因公衛意識不足下、公德心不佳使得流浪狗增加，更增加受感染的可能性。
狂犬病在台灣的紀錄可源自1947年從上海傳入台灣，在1948年發現第一個狂犬病病例之後，持續仍有零星案例發生。之後透過家中寵物狗接種、捕殺野狗等措施，從1959年起台灣就不再有人的病例，1961年1月後即未再出現動物的病例。目前台灣為狂犬病非疫區；惟2002年曾有一例來自中國大陸之境外移入病例。所以目前台灣主要的威脅來自於境外移入的傳染，檢疫的防治將會是主要的預防，但是在現有台灣與大陸間的走私交易猖獗的情況下，仍有可能會有相當大的機會從境外移入病例或傳染源。
世界狂犬病日的重要使命是希望人們能夠增加對狂犬病的警覺及重視，讓每一個人了解到這樣的疾病所存在的致病機制及情況。藉由預防及完善的治療，期望在未來能夠將狂犬病成為人類歷史上的名詞。
資料來源：
1.http://www.worldrabiesday.org/index_en.php
2.http://www.who.int/mediacentre/events/2007/world_rabies_day/en/index.html
3.http://www.economist.com/science/PrinterFriendly.cfm?story_id=8023437
4.http://www.cdc.gov.tw/index_info_info.asp?data_id=848
5.http://www.bbc.co.uk/dna/h2g2/A673599
6.http://www.avma.org/onlnews/javma/aug07/070815l.asp
7.http://news.bbc.co.uk/2/hi/asia-pacific/3235830.stm
中國狂犬病未解的問題 ‧李芳盈
狂犬病的發生屬於全球性，其中亞洲為狂犬病主要發病與死亡個案的發生地區。目前中國大陸的狂犬病發病率僅次於印度，位居世界第二位，而兩地面臨狂犬病的處理困境又略有不同。根據統計今年上半年在中國就有一千四百人感染狂犬病，約一千一百人死亡，因此台灣在金門實施小三通後，對一水之隔的中國相關傳染病疫情，更應該確實掌握。
狂犬病長久以來都是中國傳染病死亡率甚高的前幾名，對於這樣的情形，中國政府並非沒有做出行動，例如：各省訂定「養犬管理規定」，並限定必須辦理「養犬許可證」。但是中國的狂犬病問題仍然沒有解決，問題到底出在哪裡？
首先，雖然有必須辦理養犬許可證(以下簡稱「犬證」)之規定，但是辦理犬證太貴，例如在廣州要幫愛犬登記就需註冊費一萬元，且需每年審查，又要花費6000元，因而有些飼主產生投機心態，乾脆不申請犬證，飼養「黑犬」(未經登記就飼養的犬隻)。
其次是疫苗質量不穩且施打狀況不佳。注射狂犬病疫苗是預防狂犬病的最有效手段，選擇優質的狂犬病疫苗至關重要。但是中國準備的疫苗不但數量不足，甚至曾出現假疫苗致人死亡事件，對此中國衛生部、國家食品藥品監督管理局發佈緊急通知，要求加強狂犬病疫苗監管，嚴防問題疫苗流入經營和使用單位。然而今年七月底又在黑龍江省破獲一起假藥案，其中包含造假的狂犬病疫苗。
第三，綜合資料難以調查，由於寵物犬數量增多、城市的郊區和農村地區流浪狗數量大幅上升，對於犬隻的確切數量及狀況難以掌控，造成公眾缺乏警惕，包括官方也在粉飾太平。
「據我了解，中國沒有狂犬病增加的趨勢。中國是一個大國，農村地區出現幾例屬正常範圍。」衛生部副部長蔣作君在一個新聞發布會上這樣說。
再加上缺乏專門的處置及收容機構，因此有人不知要去哪裡申請犬證，即使「黑犬」很多，但卻沒有人投訴，更沒有人處理投訴。在這樣管理不善、有法不依、執法不嚴、違法不究的狀況下，使相關的管理規定形同一紙空文。
看到以上所舉之問題，中國對於減少狂犬病應該改變現有的處置方向。目前中國政府當局針對過多流浪狗的處理方式多用「管、免、滅(管理、免疫、滅殺)」的方式，然而效果不彰，許多寵物狗也被迫撲殺或是被誤殺，此舉引來許多動物保護團體的抗議。其實要解決狂犬病肆虐情形應從根本的管理問題著手，而不是蠻橫的屠殺，因為犬隻是否對人造成不良影響，端看主人自身的約束力和公德心，「狗患」的最根本原因，是養狗人沒有負起責任，沒有管好自己養的狗。以法律限制飼主，重要的是必須確實執法，因為過去並非沒有法律規定，但因執法不嚴所以仍有漏洞可鑽，例如：檢查時把大型犬轉移到別處，等風聲過了再移回；另外再輔以配套政策，降低申請犬證及年審費用、整頓犬類市場、加強發揮動物疫病預防與控制中心的功能、提供免費注射狂犬病疫苗，或是設立規範養狗自治組織，讓社區裏的養狗戶相互監督。總之，宣導飼主「文明養犬」，以不妨礙他人為原則，遵循法律規定，將會是對抗狂犬病較有效而根本的處理方法。
資料來源：
