前     言

　　中國是一個地震多發(fā)，飽受地震災害之苦特別多的國家之一,。1976年的唐山大地震和2008年汶川大地震,，都是新中國成立以來，破壞性極強,、波及范圍極大,、救災難度極大、影響極其深遠的地震災害,。地震災害不僅造成人員傷亡和財產(chǎn)損失,，而且也給疾病預防與控制工作帶來了巨大的挑戰(zhàn),。為進一步明確地震災害的公共衛(wèi)生影響，有針對、有計劃,、有目標地開展地震災害疾病預防控制工作,，確保大災之后無大疫,，中國疾病預防控制中心在世界衛(wèi)生組織的支持和幫助下,，聯(lián)合華西醫(yī)科大學、安徽醫(yī)科大學,，以及有關(guān)省市疾病預防控制中心,，在總結(jié)唐山大地震和汶川大地震疾病預防與控制工作實踐,，以及其他國家的地震災害疾病預防與控制工作經(jīng)驗后，提出了本工作指南,。本指南根據(jù)地震災害公共衛(wèi)生特征,，按照災前準備、災后應急和恢復重建等核心業(yè)務工作分別進行了描述,，以期指導各級疾控機構(gòu)進一步理清思路,、積極主動、科學規(guī)范地開展地震災害的疾病預防與控制工作,。 　　  

　　  

第一章 總論

一,、地震災害及危害

（一）地震災害特征

　　地震災害具有突發(fā)性、災難性,、次生災害多發(fā)性、影響巨大性和重建艱巨性等五大特征,。 

（二）地震災害的主要危害

　　1,、直接危害。包括：建筑物倒塌,，人員傷亡,，水、電,、氣,、道路等基礎設施破壞，能源供應受損,，交通通訊中斷,，社會服務設施受損，生態(tài)環(huán)境破壞等,； 

　　2,、間接危害。包括：政治,、經(jīng)濟,、社會和人群健康影響； 

　　3,、次生災害,。包括：火災、化學品爆炸,、化學品和放射性物質(zhì)泄漏,、洪澇災害、海嘯,、交通事故,、社會騷亂等,。 

二、地震災害不同時期引起的主要公共衛(wèi)生問題

（一）應急期,，主要是地震災害在短時期造成的直接后果

　　1,、對人群健康的直接影響 

　　（1）大量的人員傷亡。主要是指建筑物倒塌,，山體滑坡等造成身體的機械性損傷和死亡,。 

　　（2）傳染病的發(fā)生。主要是由不清潔的飲用水和食物,，大規(guī)模人群遷移和聚集,，衛(wèi)生設施不完善，媒介生物遷移和人群暴露等引起,。 

　　（3）意外傷害,。主要是由中暑，犬傷,，燒灼傷,，凍傷， CO中毒,，食物中毒,，化學品中毒，放射性物質(zhì)污染等偶發(fā)事件引起,。 

　　（3）慢性非傳染病病,。主要是由于生活和生存環(huán)境的改變，導致心腦血管疾病,，高血壓,，糖尿病等疾病發(fā)作。 

　　（4）精神及心理創(chuàng)傷,。主要是地震災害的突發(fā)性,、災難性引起的早期心理應急反應，以及生活和生存環(huán)境的改變引起的短期心理溝通障礙等,。 

　　2,、對公共衛(wèi)生服務系統(tǒng)的破壞 

　　（1）公共衛(wèi)生服務能力受到?jīng)_擊。一方面是公共衛(wèi)生服務機構(gòu)受損,。包括建筑物毀壞,，設備儀器損壞，實驗室遭到破壞,，數(shù)據(jù)和技術(shù)資料丟失,。另一方面是衛(wèi)生服務人員受損。包括個人和家庭成員失蹤,，家庭財產(chǎn)受損,、長期勞累造成的人員減員等,。 

　　（2）衛(wèi)生服務需求增加。由于大量的傷病人員需要緊急救治,，大量的心理疾患者需要疏導,，因此，短時間內(nèi)需要大量的醫(yī)務人員和醫(yī)用物資,，如醫(yī)療器械,、血液等。 

（二）恢復重建期,，主要是地震災害的間接后果和長期影響

　　1,、對人群健康的間接影響 

　　（1）破壞了公共衛(wèi)生服務體系。包括免疫規(guī)劃,，婦幼衛(wèi)生,，精神衛(wèi)生，藥物和疫苗供給等正常工作秩序受到破壞,； 

　　（2）增加了潛在的傷殘壽命,。機械性損傷導致的傷殘；氣性壞疽引起的截肢,；建筑物倒塌產(chǎn)生的粉塵吸入而引起塵肺；精神性創(chuàng)傷等,。 

　　（3）打亂了正常生活,，身體抵抗力下降，精神和情緒紊亂,，極易誘發(fā)多種疾患,； 

　　（4）生態(tài)環(huán)境破壞，有可能導致某些傳染病升高,。 

　　2,、對公共衛(wèi)生服務系統(tǒng)的間接影響 

　　（1）破壞了公共基礎設施。飲水,，電力,、燃料，通訊和排水系統(tǒng)破壞,，導致公共衛(wèi)生服務能力和工作秩序受到影響,； 

　　（2）道路交通和通訊中斷，導致醫(yī)療衛(wèi)生服務的及時性受到影響,； 

　　（3）媒體,、國際國內(nèi)社會等的過分關(guān)注和期望，造成公共衛(wèi)生服務的工作壓力,、工作強度和工作難度增加,。 

三,、地震災后疾控工作周期

　　分為災前準備、災后響應和恢復重建三個階段,。其中災前準備包括組織準備,、公共衛(wèi)生風險評估、避災和減災,、應急計劃,、政策和能力建設等。應急響應應急救援和疾病控制,?；謴椭亟òü残l(wèi)生服務能力恢復、傳染病和慢性非傳染病疾病預防與控制等,。 

