Infectious disease control.
Infectious disease control.
复制标题
传染病控制。
DOI：
10.1136/bmj.300.6738.1477
复制
发表时间：
1990
影响因子：
--
通讯作者：
N. S. Galbraith
中科院分区：
文献类型：
--
作者：
N. S. Galbraith
艾奇逊的报告《英格兰的公共卫生》指出的问题之一是对控制传染病的责任的混淆，包括一些地方和卫生当局之间的沟通不畅，以及对环境卫生医务官员的作用的不满。“沿着报告的其他方面，其中一些缺陷已经得到解决，例如，通过任命传染病控制顾问。[2]但艾奇逊委员会也指出有必要对传染病法进行审查，卫生部现在已经以咨询文件作出回应。[3]该文件提出的关键问题是，地区卫生当局或地方当局，或两者，是否应该有提供、领导和协调传染病控制服务的法定职责。[3]答案肯定是两者都应该，地区卫生当局负责监测、调查、控制和预防疾病（“影响人的事项”），地方当局负责监测、调查和控制环境危害（“与环境有关的事项”）。这种责任的澄清应能加强大多数地区环境卫生医务干事与首席环境卫生干事之间的密切工作关系，同样，与过去环境卫生医务干事相比，对传染病控制顾问进行更多的专门培训也是如此。每一种传染病都有环境因素，最明显的是食源性和水源性疾病，许多环境危害都与感染有关。因此，如果地区卫生当局和地方当局有一个相互支持的法定要求，例如，在必要时部署工作人员，顾问和首席环境卫生官员将有助于完成他们的工作。将传染病控制顾问荣誉任命到适当的地方当局，将首席环境卫生干事荣誉任命到相应的卫生当局，这将有所帮助，特别是如果地方当局”适当官员”的概念被取消的话。如果控制人的传染病成为卫生当局的责任，那么，法定的传染病通知应该是向地区卫生当局，他们应该有法律的权力来处理它，在实践中，通知应该严格保密地发送给传染病控制顾问，正如艾奇逊报告所建议的那样;事实上，这种情况目前在英格兰和威尔士的一些地区是非正式的。传染病控制顾问的法律的权力应包括不准工作或上学、将人隔离在家中或医院、强制进行体格检查，以及进入处所调查和控制感染。在调查感染事件期间或作为流行病学调查的一部分，从个人获得流行病学信息通常不需要法律的权力，尽管有时这些权力可能会有所帮助。大多数现有的公共卫生法涉及环境控制，因此是地方当局的职能。同样，食物法例，包括非专业人士呈报食物业处所的肠胃感染个案，应继续由地方当局负责。谘询文件描述了现时法定须呈报传染病法例的复杂性，可透过限制法定须呈报传染病的数目及采用相同的方法，简化法例。
One of the problems identified by the Acheson report, Public Health in England, was confusion about responsibility for the control of communicable diseases, including poor communication between some local and health authorities and dissatisfaction with the role of the medical officer for environmental health.'Along with other aspects of the report some of these deficiencies have already been tackled-for example, by appointing consultants in communicable disease control. 2 But the Acheson committee also pointed out the need for a review of the law on infectious disease, and the Department of Health has now responded with a consultation document. 3 The key question the document poses is whether district health authorities or local authorities, or both, should have the statutory duty to provide, lead, and coordinate an infectious disease control service. 3 The answer must surely be that both should, district health authorities being responsible for surveillance, investigation, control, and prevention of disease (" matters affecting persons") and local authorities being responsible for surveillance, investigation, and control of environmental hazards (" matters relating to the environment"). This clarification of responsibilities should enhance the close working relationships between medical officers for environmental health and chief environmental health officers that exist in most districts, as should the greater specialist training given to the consultants in communicable disease control than the medical officers for environmental health received in the past. Every infectious disease has an environmental component, most notably in food borne and waterborne disease, and many environmental hazards are related to infection. So consultants and chief environmental health officers would be helped to do their job if district health authorities and local authorities had a statutory requirement to provide support for each other-for example, by deploying staff when necessary. An honorary appointment of the consultants in communicable disease control to the appropriate local authorities and of the chief environmental health officer to the corresponding health authorities would help, especially if the concept of the" proper officer" to local authorities were discontinued. If control of infection in people is to become a health authority responsibility it follows that statutory notification of infectious disease should be to district health authorities and that they should have the legal powers to deal with it. In practice, notifications should be sent in strict confidence to the consultants in communicable disease control, as the Acheson report suggested; indeed, this currently happens informally in some parts of England and Wales. The legal powers available to the consultants in communicable disease control should include exclusion from work or school, isolation of people at home or in hospital, compulsory medical examination, and entry to premises for investigating and controlling infection. Obtaining epidemiological information from individual people, either during investigation of an episode of infection or as part of an epidemiological survey, does not usually require legal powers, although occasionally these might be helpful. Most existing public health law is concerned with environmental control and is therefore a local authority function. Similarly, food law, including the lay reporting of gastrointestinal infections from food premises, should continue to be a local authority responsibility.The consultation document describes the complexity of current legislation on statutorily notifiable infectious disease, which could be simplified by limiting the number of notifiable diseases and applying the same …