http://www.39kf.com/focus/zt/Rabies/
http://www.cdc.gov.tw/
經濟起飛印度大國 狂犬病盛行率仍為世界第一 ‧吳佳真
狂犬病可藉由疫苗施打及動物管理計畫作到百分之百的預防，但是印度仍為狂犬病高度危險國家。由於疫苗及藥品昂貴、施打療程長且痛苦以及大量流浪狗患有狂犬病，使該國狂犬病疫情居高不下。根據APCRI在2003年做的社區調查，估計每100000人中大約有20000多人感染狂犬病，大多數患者為成年男姓、住在偏遠地區且未施打疫苗，其中95～97％是因流浪狗咬傷。從新德里的Center for Community Medicine統計可發現，每年狗咬率為千分之25.7，則患有狂犬病的寵物犬及流浪狗的是疫情發燒的一大主因。
動物防治區域短期見效 治標不治本
動物的狂犬病防治方法包括，強制民眾為所飼養的家犬依法辦理登記並處理疫苗，否則所飼的犬隻視為流浪狗處理。掌握流浪狗的數量並以口服狂犬病疫苗誘餌引其食用，同時捕捉撲殺患有狂犬病之流浪狗，最後應定期檢視或撲滅可疑的流浪狗。以上策略適合小區域的末端防治，可能在短期見效，但因流浪狗族群流動大，控管經費及疫苗籌措皆不容易，故無法長期防堵狂犬病疫情。
政府的長期動物防治策略，應從調查各地流浪狗的源頭動向開始，規劃犬類結紮，遏止流浪狗數量擴大。同時加強民眾對狂犬病及其預防方法的衛生教育，宣導大眾應遠離流浪狗，且須將自家寵物犬的帶往獸醫結紮和做疫苗防治，更勿擅自棄養使流浪狗增加。如此才能自根本減少犬類傳染狂犬病的問題。
正視疫苗防治的重要 印度政府應積極與藥商協調
狗類咬傷雖然為印度狂犬病盛行的一大主因，但是除了以動物防治抑止疫情以外，該國醫生表示疫苗及治療藥物過於昂貴，且需花14天施打疫苗，病患大多沒有完成完整療程，使狂犬病防治出現一大漏洞。
印度National Coordination Committee及JSA(Jan Swasthya Abhiyan)在2007年發行New Technologies in Public Health – Who pays and who benefits？ 中第一部份Is it just vaccines? 第一章 Rabies Vaccines in India控訴印度政府使用的羊腦培養疫苗落後、昂貴且不安全。印度藥物控制委員（Drug Controller）從未與MNC藥物公司溝通協調，使較安全新穎細胞培養疫苗降價並普及化，而新的疫苗表皮間施打技術I.D route（Intra Dermal route）可減低一次注射藥量，省錢且不失安全，但MNC藥物公司的兩個品牌Rabipur和Verorab皆未註冊此技術，因此印度國內多以用藥較多的肌肉內注射（intramuscular） 技術施打疫苗。
印度的狂犬病疫情高燒不退，將來除了影響該國國內的政經進步，亦是全球的防疫大漏洞，在國際組織以強制手段要求有關當局進行實質控管之前，其藥物控制委員若能正視疫苗費用過高及施打技術落後的問題，自行以適當的政治手段施壓或做其他交換協商，才可顯示印度為貨真價實的經濟文化人道大國，值得全球產業投資的尊重及重視。
資料來源：
1.Indian doctors want cheaper rabies drugs ,http://news.bbc.co.uk/2/hi/south_asia/822457.stm
2.The safety and efficacy of the oral rabies vaccine SAG2 in Indian stray dogs , F. Cliquet, J.P. Gurbuxani, H.K. Pradhan,Vaccine ,Volume 25, Issue 17, 30 April 2007, Pages 3409-3418
3.Human rabies in India: epidemiological features, management and current methods of prevention. Dutta JK. Trop Doct. 1999 Oct;29(4):196-201
4.Epidemiology of dog bites: a community-based study in India. Agarwal N, Reddajah VP. Trop Doct. 2004 Apr;34(2):76-8.
5.http://phm-india.org/pdf/nha2/New_technologies.pdf ,New Technologies in Public Health – Who pays and who benefits?