四,、疾控工作面臨的挑戰(zhàn)

（一）準備不充分

　　主要是應對體制和機制不完善，物資與技術(shù)儲備不足夠,，風險與危害認識不到位,，導致災后短期內(nèi)工作混亂，不系統(tǒng)全面,。 

（二）組織機構(gòu)不健全

　　主要是指預案啟動不經(jīng)常性,，機構(gòu)的臨時性，導致應急指揮不統(tǒng)一,，信息不通暢,，反應不靈敏，不能有效動員內(nèi)部和外部資源,。 

（三）短時期人員和物資缺乏

　　主要是指公共衛(wèi)生服務需求與公共衛(wèi)生服務能力之間存在的短時間差距,，導致在人員、應急裝備,、運輸工作和專業(yè)設備不足,。 

（四）工作條件簡陋

　　主要是災后公共設施破壞，疾控工作現(xiàn)場缺電,、少水,，食物、藥品不足,，生活條件十分艱苦,。 

（五）工作壓力巨大

　　主要是指災害造成的公共衛(wèi)生影響大，災后面臨的形勢復雜,，任務繁重,，政府和群眾的需求與要求都比較高。特別是“大災之后無大疫”的艱巨任務,，容不得疾控部門有絲毫的懈怠和馬虎,。 

五,、地震災害疾控工作關(guān)鍵要素

（一）做好日常應急準備工作

　　包括完成組織準備、公共衛(wèi)生風險評估,、避災和減災,、應急計劃、政策和能力等建設,。 

（二）建立衛(wèi)生部門統(tǒng)一協(xié)調(diào)機制

　　包括指揮決策,，組織協(xié)調(diào)，監(jiān)測預警,，信息收集和報告,，社會動員，應急保障（含物資分發(fā)機制）等機制,。 

（三）當?shù)氐募部亓α渴菓?zhàn)勝災害的關(guān)鍵

　　主要是指當?shù)氐募部仃犖?，比其他力量更熟悉當?shù)氐娜宋暮偷乩憝h(huán)境，能更好的組織開展疾病預防控制工作,。 

（四）外援疾控力量要以災區(qū)需求為導向

　　外部援助可以幫助受災地區(qū)迅速從災難的打擊中恢復過來,。但如果這種援助并不是當?shù)卣嬲枰模蚓仍镔Y和人員過剩,，極易給災區(qū)帶來新的負擔,，并影響當?shù)丶膊☆A防與控制工作的順利進行。 

（五）建立適宜的保障措施

　　首先是通信保障,。采用各種有線,、無線以及衛(wèi)星通訊以及人員傳遞等方式，保證指揮系統(tǒng),、疾控機構(gòu)、醫(yī)院,、消防隊,、機場、車站,、港口,、各救援力量等重要部門和組織之間的通訊聯(lián)絡暢通，以確保指揮和協(xié)調(diào)各疾病預防與控制力量的行動,，及時了解災區(qū)受災的消息以及他們的需求,。其次是物資裝備保障。包括個人生活攜行裝備,、個人防護裝備,、辦公通訊裝備和現(xiàn)場快檢裝備等，確?，F(xiàn)場工作順利開展,。再其次是后勤保障,。包括車輛的調(diào)配，生活安排,，各類救災物品的接收和分發(fā)管理等,。 　　  

　　 　　  

第二章 災前準備

　　地震災前準備是為了降低地震災害對疾病預防與控制工作秩序的沖擊和破壞，提高疾控部門應對災害的能力,，預防和減緩各種與地震相關(guān)的突發(fā)公共衛(wèi)生事件發(fā)生,。 

　　疾病預防與控制工作的地震災前準備主要包括了組織準備、公共衛(wèi)生風險評估,、預防和減輕公共衛(wèi)生影響,、人力資源準備、應急物資準備,、現(xiàn)場處置工具準備等六個關(guān)鍵因素,。 

一、組織準備

（一）建立組織框架

　　包括指揮部門,、協(xié)調(diào)部門和執(zhí)行部門的邏輯框架,。重點構(gòu)建日常應急處置中心（EOC），提供相關(guān)人員進行規(guī)劃,、組織,、獲取和分配資源的場所，完成評估災情和需求,、決策應對方式,、調(diào)動各種資源、啟動行動指令,、跟蹤資源利用和上報工作進展等六項工作任務,，來提供政策指導和支持、確定工作重點和協(xié)調(diào)機構(gòu)之間行動,。 

（二）制定政策,，即運行機制和制度

　　1、機制,。包括指揮決策機制,，組織協(xié)調(diào)機制，監(jiān)測預警機制,，信息收集和報告機制,，社會動員機制，應急保障機制（含物資分發(fā)機制）,。 

　　2,、制度。包括崗位職責，監(jiān)督評價,，獎懲等制度,。 

（三）制定計劃和預案

　　1、編制應急預案準備,。包括全面分析本系統(tǒng),、本單位危險因素，可能發(fā)生的突發(fā)事件類型及事件的危害程度,；排查突發(fā)事件隱患的種類,、數(shù)量和分布情況，并在隱患治理的基礎上,，預測可能發(fā)生的突發(fā)事件類型及其危害程度,；確定突發(fā)事件危險源，進行風險評估,；針對突發(fā)事件危險源和存在的問題,，確定相應的防范措施；客觀評價本單位應急能力,；充分借鑒國內(nèi)外同行業(yè)突發(fā)事件教訓及應急工作經(jīng)驗,。   

　　2、預案的主要內(nèi)容,。主要包括組織指揮體系,，各部門的職責和分工，信息收集,、分析和報告,，災后的疾病預防與控制措施和行動（包括飲水衛(wèi)生、食品衛(wèi)生,、環(huán)境管理與消毒,、傳染病監(jiān)測與控制、媒介生物控制,、傷害預防,、健康教育等），溝通協(xié)調(diào)方式,，后勤支持,，安全與保障等相關(guān)內(nèi)容,。   

