The Chinese early detection system for infectious disease could identify clusters of bird-flu in humans in real time, thus providing authorities and the rest of the world with early warning of the start of the pandemic. This is among the conclusions of the second paper in The Lancet Series on Health System Reform in China, written by Professor Longde Wang, Chinese Ministry of Health, and Professor Zunyou Wu, Chinese Centre for Disease Control and Prevention, Beijing, China, and colleagues.
Since the People's Republic of China was established in 1949, the average life expectancy has increased from 35 years at birth to 72 years in 2000-2005. Infant mortality has decreased from 200 per 1000 livebirths to 23 per 1000 during the same period. The authors say: "These impressive gains were probably due to a substantial reduction in rates of infectious diseases." The Chinese government has a reporting system for 27 infectious diseases, which has used web-based reporting since 2003, and covers all the main infectious diseases such as HIV, syphilis, meningitis, hepatitis and others. In 2006, tuberculosis, hepatitis B, dysentery, syphilis, and gonorrohea accounted for 86% of over 4.5 million reported cases of these 27 diseases; while tuberculosis, rabies, HIV/AIDS, hepatitis and Japanese encephalitis B accounted for 9439 of 10726 (88%) of deaths from these 27 diseases.
Proven strategies such as improving water supply and sanitation, blood collection, fly, mite and rodent control have all aided in the Chinese government's quest to reduce the impact of infectious disease. Specific example of success include a seven-fold increase in the tuberculosis budget between 2000-05, with detection rates for tuberculosis increasing to 80% and successful treatment for 92% of these cases, surpassing the 2005 WHO target. China was only one of four countries with a high tuberculosis burden to achieve this target.
The Chinese Government learnt a great deal from the severe acute respiratory syndrome (SARS) epidemic in 2003, and improved its reporting system for pneumonia of unknown cause. It replaced its lengthy system of 'chain' reporting through local centres for disease control to government to an instant, real-time web-based reporting system where every case of unidentified pneumonia has to be reported within 24 hours and, if necessary, contained. This surveillance system identified 21 cases of human bird-flu from 236 of unidentified pneumonia in 2005-06.
The authors conclude: "Preparation for a pandemic will require a high degree of coordination between ministries and agencies in all countries, and the financial and technical support of the worldwide community. China can lead in developing systems for surveillance and response that can serve as a model for other developing countries."
An accompanying Comment, by Dr Kong-Lai Zhang, Institute of Basic Medical Sciences, Beijing, and colleagues, focuses on China's HIV/AIDS epidemic, which has gained momentum because of 'the profound change in sexual attitudes and behaviour, and the rapid growth of the sex industry during the past two decades." They conclude: "China also needs to mobilise and engage civil society in the fight against HIV/AIDS, and to encourage interdisciplinary approaches for HIV research, treatment, care, and prevention."
A further Comment discusses the blight of schistosomiasis, a chronic and debilitating disease endemic in the tropics of China, and affecting mainly poor populations.
Professor Zunyou Wu, Chinese Centre for Disease Control and Prevention, Beijing, China. T) Office: +86-10-63165758; mobile +86-13801251578 E) wuzy@263.net
Dr Kong-Lai Zhang, Institute of Basic Medical Sciences, Beijing T) +86 13910-506-195 / +86-10-65296973 E) Konglai_Zhang@163.com
Full paper: http://press.thelancet.com/china2.pdf
Journal
The Lancet