台灣面臨狂犬病爆發的風險？ ‧顏稚浩
台灣自從民國48年不再有人的病例出現，50年開始沒有動物的病例出現後，「狂犬病」這個詞對年輕一輩的台灣人來說是個相當陌生的名詞。不過大家可能不知道的是，台灣是世界上僅僅少數七個非狂犬病疫區的國家之一，其他六個為日本、英國、瑞典、澳洲、紐西蘭、冰島。大家可能更不清楚的是，狂犬病是人畜共通的疾病，主要是在溫血動物間流行。人通常係經由被帶有狂犬病病毒之貓、狗等溫血動物咬傷、抓傷、舔舐傷口感染才會致病。而且雖然有狂犬病的疫苗，但是一但等到感染發病後再施打疫苗就沒有用了，狂犬病發病後死亡率幾達100%。台灣目前雖然是狂犬病的非疫區，但是目前台灣面臨了幾個狂犬病爆發的隱憂，而且是社會大眾常常忽略掉的一部分。
1.國際衛生資訊的取得管道不流通：
囿於國際的政治情勢，台灣一直無法以會員的身分參與重要的國際衛生組織，例如世界衛生組織，當嚴重的傳染病爆發時這會影響台灣對於相關疫情資訊的”及時取得”，以及來自國際上的援助也會因此而受到影響。最明顯的一個例子是2003年初台灣爆發SARS流行時，不但相關的消息和檢體取得不易，甚至連世界衛生組織的專家受限於一些因素，直到當年五月疫情已經舒緩時才能來台幫忙防疫。如果國內爆發狂犬病流行時，或許會重演前幾年SARS的情況。
2.中國大陸的疫情和資訊不透明、離島走私猖獗：
根據中國衛生部的統計資料，今年上半年已知中國有一千四百人感染狂犬病，約一千一百人死亡。在今年一月，狂犬病通報217例，死亡182例，致死率83.87%，並連續8個月居中國法定傳染病死亡數之冠，遠高於第2位的肺結核（94例），由此可見中國為狂犬病重要疫區，這對和中國鄰近的台灣來說自然是個隱憂。兩個情形使得情況更加對台灣不利，第一是中國當局對於國內的疫情一向是盡其所能的隱匿不報，前幾年的SARS從區域性的小規模感染，以至於到全球警戒的傳染，一個重要的原因是中國政府當局對於疫情通報的隱匿，和欺瞞世界衛生組織的檢察員有關。加上中國很多偏遠的鄉村資源匱乏，對外的交通聯繫不易，其中央政府所統計的衛生數據很有可能會忽略掉那些地區，使得其數據的參考價值受到影響。第二是中國沿岸距離台灣的外島很近，兩岸的人民往來頻繁，走私的事件也時有所聞。事實上，如果從國外輸入犬貓，必須經過行政院農業委員會防疫檢疫局的檢疫後，還要植入晶片才能放行。有一些國家的檢疫規定更嚴格，像澳洲還會對犬貓進行抽血檢查。但是那些是對循正常管道入境的動物而言，如果是以走私偷渡的方式，又僥倖沒有被海關檢查出來，那這個防疫漏洞真的就很令人擔心。
3.島內的流浪犬問題：
台灣的流浪動物一直是個棘手的老問題，在平時會造成一些環境和人身安全的問題，但是一但不幸台灣成為狂犬病傳染的疫區，在路上隨處可見的流浪狗就可能變成一個個攜帶病毒的宿主，這對民眾日常的生活將造成相當大的衝擊。而部分民眾對生命的不尊重，未考慮自身的情況就貿然飼養寵物，等到厭煩後又任意棄養，使得流浪動物的問題一直無法得到有效解決，這也直接的增加了防疫問題的複雜程度。
總而言之，要杜絕上述的隱憂，政府在國際社會上可用加強和邦交國的衛生合作交流、積極參與世衛組織的周邊活動和會議、以台灣的防疫經驗和技術來援助開發中國家等方式來增加台灣在國際上的能見度。
在日常生活中，政府應該教育民眾關於防疫檢疫相關的知識，以及加強走私的查緝工作和刑罰。而國民應該要有尊重生命的觀念，不要隨便從國外走私未經檢疫的動物回台。飼主也要盡到責任，所飼養的犬貓應帶到獸醫診所或各縣市的家畜疾病防治所施打狂犬病疫苗，萬一真的無法繼續飼養下去，也要連絡相關的政府機關(清潔隊、動物收容所等)，讓有能力的飼主可以接手，而不至於造成社會問題。
資料來源：
1.http://www.doh.gov.tw/cht2006/index_populace.aspx
2.http://tw.news.yahoo.com/article/url/d/a/070804/5/i99i.html
3.http://web.kinmen.gov.tw/371022800g/news/news16.htm
4.http://www.baphiq.gov.tw/mp.asp?mp=1 (農委會動植物防檢局)
5.http://www.cdc.gov.tw/index.asp (疾病管制局)
台灣狂犬病的過去、現在及未來 ‧林民浩