　　3,、預案的基本結(jié)構(gòu)。包括背景,、目的,、職責分工、操作思路,、協(xié)作配合和附錄等六部分,。其中背景可簡單介紹當?shù)氐卣馂暮捌溆绊?、預案的必要性等；操作思路可簡要說明總體政策,、結(jié)構(gòu)和預案目標,；協(xié)作配合可對報告程序、通訊渠道和建立有效,、適宜的協(xié)作機制做出安排,。附錄主要顯示協(xié)作程序的框架圖，以及不同部門支持履行職責分別制定的配套預案等,。 

二,、地震災害的公共衛(wèi)生風險評估

　　收集當?shù)貫暮π畔ⅲM行危害識別,，社區(qū)人群,、供水系統(tǒng)、環(huán)境衛(wèi)生等脆弱性分析,，應對能力分析以及社區(qū)風險分析,。在此基礎上，完成風險管理地圖,。標識出本地區(qū)危害,、脆弱性提示圖和風險、信息資源,、物資資源,、人力資源分布圖。 

三,、預防和減輕災害對公共衛(wèi)生影響

（一）倡導社區(qū)環(huán)境改善

　　依靠社區(qū)健康教育活動,，組織和動員社區(qū)群眾清潔生活環(huán)境，改變不良的生活習慣,，提高防病意識,。 

（二）參與制定環(huán)境安全規(guī)則

　　包括建立供水設施，廁所等公共衛(wèi)生設施,，垃圾和污水處理設施等環(huán)境衛(wèi)生地方標準,。 

（三）評價和督導社區(qū)環(huán)境衛(wèi)生基礎設施的改善

　　在法律框架范圍內(nèi)，積極主動參與當?shù)亟ㄔO規(guī)劃和防震減災設施的衛(wèi)生學評價工作中,，指導進行合理設置和建設,。 

（四）加強公共衛(wèi)生服務設施的安全

　　確實保障衛(wèi)生部門自身基礎設施設備在地震災害中免于或減輕破壞。 

四,、人力資源準備

（一）建立相關(guān)專業(yè)專家?guī)?/span>

　　建立由公共衛(wèi)生,、醫(yī)院、交通、通訊等部門以及各大專院校相關(guān)專業(yè)組成的專家團隊,，完善專家信息,，加強專家從業(yè)素質(zhì)、專業(yè)能力,、工作態(tài)度,、敬業(yè)精神、廉潔自律等方面培訓和考核,。 

（二）成立由專業(yè)人員組成的應急隊伍

　　建立由傳染病,、食品和化學中毒、核和輻射安全等專業(yè)的流行病學專業(yè)人員和實驗室專業(yè)人員,，以及后勤保障人員組成的專業(yè)團隊,，并配備專業(yè)的現(xiàn)場工作裝備，進行經(jīng)常性的培訓和演練,。  

（三）公共衛(wèi)生專業(yè)人員災害衛(wèi)生應急培訓

　　培訓分為專業(yè)知識培訓和現(xiàn)場技能培訓兩部分,；其中專業(yè)培訓包括各種相關(guān)法律、法規(guī),，災害現(xiàn)場信息收集,、評估和報告，突發(fā)公共衛(wèi)生事件的應急調(diào)查和處置等,，現(xiàn)場技能包括各種急救醫(yī)學知識,，急危重病人的急救技能，群體傷病員處理流程,，傳染病和常見中毒的急救知識,，自然災害、意外事故狀態(tài)下自救互救技能,，心理素質(zhì)培訓以及怎樣聯(lián)絡報警,，怎樣接近傷員等。培訓要求制訂培訓計劃和編寫培訓教材,，制定考核標準和獎懲措施,，對參與培訓人員進行考核，確保培訓實效,。 

（四）組織災難衛(wèi)生應急模擬演習

　　演練主要是為了檢驗預案,、完善準備、鍛煉隊伍,、磨合機制和宣傳教育,。演練的形式有研討式型演練、桌面推演,、操作演示,、特定功能演練和全面系統(tǒng)演練五種。 

五,、衛(wèi)生應急物資資源的準備  

　　包括建筑設施和場所,，通訊設施和設備、應急能源設備和物資,，交通工具和設備,，個人防護用品，隊伍標識,，健康教育材料,，試驗室快檢設備。準備原則要因地制宜,，確保安全,、經(jīng)濟和適用。 

六,、現(xiàn)場處置工具準備

（一）快速評估工具開發(fā)

　　包括災情,、災后需求、災后公共衛(wèi)生風險等評估工作,。根據(jù)評估現(xiàn)場條件,，采用不同的評估工具。 

（二）地震災害疾控工作手冊

　　經(jīng)常進行地震災害疾控工作技術(shù)資料的跟蹤和整理匯編,，內(nèi)容包括各種政策,、指南、預案,、技術(shù)方案和規(guī)范等,。 

（三）現(xiàn)場個人防護和安全手冊

　　包括前期準備、現(xiàn)場工作備忘,、現(xiàn)場生活注意事項,、常見疾病防治和防護、常見病媒生物的活動規(guī)律,、各地基本情況及重點傳染病提示,、工作通訊錄等內(nèi)容,。 

　　 　　  

第三章 災后應急階段疾病預防控制

 一,、災后快速反應行動

　　包括快速核實和評估災情,，并迅速報告有關(guān)部門,；啟動預案措施,，初步確定應急目標,；緊急動員專業(yè)人員和社會力量參與行動,；緊急調(diào)配物資調(diào)用,，實現(xiàn)既定目標,；建立公共衛(wèi)生信息交流平臺；收集和反饋群眾需求信息,；確保監(jiān)測系統(tǒng)和應急實驗室正常運轉(zhuǎn),，核實功能是否健全；編寫人事計劃,、更新聯(lián)絡相關(guān)信息和花名冊,，以供后來者使用,，告知后來者目前的工作任務和以待解決的問題,；做好國家和政府領(lǐng)導到達現(xiàn)場援助的準備工作,；評估已經(jīng)獲得和還未滿足的衛(wèi)生資源需求；做好救援力量的后勤保障和心理援助等十一項內(nèi)容,。 

