How the SARS experience has helped preparations for future outbreaks: The Taiwan experience, with emphasis on the successful control of institutional outbreak of influenza in 2003/2004 using a stockpile of antivirals

[[abstract]]The experience and lessons learned from SARS in 2003 have driven Taiwan to prepare for the coming outbreak of SARS, pandemic influenza and other emerging infectious diseases. Several control measures were activated in the post-SARS period including central command and governance structure re-organization, improved scientific capability and laboratory diagnostics, surveillance and real-time reporting, and law revision and enforcement. Furthermore, the government implemented a policy to self-manufacture antivirals and vaccine for influenza and H5N1. The above measures proved to be effective for the control of dengue infection, seasonal influenza and enteroviruses in the post-SARS period. The measure most worthwhile to share with the world is the stockpile of 2.3 million dosages of the antiviral Tamiflu on November 2003 in the belief that the majority of influenza-like illness (ILI) should represent influenza in winter season and to avoid the confusion with SARS. A total of 68 ILI outbreaks were reported in 2003/2004 and Tamiflu was immediately given to the patients and their contacts. A total of 311 samples were obtained and 24% of them were laboratory-proved to be caused by influenza A. None of them were caused by SARS-CoV. All the ILI outbreaks were successfully controlled and no transmission was reported thereafter. In parallel to this control measure, the ILI prevalence and institutional mortalities due to ILI reduced remarkably in 2003/2004. Therefore, the control policy of ILI illness by antivirals proves to be effective in institutional outbreaks of influenza. This strategy can be considered for application in the case of H5N1 pandemic flu