台灣的狂犬病一般相信是在1947年自上海傳入，但亦有文獻記載，早在日據時期台灣就有狂犬病病例。台灣第一起狂犬病人病例是由林宗義醫師於1948年4月15日在台大醫院所發現，其後陸陸續續有疫情傳出，並在1951年至1952年間疫情達到高峰，兩個年度各有238例及102例，直到1959年才不再有人病例傳出，1961年後也未再有動物病例。但在2002年發現一起狂犬病境外移入病例，震驚台灣公衛界。
根據行政院農委會家畜衛生試驗所進行的「2003年台灣犬隻狂犬病監測結果」指出，經調查並未發現有狂犬病病例，台灣目前仍為狂犬病的非疫區，整體而言，台灣犬隻的抗體陽性率約為50.4%(見表一，李淑慧 et al., 2003)，距離世界衛生組織建議陽性率最低應維持在54%至62%的目標仍須努力。
在亞洲地區，除了日本與我國為非疫區外，其他國家仍是狂犬病疫區，在運輸發達的今日，難免會有漏網之魚，再加以兩岸間走私貿易猖獗，因此未來首重提升台灣犬隻的抗體陽性率，擴大接種狂犬病疫苗的範疇，讓台灣犬隻蓄積集體免疫能量，才能避免未來狂犬病在台灣爆發的可能。
其次，除現有的動物傳染病防制條例外，應訂定寵物管理法規，法規內容應強制飼養寵物者應將寵物植入晶片，並包含定期檢疫、施打疫苗的規定，如此一來，可使相關的管理有法源依據，不再單純依賴飼主良心，而造成防疫漏洞。再加以台灣上一波狂犬病爆發已超過半個世紀，新一代年輕人對於狂犬病可能一知半解，甚至覺得不會在台灣發生，因此應保持對民眾的狂犬病防治宣導，以提升民眾的風險知覺，進而主動配合防疫措施。
最後是建立狂犬病監測系統，對於流浪狗、家犬及各類溫血動物應有監測系統，蒐集組織、血液標本及各溫血動物病理症狀，建立流行病學資料，以隨時掌握疫情變化而得以採取適宜反應。
台灣過去對於狂犬病的防疫作為讓台灣成為世界僅有的七個非疫區國家之一，未來若能讓防疫作為更加徹底，咸信很快狂犬病便能正式宣布自台灣根絕，成為台灣另一項公共衛生的偉大成就。
表一、2003年犬隻狂犬病疫苗抗體ELISA檢驗結果
來 源 血清學檢驗數量 陽性數(陽性率)
家 犬 1,559 980 (62.9%)
流浪犬 2,099 863 (41.1%)
合 計 3,658 1,843 (50.4%)
資料來源：行政院農委會「2003年台灣犬隻狂犬病監測結果」
資料來源
1.http://vettech.nvri.gov.tw/Articles/report/886.html
2.http://www.adccyl.gov.tw/Animal_Dise/rabies/rabies.htm
3.http://www.cdc.gov.tw/index.asp (疾病管制局)
4.http://www.rabies.com/
今年的九月八日世界狂犬病日，WHO響應Harris County Public Health and Environmental Services(HCPHES)、World Organization for Animal Health (OIE)、Pan American Health Organization (PAHO)以提醒大家目前世界現有的狂犬病流行狀況以及是可以藉由疫苗所避免的。
狂犬病的傳染是從患有狂犬病的動物或病患，因其唾液中含有病毒，狂犬病病毒即從已感染者的唾液中隨著抓、咬而進入人體（偶而經由皮膚的傷口、黏膜）。故被感染狂犬病的動物的爪子抓傷也是危險的，其原因是動物會舔牠們的腳。狂犬病會感染任何一種哺乳類動物，但多半會傳染人類的主要動物則是：貓、狗、浣熊及蝙蝠。這些動物多半與人類有較多的機會接觸到(尤其是貓狗，而浣熊與蝙蝠則是在野外活動時容易接觸)。
世界上現今每十分鐘即有一人因狂犬病而死亡，這樣的情況主要發生在亞洲及非洲(尤其是印度及中國大陸)，這些人其實有很大的機會不需要面對死亡，因為就現在的醫療技術，狂犬病疫苗可以有極高的效用防止疾病的發生。另一方面，針對相同會受到感染的哺乳類而言，也有開發出類似的口服疫苗，對於一些會受到狂犬病威脅而瀕臨絕種的野生動物來說，這或許是另一條活路。
雖然狂犬病是有辦法可以治療的，但是世界上仍然有這麼多人因為狂犬病而死亡(並且多數是孩童)。這樣的問題可能不完全是醫療的問題，反而是有沒有辦法讓每一個可能受感染的對象得到治療。這樣的原因可能歸咎於疫苗不夠和藥物價格過高的問題。另外，像在中國則是在快速發展寵物快速增加，因公衛意識不足下、公德心不佳使得流浪狗增加，更增加受感染的可能性。