二、現(xiàn)場的協(xié)調(diào)和組織

　　重點是疾控隊伍內(nèi)部資源及相關(guān)外部資源,。包括本地,，外援，督導隊伍和自愿者等人員管理,，物資管理,，信息管理,，后勤保障管理,。 

三,、災區(qū)公共衛(wèi)生現(xiàn)狀與需求的快速評估

（一）快速評估的原則

　　根據(jù)響應確定優(yōu)先內(nèi)容,，邊響應邊評估,，建立在可得到的信息,。力求快速簡潔，不苛求完整全面詳盡,， 

（二）評估的內(nèi)容

　　災情和醫(yī)療能力,，風險源，服務對象狀況,，衛(wèi)生服務能力,。 

（三）評估的方式和渠道

　　建立信息收集的機制，臨時收集信息的平臺,。利用評估工具,，包括評估表。 

（四）評估結(jié)果分析和表達，及表達渠道,。

四,、災后疾病監(jiān)測

　　利用幸存的監(jiān)測能力和開展應急監(jiān)測；必要時開展特殊人群的癥狀監(jiān)測,。 

五,、傳染病風險控制與流行病預防

（一）飲用水衛(wèi)生

　　指導和幫助尋找、監(jiān)測,、宣傳,、督導和評估可用的水源；采取簡易,、快熟,、可用的觀察和檢測手段及評估指標，初步分析飲用水風險,，應急飲用水標準,，提出可飲用水指導意見；指導采取必要可行的衛(wèi)生措施,，進行飲用水的處理,；開展清潔衛(wèi)生飲用水的宣傳教育。 

（二）食品安全

　　識別食物風險,，提出可食用的食物類型,；及時診斷和處理各種食物中毒事件；盡可能調(diào)查食物中毒原因,，防止食物中毒的擴大和再發(fā),；食物運輸、倉儲和加工管理,；開展預防食物中毒的宣傳教育,。 

（三）環(huán)境衛(wèi)生與消毒

　　參與與指導人畜糞便、垃圾,、尸體的處理,，保護水源；采用當?shù)匾子诮邮艿姆绞?，指導災民正確的衛(wèi)生習慣,。 

（四）病媒生物控制

　　采用個人感覺或者利用技術(shù)手段等監(jiān)測老鼠、蚊子,、蒼蠅等媒介生物活動,；指導社會力量正確開展環(huán)境消殺滅，控制媒介生物孳生,；開展健康教育,，指導群眾做好個人防護。 

（五）喪葬服務與死亡處理

　　消除尸體在傳染病傳播中的作用的謠言和誤解；根據(jù)現(xiàn)場實際情況,，協(xié)助有關(guān)部門快速制定尸體處理的流程和注意事項,；快速評估尸體處理所需資源；指導尸體處理過程中體現(xiàn)的人文關(guān)懷和尊重,；對尸體處理者提供心理援助,。 

六、傳染病預防與控制

（一）疫情處置

　　評估緊急情況下特定傳染病流行閾值,；監(jiān)視異常信息,，并迅速核實；暴發(fā)證實,，如有可能實驗室確認,；傳染源和傳播方式的現(xiàn)場調(diào)查；現(xiàn)場控制過程中防止暴露,、預防感染,、預防疾病和防止死亡； 

（二）應急疫苗接種

　　制定詳細的應急接種計劃,；確定疫苗群體接種策略,；接種的危險性評估和后勤需求評估；接種人員培訓,；接種地點的選擇,；注射安全；疫苗的冷鏈,；疫苗的緊急供應,。 

七、意外傷害事故的風險源管理

　　確定化學物質(zhì),、放射性物質(zhì)和致癌,、致畸物質(zhì),，如房屋中的石棉等危險源,；指導做好泄漏的巡查和暴露的防范；協(xié)助做好泄漏的控制和受威脅人員轉(zhuǎn)移,；指導暴露人員的救治和心理咨詢,。 

八、健康宣傳與風險溝通

　　進行災區(qū)的健康教育社會學,、流行病學和行為學診斷,；以飲水衛(wèi)生、食品衛(wèi)生,、個人衛(wèi)生,、蚊蠅等媒介防護、疾病常識、就醫(yī)指南等為宣傳重點,，利用宣傳專欄,、宣傳畫、傳單等平面媒體,、廣播和電視等現(xiàn)代傳播手段,、以及講座和口頭傳幫等傳統(tǒng)方式進行宣傳。確定媒體和公眾溝通核心信息,，主動開辟媒體宣傳專欄,，建立群眾健康熱線。 

　　災后風險溝通的目標是預防和防范風險,、控制公眾憤怒和危機溝通,。溝通的原則是平等、真誠,、坦率和透明,。溝通策略有四點：一是告訴人們會發(fā)生什么，不要追求零恐懼,；二是承認不確定性,；三是愿意負責任作出推測；四是讓公眾參與,。  

九,、心理關(guān)懷與危機疏導

　　明確干預對象；遵循干預原則,；制定詳細的工作方案,；開展心理健康狀況評估；根據(jù)不同的心理健康狀況采取不同的心理危機現(xiàn)場干預措施,；干預結(jié)束后要及時隨訪和評估,。 