狂犬病在台灣的紀錄可源自1947年從上海傳入台灣，在1948年發現第一個狂犬病病例之後，持續仍有零星案例發生。之後透過家中寵物狗接種、捕殺野狗等措施，從1959年起台灣就不再有人的病例，1961年1月後即未再出現動物的病例。目前台灣為狂犬病非疫區；惟2002年曾有一例來自中國大陸之境外移入病例。所以目前台灣主要的威脅來自於境外移入的傳染，檢疫的防治將會是主要的預防，但是在現有台灣與大陸間的走私交易猖獗的情況下，仍有可能會有相當大的機會從境外移入病例或傳染源。
世界狂犬病日的重要使命是希望人們能夠增加對狂犬病的警覺及重視，讓每一個人了解到這樣的疾病所存在的致病機制及情況。藉由預防及完善的治療，期望在未來能夠將狂犬病成為人類歷史上的名詞。
資料來源：
1.http://www.worldrabiesday.org/index_en.php
2.http://www.who.int/mediacentre/events/2007/world_rabies_day/en/index.html
3.http://www.economist.com/science/PrinterFriendly.cfm?story_id=8023437
4.http://www.cdc.gov.tw/index_info_info.asp?data_id=848
5.http://www.bbc.co.uk/dna/h2g2/A673599
6.http://www.avma.org/onlnews/javma/aug07/070815l.asp
7.http://news.bbc.co.uk/2/hi/asia-pacific/3235830.stm
中國狂犬病未解的問題 ‧李芳盈
狂犬病的發生屬於全球性，其中亞洲為狂犬病主要發病與死亡個案的發生地區。目前中國大陸的狂犬病發病率僅次於印度，位居世界第二位，而兩地面臨狂犬病的處理困境又略有不同。根據統計今年上半年在中國就有一千四百人感染狂犬病，約一千一百人死亡，因此台灣在金門實施小三通後，對一水之隔的中國相關傳染病疫情，更應該確實掌握。
狂犬病長久以來都是中國傳染病死亡率甚高的前幾名，對於這樣的情形，中國政府並非沒有做出行動，例如：各省訂定「養犬管理規定」，並限定必須辦理「養犬許可證」。但是中國的狂犬病問題仍然沒有解決，問題到底出在哪裡？
首先，雖然有必須辦理養犬許可證(以下簡稱「犬證」)之規定，但是辦理犬證太貴，例如在廣州要幫愛犬登記就需註冊費一萬元，且需每年審查，又要花費6000元，因而有些飼主產生投機心態，乾脆不申請犬證，飼養「黑犬」(未經登記就飼養的犬隻)。
其次是疫苗質量不穩且施打狀況不佳。注射狂犬病疫苗是預防狂犬病的最有效手段，選擇優質的狂犬病疫苗至關重要。但是中國準備的疫苗不但數量不足，甚至曾出現假疫苗致人死亡事件，對此中國衛生部、國家食品藥品監督管理局發佈緊急通知，要求加強狂犬病疫苗監管，嚴防問題疫苗流入經營和使用單位。然而今年七月底又在黑龍江省破獲一起假藥案，其中包含造假的狂犬病疫苗。
第三，綜合資料難以調查，由於寵物犬數量增多、城市的郊區和農村地區流浪狗數量大幅上升，對於犬隻的確切數量及狀況難以掌控，造成公眾缺乏警惕，包括官方也在粉飾太平。
「據我了解，中國沒有狂犬病增加的趨勢。中國是一個大國，農村地區出現幾例屬正常範圍。」衛生部副部長蔣作君在一個新聞發布會上這樣說。
再加上缺乏專門的處置及收容機構，因此有人不知要去哪裡申請犬證，即使「黑犬」很多，但卻沒有人投訴，更沒有人處理投訴。在這樣管理不善、有法不依、執法不嚴、違法不究的狀況下，使相關的管理規定形同一紙空文。
看到以上所舉之問題，中國對於減少狂犬病應該改變現有的處置方向。目前中國政府當局針對過多流浪狗的處理方式多用「管、免、滅(管理、免疫、滅殺)」的方式，然而效果不彰，許多寵物狗也被迫撲殺或是被誤殺，此舉引來許多動物保護團體的抗議。其實要解決狂犬病肆虐情形應從根本的管理問題著手，而不是蠻橫的屠殺，因為犬隻是否對人造成不良影響，端看主人自身的約束力和公德心，「狗患」的最根本原因，是養狗人沒有負起責任，沒有管好自己養的狗。以法律限制飼主，重要的是必須確實執法，因為過去並非沒有法律規定，但因執法不嚴所以仍有漏洞可鑽，例如：檢查時把大型犬轉移到別處，等風聲過了再移回；另外再輔以配套政策，降低申請犬證及年審費用、整頓犬類市場、加強發揮動物疫病預防與控制中心的功能、提供免費注射狂犬病疫苗，或是設立規範養狗自治組織，讓社區裏的養狗戶相互監督。總之，宣導飼主「文明養犬」，以不妨礙他人為原則，遵循法律規定，將會是對抗狂犬病較有效而根本的處理方法。
資料來源：
http://www.39kf.com/focus/zt/Rabies/
http://www.cdc.gov.tw/
經濟起飛印度大國 狂犬病盛行率仍為世界第一 ‧吳佳真
狂犬病可藉由疫苗施打及動物管理計畫作到百分之百的預防，但是印度仍為狂犬病高度危險國家。由於疫苗及藥品昂貴、施打療程長且痛苦以及大量流浪狗患有狂犬病，使該國狂犬病疫情居高不下。根據APCRI在2003年做的社區調查，估計每100000人中大約有20000多人感染狂犬病，大多數患者為成年男姓、住在偏遠地區且未施打疫苗，其中95～97％是因流浪狗咬傷。從新德里的Center for Community Medicine統計可發現，每年狗咬率為千分之25.7，則患有狂犬病的寵物犬及流浪狗的是疫情發燒的一大主因。
動物防治區域短期見效 治標不治本
動物的狂犬病防治方法包括，強制民眾為所飼養的家犬依法辦理登記並處理疫苗，否則所飼的犬隻視為流浪狗處理。掌握流浪狗的數量並以口服狂犬病疫苗誘餌引其食用，同時捕捉撲殺患有狂犬病之流浪狗，最後應定期檢視或撲滅可疑的流浪狗。以上策略適合小區域的末端防治，可能在短期見效，但因流浪狗族群流動大，控管經費及疫苗籌措皆不容易，故無法長期防堵狂犬病疫情。
政府的長期動物防治策略，應從調查各地流浪狗的源頭動向開始，規劃犬類結紮，遏止流浪狗數量擴大。同時加強民眾對狂犬病及其預防方法的衛生教育，宣導大眾應遠離流浪狗，且須將自家寵物犬的帶往獸醫結紮和做疫苗防治，更勿擅自棄養使流浪狗增加。如此才能自根本減少犬類傳染狂犬病的問題。
正視疫苗防治的重要 印度政府應積極與藥商協調
狗類咬傷雖然為印度狂犬病盛行的一大主因，但是除了以動物防治抑止疫情以外，該國醫生表示疫苗及治療藥物過於昂貴，且需花14天施打疫苗，病患大多沒有完成完整療程，使狂犬病防治出現一大漏洞。
印度National Coordination Committee及JSA(Jan Swasthya Abhiyan)在2007年發行New Technologies in Public Health – Who pays and who benefits？ 中第一部份Is it just vaccines? 第一章 Rabies Vaccines in India控訴印度政府使用的羊腦培養疫苗落後、昂貴且不安全。印度藥物控制委員（Drug Controller）從未與MNC藥物公司溝通協調，使較安全新穎細胞培養疫苗降價並普及化，而新的疫苗表皮間施打技術I.D route（Intra Dermal route）可減低一次注射藥量，省錢且不失安全，但MNC藥物公司的兩個品牌Rabipur和Verorab皆未註冊此技術，因此印度國內多以用藥較多的肌肉內注射（intramuscular） 技術施打疫苗。
印度的狂犬病疫情高燒不退，將來除了影響該國國內的政經進步，亦是全球的防疫大漏洞，在國際組織以強制手段要求有關當局進行實質控管之前，其藥物控制委員若能正視疫苗費用過高及施打技術落後的問題，自行以適當的政治手段施壓或做其他交換協商，才可顯示印度為貨真價實的經濟文化人道大國，值得全球產業投資的尊重及重視。
資料來源：
1.Indian doctors want cheaper rabies drugs ,http://news.bbc.co.uk/2/hi/south_asia/822457.stm
2.The safety and efficacy of the oral rabies vaccine SAG2 in Indian stray dogs , F. Cliquet, J.P. Gurbuxani, H.K. Pradhan,Vaccine ,Volume 25, Issue 17, 30 April 2007, Pages 3409-3418
3.Human rabies in India: epidemiological features, management and current methods of prevention. Dutta JK. Trop Doct. 1999 Oct;29(4):196-201
4.Epidemiology of dog bites: a community-based study in India. Agarwal N, Reddajah VP. Trop Doct. 2004 Apr;34(2):76-8.