　　處理情感時注意不要追求零恐懼，不要嘲笑公眾的情緒,，認同人們的恐懼,，表現(xiàn)您自己的仁慈。 

十,、集中安置場所衛(wèi)生管理

　　參與和指導安置場所的衛(wèi)生設施設置和建設,；指導做好安置場所的人畜糞便、生產(chǎn)生活污水和固體垃圾的評估,、儲存,、收集和運輸，以及媒介控制和環(huán)境消殺滅,；設立臨時醫(yī)療衛(wèi)生防疫點,，開展常見病救治,、傳染病登記、報告工作,，開展飲水,、食品、環(huán)境衛(wèi)生監(jiān)測與指導,、衛(wèi)生防病知識宣傳等工作,，必要時開展癥狀監(jiān)測的登記報告工作。 

十一,、專業(yè)人員安全及防護

　　為參與應急處置工作人員進行培訓并攜帶安全手冊,；事先告知可能的安全風險和必要的注意事項；裝備個人防護服,、防護眼鏡,、口罩、手套,、消毒液等必要的個人防護用品,；如有可能，進行疫苗注射和預防性服藥,。 

　　 　　　  

第四章 恢復和重建疾病預防與控制工作

一,、恢復重建時期的準確含義和工作重點

　　恢復重建時期是指服務體系和能力沒有完全恢復的時期。重點是恢復疾病預防控制工作秩序,；逐步提高疾病預防與控制工作能力,；減輕和減緩地震災害可能帶來的公共衛(wèi)生風險。 

二,、公共衛(wèi)生需求和恢復狀況評估與評價

　　持續(xù)對災區(qū)醫(yī)療衛(wèi)生機構(gòu)能力現(xiàn)狀與需求,，安置點醫(yī)療衛(wèi)生服務、飲用水與環(huán)境衛(wèi)生,、食品衛(wèi)生和營養(yǎng),、媒介生物監(jiān)測和控制、健康教育等方面的現(xiàn)狀與需求,，以及特殊人群（殘疾人,、兒童、老年人,、孕產(chǎn)婦和哺乳期婦女等）衛(wèi)生服務需求進行評估,，并實時調(diào)整恢復重建策略；開展恢復重建項目效果評價,，提高項目效率。 

三,、傳染病預防與控制

（一）傳染病監(jiān)測與報告

　　根據(jù)災區(qū)實際情況,，科學規(guī)劃,、設計災區(qū)傳染病監(jiān)測網(wǎng)絡，確保疫情監(jiān)測報告系統(tǒng)覆蓋災區(qū)所有臨時和固定的醫(yī)療衛(wèi)生單位以及城鄉(xiāng)社區(qū),。通過監(jiān)測報告網(wǎng)絡的恢復重建,，傳染病疫情報告的指導、培訓和督導,，疫情分析會商機制的建立,，實驗室重點傳染病診斷能力的加強，不斷提高傳染病監(jiān)測和預警能力,，及時發(fā)現(xiàn)和識別聚集性病例或暴發(fā)苗頭,。  

（二）傳染病暴發(fā)調(diào)查與控制

　　努力提升傳染病暴發(fā)疫情識別的技術(shù)手段和發(fā)現(xiàn)能力；完善傳染病暴發(fā)調(diào)查和控制程序和規(guī)范,；吸收和增加專業(yè)人員,，并及時進行流行病學等知識培訓；提高實驗室重點傳染病診斷技術(shù)裝備水平和檢測能力,；提高綜合運用控制傳染源,、切斷傳播途徑、疫苗接種和公眾教育等手段的技術(shù)儲備和能力,；不斷開展傳染病風險評估和危險源控制,，減少和減緩傳染病暴發(fā)的發(fā)生頻次。 

（三）媒介昆蟲與嚙齒動物監(jiān)測與控制

　　制定常規(guī)的媒介生物監(jiān)測控制計劃和方案,；選擇適合本地,、簡便易行的方法進行蚊、蠅,、鼠的密度監(jiān)測,，根據(jù)監(jiān)測結(jié)果，適時調(diào)整消殺滅策略,；參與建筑物的規(guī)劃和衛(wèi)生學評價,，考慮廁所、垃圾的合理配置和管理,，減少孳生地和蚊蠅的孳生,；倡導愛國衛(wèi)生運動，積極提供技術(shù)支持,；指導公眾做好媒介生物的個人防護,。 

（四）醫(yī)院感染控制

　　醫(yī)院感染控制工作進入常態(tài)管理，恢復醫(yī)院感染控制組織運轉(zhuǎn),，開展常規(guī)醫(yī)院感染監(jiān)控工作,；加強醫(yī)院內(nèi)傳染病預防控制，嚴格消毒,、隔離和防護制度,，按相關(guān)規(guī)定處理醫(yī)療廢物和醫(yī)院污水,；選擇綜合性醫(yī)療機構(gòu)建立傳染病病區(qū)，統(tǒng)一收治傳染病病人,；綜合性醫(yī)療機構(gòu)建立,、恢復消毒供應室，并可對其它醫(yī)療機構(gòu)提供服務,；強化醫(yī)務人員的消毒,、隔離和防護知識的培訓，并開展對傳染病患者及陪護人員的健康教育工作,。 

四、公共衛(wèi)生與環(huán)境衛(wèi)生

（一）飲用水衛(wèi)生

　　指導和參與永久性供水水源選擇,、設施建設的衛(wèi)生學評價,；持續(xù)開展重點供水設施常規(guī)監(jiān)測評估；推動居民安全飲水知識的普及,。 

（二）環(huán)境衛(wèi)生

　　開展環(huán)境衛(wèi)生狀況評估,；指導做好水源保護，生活垃圾糞便的處理,，環(huán)境清理,、消毒、殺蟲和滅鼠工作,；開展公眾宣傳教育,，動員和指導社會力量參與環(huán)境衛(wèi)生保護。 

（三）食品衛(wèi)生

　　開展災后餐飲業(yè),、熟食加工業(yè),、安置點以及外援工作隊集體食堂等重點對象的食品監(jiān)測和安全風險評估；參與處置食物中毒事件處置,；指導群眾正確的就餐和飲食習慣,。  