5.http://phm-india.org/pdf/nha2/New_technologies.pdf ,New Technologies in Public Health – Who pays and who benefits?
台灣面臨狂犬病爆發的風險？ ‧顏稚浩
台灣自從民國48年不再有人的病例出現，50年開始沒有動物的病例出現後，「狂犬病」這個詞對年輕一輩的台灣人來說是個相當陌生的名詞。不過大家可能不知道的是，台灣是世界上僅僅少數七個非狂犬病疫區的國家之一，其他六個為日本、英國、瑞典、澳洲、紐西蘭、冰島。大家可能更不清楚的是，狂犬病是人畜共通的疾病，主要是在溫血動物間流行。人通常係經由被帶有狂犬病病毒之貓、狗等溫血動物咬傷、抓傷、舔舐傷口感染才會致病。而且雖然有狂犬病的疫苗，但是一但等到感染發病後再施打疫苗就沒有用了，狂犬病發病後死亡率幾達100%。台灣目前雖然是狂犬病的非疫區，但是目前台灣面臨了幾個狂犬病爆發的隱憂，而且是社會大眾常常忽略掉的一部分。
1.國際衛生資訊的取得管道不流通：
囿於國際的政治情勢，台灣一直無法以會員的身分參與重要的國際衛生組織，例如世界衛生組織，當嚴重的傳染病爆發時這會影響台灣對於相關疫情資訊的”及時取得”，以及來自國際上的援助也會因此而受到影響。最明顯的一個例子是2003年初台灣爆發SARS流行時，不但相關的消息和檢體取得不易，甚至連世界衛生組織的專家受限於一些因素，直到當年五月疫情已經舒緩時才能來台幫忙防疫。如果國內爆發狂犬病流行時，或許會重演前幾年SARS的情況。
2.中國大陸的疫情和資訊不透明、離島走私猖獗：
根據中國衛生部的統計資料，今年上半年已知中國有一千四百人感染狂犬病，約一千一百人死亡。在今年一月，狂犬病通報217例，死亡182例，致死率83.87%，並連續8個月居中國法定傳染病死亡數之冠，遠高於第2位的肺結核（94例），由此可見中國為狂犬病重要疫區，這對和中國鄰近的台灣來說自然是個隱憂。兩個情形使得情況更加對台灣不利，第一是中國當局對於國內的疫情一向是盡其所能的隱匿不報，前幾年的SARS從區域性的小規模感染，以至於到全球警戒的傳染，一個重要的原因是中國政府當局對於疫情通報的隱匿，和欺瞞世界衛生組織的檢察員有關。加上中國很多偏遠的鄉村資源匱乏，對外的交通聯繫不易，其中央政府所統計的衛生數據很有可能會忽略掉那些地區，使得其數據的參考價值受到影響。第二是中國沿岸距離台灣的外島很近，兩岸的人民往來頻繁，走私的事件也時有所聞。事實上，如果從國外輸入犬貓，必須經過行政院農業委員會防疫檢疫局的檢疫後，還要植入晶片才能放行。有一些國家的檢疫規定更嚴格，像澳洲還會對犬貓進行抽血檢查。但是那些是對循正常管道入境的動物而言，如果是以走私偷渡的方式，又僥倖沒有被海關檢查出來，那這個防疫漏洞真的就很令人擔心。
3.島內的流浪犬問題：
台灣的流浪動物一直是個棘手的老問題，在平時會造成一些環境和人身安全的問題，但是一但不幸台灣成為狂犬病傳染的疫區，在路上隨處可見的流浪狗就可能變成一個個攜帶病毒的宿主，這對民眾日常的生活將造成相當大的衝擊。而部分民眾對生命的不尊重，未考慮自身的情況就貿然飼養寵物，等到厭煩後又任意棄養，使得流浪動物的問題一直無法得到有效解決，這也直接的增加了防疫問題的複雜程度。
總而言之，要杜絕上述的隱憂，政府在國際社會上可用加強和邦交國的衛生合作交流、積極參與世衛組織的周邊活動和會議、以台灣的防疫經驗和技術來援助開發中國家等方式來增加台灣在國際上的能見度。
在日常生活中，政府應該教育民眾關於防疫檢疫相關的知識，以及加強走私的查緝工作和刑罰。而國民應該要有尊重生命的觀念，不要隨便從國外走私未經檢疫的動物回台。飼主也要盡到責任，所飼養的犬貓應帶到獸醫診所或各縣市的家畜疾病防治所施打狂犬病疫苗，萬一真的無法繼續飼養下去，也要連絡相關的政府機關(清潔隊、動物收容所等)，讓有能力的飼主可以接手，而不至於造成社會問題。
資料來源：
1.http://www.doh.gov.tw/cht2006/index_populace.aspx
2.http://tw.news.yahoo.com/article/url/d/a/070804/5/i99i.html
3.http://web.kinmen.gov.tw/371022800g/news/news16.htm
4.http://www.baphiq.gov.tw/mp.asp?mp=1 (農委會動植物防檢局)
5.http://www.cdc.gov.tw/index.asp (疾病管制局)
台灣狂犬病的過去、現在及未來 ‧林民浩