五、基本公共衛(wèi)生服務（項目）恢復

（一）公共衛(wèi)生實驗室

　　逐步重建和恢復公共衛(wèi)生實驗室,，開展重要傳染病,、飲用水和食品衛(wèi)生檢測檢驗項目，為災后疾病預防控制工作提供實驗室支持,。  

（二）結(jié)核病防治

　　恢復災區(qū)結(jié)核病防治工作,，確保災前在治肺結(jié)核患者能夠完成后續(xù)的治療管理；及時發(fā)現(xiàn)新發(fā)的肺結(jié)核患者并予以及時報告,、規(guī)范治療與管理,。  

（三）兒童免疫服務

　　定期進行免疫規(guī)劃工作綜合評估；恢復免疫規(guī)劃資料管理,；恢復和重新設定預防接種場所,，配備接種人員,，恢復冷鏈運轉(zhuǎn),，促進兒童免疫接種服務盡快恢復運轉(zhuǎn),；開展疫苗可預防疾病的監(jiān)測，根據(jù)疫情預防控制需要,，及時組織開展群體性接種或強化免疫,。 

（四）艾滋病防治

　　優(yōu)先保障已經(jīng)接受抗病毒治療的艾滋病病人、美沙酮門診病人的治療工作,；適時開展對現(xiàn)有艾滋病病毒感染者/艾滋病病人的隨訪,、干預工作；恢復和重建艾滋病檢測實驗室的建設和網(wǎng)絡直報,。 

（五）婦幼衛(wèi)生

　　對婦幼衛(wèi)生資源和服務對象需求進行快速評估,；盡快完成婦幼衛(wèi)生基本服務網(wǎng)絡體系的重建，優(yōu)先恢復亟需的基本婦幼保健服務,；充實人員,，開展知識、技能培訓,；制作婦幼保健健康教育材料,，開展婦幼衛(wèi)生大眾健康教育；恢復和重建婦幼衛(wèi)生信息網(wǎng)絡,。 

（五）營養(yǎng)改善與健康

　　開展兒童,、孕產(chǎn)婦等重點人群的營養(yǎng)狀況監(jiān)測和評價，提出合適的保障,、干預措施,。 

六、其他健康管理秩序的恢復

（一）慢性非傳染性疾病預防與管理

　　整理和登記社區(qū)高血壓,、糖尿病等慢性病患者資料,；指導患者合理用藥，幫助養(yǎng)成健康的生活方式,；為重點對象提供血壓測量,、血糖測量等服務；開展合理膳食,、心理健康,、戒煙限酒等知識的宣傳教育，營造有利于健康生活方式的支持環(huán)境,。 

（二）心理衛(wèi)生關(guān)懷

　　在安置場所和學校,，以講課、座談,、宣傳資料,、娛樂等形式開展人群心理健康教育,；對教師、安置點醫(yī)務人員和管理人員等進行培訓,，提高他們對心理障礙的識別能力,，將需要進一步干預者及時轉(zhuǎn)介給精神科醫(yī)師或經(jīng)過認證的心理治療師。 

（三）傷害預防與控制

　　開展公眾宣傳和教育,，提高交通意外,、中暑、犬傷,、凍傷,、一氧化碳中毒、防火用電等意外傷害的防范意識,；倡導犬只管理,、消殺滅藥物管理、高溫作業(yè)管理,、老人和兒童照料,、水域安全護欄和建筑物危險區(qū)域警示設置等安全措施。 

七,、健康促進和社區(qū)參與

　　建立并完善縣,、鄉(xiāng)、村及災區(qū)群眾集中安置點開展健康教育工作的機制,；評估確定優(yōu)先解決的健康問題,；確定目標人群；確定傳播核心信息,。 

八,、重建項目的衛(wèi)生學評價

　　參與重大公共設施和建設項目的衛(wèi)生學評價。 

九,、開展地震災害健康影響及災后衛(wèi)生應急評估研究

　　長期監(jiān)測與追蹤災后公共衛(wèi)生風險,；科學分析地震災害對災區(qū)群眾健康造成的直接和間接影響，識別相關(guān)危險因子,；全面的評估和總結(jié)災后衛(wèi)生應急救援工作的經(jīng)驗與教訓,；開展深入的專項評估和專題研究。 

　　 　　  

　　  

Forward

　　  

　　China is a one of the earthquake-prone countries that suffer a lot from earthquakes. Tangshan Earthquake in 1976 and Wenchuan Earthquake in 2008 were both disasters of great destructiveness and vast affected area, resulting in a great deal of difficulties in disaster relief and leaving very deep and far impact. The earthquakes not only caused casualties and property losses, but also brought big challenges to disease prevention and control after disasters happened. In order to further guide the work of disease control institutions at all levels, and to carry out plans pertinent to the disease prevention after earthquakes to ensure no outbreak of epidemics, with the help and support from the World Health Organization, the Chinese Center for Disease Control and Prevention has cooperated with West China University of Medical Sciences, Anhui Medical University and some provincial centers for disease control and prevention to develop this technical guide based on summarization of experience obtained from disease prevention and control in Tangshan Earthquake and Wenchuan Earthquake and lessons learned from other countries’ disease prevention and control work. According to the characteristics of public hygiene in earthquakes, this guide describes separately such core work at different stages as pre-disaster preparation, post-disaster emergency measures and restoration and reconstruction, so that disease control institutions at all levels can carry out their earthquake-related disease prevention and control work in a clear, active, scientific, orderly and efficient manner. 

　　  

Chapter I Overview

I. Seismic Disaster and Its Hazards

(i) Seismic disaster and its characteristics

　　It contains the definition of seismic disaster and the five characteristics of seismic disaster, that is, emergent, cataclysmic, secondary-disaster prone, tremendously-impacted, and arduous restoration. 

(ii) Main hazards of seismic disaster

　　1. Direct hazards. Include: collapse of buildings, casualties, destruction of infrastructure like water, electricity, gas, road, etc., damages to energy supply, break of communication, impairment of social service facilities and destruction of ecological environment 

　　2. Indirect hazards. Include: impacts on politics, economy, society and people. 

　　3. Secondary disaster. Include: fires, explosion of chemicals, leak of chemicals and radioactive substance, floods, tsunami, traffic accidents, social disturbances, and so on. 

II. Public Health Problems Occurred at Different Stages of Seismic Disaster

(i)The emergency stage: most are direct outcomes caused by the seismic disasters in a short time

　　1. Direct impacts on public health 

　　(1) Large numbers of casualties. It mainly means mechanical injuries to bodies and deaths caused by collapse of buildings, landslide, etc; 

　　(2) Outbreak of infectious disease. It is mainly caused by unclean water and food, massive human migration and gathering, imperfect sanitary facilities and changes in distribution of biological vector and human exposure; 

　　(3) Accident injury. It is mainly caused by contingencies such as fires, heat stroke, CO intoxication, food poisoning, chemical poisoning, radioactive substance contamination, etc; 

　　(4) Chronic non-communicable diseases. These are mainly attacks of cardia-cerebrovascular disease, hypertension, and diabetes and so on resulted from changes in living environment. 

　　(5) Mental and psychic trauma. These are mainly contingent reaction in psychology caused by the emergent disaster and short-term psychological communication difficulty when living and surviving environment changed. 

　　2 Damages to public medical facilities 

　　(1)The capability of public medical facilities is under impact. On one hand, the hardware of public medical services has been impaired, including destruction of buildings, impairment of apparatus, damages of laboratories, and loss of data and technological documents; on the other hand, the medical services personnel have been affected, including individual and family members injuries and death, loss of family properties and depletion of personnel because of long-term overwork. 

　　(2)Increase of need for medical services. A lot of wounded and sick people needing urgent medical care and a lot of mind-hurt people need consolation and communication, therefore, a great amount of medical personnel and materials like medical instrument and blood will be required in a short time. 

(II) The stage of restoration and reconstruction: mainly indirect outcomes and long-term impacts caused by seismic disasters

　　1. Indirect impacts on public health 

　　(1) Destruction of the public medical care system: including damages to normal public health services such as immunization, maternal and children health, mental health, and medicine and vaccine supply; 

　　(2)The public normal life order has been changed, bodies’ resistance to diseases is lowered down, and people incurred mental and emotional disorder. All of these are prone to result in diseases; 

　　(3)Destruction of the biological environment can lead to higher occurrence possibility of some infectious diseases. 

　　2. Indirect impacts on public medical care system 

　　(1) Infrastructure such as water, electricity, fuel, communication and drainage are destroyed, resulting in adverse effect on public medical care capability and work order; 

　　(2) Traffics and communication are blocked, which have impact on timely supply of medical care services; 

　　(3) Over attention and expectation from media and domestic and international communities increase pressure, intensiveness and difficulty of public medical care services. 

III. Work Cycle of Disease Control in Seismic Disaster

　　The work cycle of disease control in seismic disaster is divided into three stages, that is, pre-disaster preparation, post-disaster response and restoration and reconstruction. Pre-disaster contains organization and preparation, risk assessment on public health, disaster avoidance and reduction, emergency plans, policy and capability establishment, etc. Post-disaster response contains emergency rescue and disease control. Restoration and reconstruction contains restoration of the capability of public medical care services and prevention and control of infectious diseases and chronic non-communicable diseases, etc. 

IV. Challenges Confronted by Disease Control

(i) Insufficient preparation

　　This mainly means that imperfect dealing system and mechanism, insufficient reserve of materials and technology, unclear recognition of disaster-related public health risks and hazards. These can lead to disordered work in the short time after disaster. 

(ii) Imperfect organization and institution

　　This mainly pertains to lack of unified and efficient emergency command and management, impeded information channel, and slow response. Internal and external resources cannot be mobilized and allocated effectively. 

(iii) Lack of personnel and materials in the early post-disaster period

　　This mainly indicates that in the short time after disaster, there exists a gap between demand and supply of public medical care services. Personnel, emergency equipment, transportation and professional facilities are also comparatively lacked.  

(iv)Work conditions are poor

　　This indicates that public facilities are destroyed so much in disasters that living condition is very hard at disease control work site due to lack of electricity, water, food, medicine and so on. 

(v) High pressure on work

　　This implies that disasters have made huge impacts on public health and complicated situations are confronted after disasters with massive tasks and social pressure. Especially, the arduous task of ensuring no outbreak of epidemics after big disasters can bear little carelessness. 

V. Key Factors of Disease Control in Seismic Disaster

　　(i) Preparation for emergency measures in daily work shall be completed well.This includes organization and preparation, assessment on the risks of public hygiene, disaster avoidance and reduction, contingent plan, policy and capability, etc.  

　　(ii)Establishment of unifying and coordinating mechanism and disaster emergency management system within health authorities shall be completed, including mechanism such as commanding and decision-making, organization and coordination, monitoring and warning, information collection and report, social mobilization and emergency guarantee (material distribution included), etc.  

　　(iii) The key to winning the battle against disasters is the local strength in disease control, which means the local workforce of disease control are more familiar with local culture, customs, and geology, so that they can do a better job. 

　　(iv)The aid to disease control workforce outside disaster area should be oriented at the needs of disaster area.The external aids can help disaster-affected areas return to normal quickly from disaster. However, if the aids do not match the local needs, or excessive aiding materials and staff are allocated, the disaster-affected area is prone to be put on new burdens, thus the work of disease prevention and control will be influenced.  