台灣的狂犬病一般相信是在1947年自上海傳入，但亦有文獻記載，早在日據時期台灣就有狂犬病病例。台灣第一起狂犬病人病例是由林宗義醫師於1948年4月15日在台大醫院所發現，其後陸陸續續有疫情傳出，並在1951年至1952年間疫情達到高峰，兩個年度各有238例及102例，直到1959年才不再有人病例傳出，1961年後也未再有動物病例。但在2002年發現一起狂犬病境外移入病例，震驚台灣公衛界。
根據行政院農委會家畜衛生試驗所進行的「2003年台灣犬隻狂犬病監測結果」指出，經調查並未發現有狂犬病病例，台灣目前仍為狂犬病的非疫區，整體而言，台灣犬隻的抗體陽性率約為50.4%(見表一，李淑慧 et al., 2003)，距離世界衛生組織建議陽性率最低應維持在54%至62%的目標仍須努力。
在亞洲地區，除了日本與我國為非疫區外，其他國家仍是狂犬病疫區，在運輸發達的今日，難免會有漏網之魚，再加以兩岸間走私貿易猖獗，因此未來首重提升台灣犬隻的抗體陽性率，擴大接種狂犬病疫苗的範疇，讓台灣犬隻蓄積集體免疫能量，才能避免未來狂犬病在台灣爆發的可能。
其次，除現有的動物傳染病防制條例外，應訂定寵物管理法規，法規內容應強制飼養寵物者應將寵物植入晶片，並包含定期檢疫、施打疫苗的規定，如此一來，可使相關的管理有法源依據，不再單純依賴飼主良心，而造成防疫漏洞。再加以台灣上一波狂犬病爆發已超過半個世紀，新一代年輕人對於狂犬病可能一知半解，甚至覺得不會在台灣發生，因此應保持對民眾的狂犬病防治宣導，以提升民眾的風險知覺，進而主動配合防疫措施。
最後是建立狂犬病監測系統，對於流浪狗、家犬及各類溫血動物應有監測系統，蒐集組織、血液標本及各溫血動物病理症狀，建立流行病學資料，以隨時掌握疫情變化而得以採取適宜反應。
台灣過去對於狂犬病的防疫作為讓台灣成為世界僅有的七個非疫區國家之一，未來若能讓防疫作為更加徹底，咸信很快狂犬病便能正式宣布自台灣根絕，成為台灣另一項公共衛生的偉大成就。
表一、2003年犬隻狂犬病疫苗抗體ELISA檢驗結果
來 源 血清學檢驗數量 陽性數(陽性率)
家 犬 1,559 980 (62.9%)
流浪犬 2,099 863 (41.1%)
合 計 3,658 1,843 (50.4%)
資料來源：行政院農委會「2003年台灣犬隻狂犬病監測結果」
資料來源
1.http://vettech.nvri.gov.tw/Articles/report/886.html
2.http://www.adccyl.gov.tw/Animal_Dise/rabies/rabies.htm
3.http://www.cdc.gov.tw/index.asp (疾病管制局)
4.http://www.rabies.com/
2007年9月2日 星期日
本期截稿及下期主題
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WHO Regional Committee for South-East Asia meets in Bhutan
31 August 2007 -- The 60th session of the WHO Regional Committee for South-East Asia begins today in Thimphu, Bhutan. Avian and pandemic influenza preparedness and a revised malaria control strategy are among the topics to be discussed.
為主要主題，如有其他興趣或是相關議題可以再另外提出，大家可以討論，另外我將會重新分配下次的工作，應該會調動大家的工作並更換夥伴，如果有任何問題及意見，也請儘快提出！謝謝大家！
下期主題我希望能夠以：
WHO Regional Committee for South-East Asia meets in Bhutan
31 August 2007 -- The 60th session of the WHO Regional Committee for South-East Asia begins today in Thimphu, Bhutan. Avian and pandemic influenza preparedness and a revised malaria control strategy are among the topics to be discussed.
為主要主題，如有其他興趣或是相關議題可以再另外提出，大家可以討論，另外我將會重新分配下次的工作，應該會調動大家的工作並更換夥伴，如果有任何問題及意見，也請儘快提出！謝謝大家！
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