　　(v) Appropriate guarantee measures shall be taken. The first is communication guarantee.Efforts shall be made to ensure successful communication among the main departments and organizations, such as commanding system, disease control institutions, hospitals, fire brigade, airport, stations, ports, all aid forces, by applying wired, wireless, satellite and labor communication, so that all forces of disease prevention and control can be commanded and coordinated with timely information from the disaster-affected area and understanding of their needs. The second is materials and equipment guarantee, including individual portable living equipment, individual safeguard equipment, office and communication equipment and on-site fast detection equipment. They can help smooth work on site. The third is logistic guarantee, including allocation of vehicles, life arrangement and receiving and distribution management of all kinds of disaster relief materials. 

　　  

　　  

Chapter II Pre-disaster Preparation

　　The fundamental purpose of pre-disaster preparation is to raise the capability to deal with disasters and carry out the work of post-disaster disease prevention and control. 

　　Pre-disaster preparation for disease prevention and control primarily includes six key factors, that is, organization and preparation, risks assessment on public health, prevention and reduction of impacts on pubic health, preparation of human resources, emergency materials and on-the-spot treatment equipment. 

I. Organization and Preparation

(i)Establishment of organization structure

　　The organization structure is logical structure that includes command department, coordination department and execution department. Great importance should be paid to EOC and provide sites for related personnel to develop planning, to conduct organizing, to obtain and distribute materials as well as to complete the six tasks including assessing on the condition of disasters and the needs, deciding handling measures, mobilizing all kinds of resources, starting action instructions, following the usage of resources and reporting the work development to superiors, aimed at providing policy guide and support and ensuring the key works and coordinating actions among institutions. 

(ii)Formulation of policies – running mechanism and system

　　(1) Mechanism. It includes commanding and decision-making mechanism, organizing and coordinating mechanism, monitoring and warning mechanism, information collecting and reporting mechanism, social mobilizing mechanism, contingent guarantee mechanism (material distribution mechanism).  

　　(2) System. It includes position responsibilities, supervision and assessment, encouragement and punishment, etc. 

(iii) Formulation of plan

　　(1) Formulation of emergency plan and preparation. This includes overall analyses on risk factors of the system and the unit, types of possible emergency events and their hazardous degree; identification and elimination of hidden dangers’ type, number and distribution, forecasting of the types of possible emergencies and their hazardous degree; determination of risk sources for emergency events and risk assessment; determination of corresponding preventing measures based on the identified risk sources and existing problems; subjective evaluation on the unit’s emergency response capability; full reference to domestic and overseas emergencies’ lessons in the same industry and their experience. 

　　(2) The contents of the plan. The contents of the plan are mainly organization and commanding system, responsibilities and division of work, information collection, analysis and report, measures and actions disease prevention and control after disasters (including drinking water health, food safety, environmental management and disinfection, infectious disease surveillance and control, control of vector organisms, injury prevention, health education, etc.), ways of communication and coordination, logistical support, safety and security, etc. 

　　(3) Basic structure of the plan. The basic structure includes six parts: background, purpose, division of responsibilities, operation ways, coordination and cooperation and appendix. In the background part, the seismic disaster and its impacts, the necessity of the plan, etc are introduced; the overall policy, structure and purpose of the plan are explained in the operation ways parts; the coordination and cooperation part can make arrangement for the reporting procedure, communication channel and establishment of effective and appropriate coordinating mechanism. The appendix shows the flow chart of the procedure and separate completing plans made by different departments when supporting and practicing responsibilities.  

II. Risk Assessment on Public Health in Seismic Disaster

　　Efforts shall be made to collect disaster information, identify the hazards and make analysis on vulnerability of community and population, water supply system and environmental hygiene, as well as on response capabilities and community risks. And risk management map shall be developed based on the analyses, at the same time, marking of the hazards and vulnerability on the maps and marking of risk distribution, information, materials and human resources shall be completed.     

III. Prevention and Mitigation of Disaster Impacts on Public Health

(i)Advocating improvement of community environment

　　Upon community health education, organize and mobilize the community masses to clean living environment, change unhealthy habits and raise awareness of disease prevention. 

(ii)Participating in setting environmental security rules

　　The rules include setting up local standards for environmental health of some public facilities like water supply, toilet, disposal of refuse and sewage. 

(iii)Evaluating and supervising the improvement of community environmental health infrastructure

　　Within the frame of laws, participate actively in hygienic evaluation of local construction planning and facilities for seismic disaster prevention and mitigation. Guide the local setting up and construction to be conducted in a reasonable way. 

(iv)Improving the security of the public hygiene facilities

　　Efforts shall be made to ensure no or less damages to the health departments’ facilities.    

IV. Reserve on Human Resources

(i) Establishment of expert reservoir of related majors

　　Expert team composed of some departments like public health, hospitals, transportation, communication and related majors in universities shall be established. Experts’ information shall be complete and training and assessment on experts’ professional quality, capability, work attitude, devotion and honesty and self-discipline shall be strengthened. 

(ii)Establishment of an emergency team composed of professionals

　　A professional team composed of epidemic professionals majored in infectious disease and food and chemical poisoning and nuclear radiation, laboratory professionals and logistics professionals shall be built. The professional team should be furnished with on-site work equipment and on-going training and rehearsal. 

(iii)Emergency training on disaster health for public health professionals shall be provided

　　The training contains professional knowledge and on-site skills. The professional knowledge training includes related laws and regulations, information collection, assessment and report at the site of disaster and contingent investigation and treatment of emergently-prompted public hygienic event. The on-site skill training includes all first-aid medical knowledge, first-aid skill for saving fatal and critical patients, treating procedure for the group of the wounded and the sick, first-aid knowledge of infectious disease and common poisoning, self and mutual aid when natural disasters and accidents happen, mental quality training, how to contact and call police, how to get close to the wounded, etc. To ensure effectiveness of the training, there should be training plans and teaching books, trainees will be evaluated according to the stipulated evaluation standards and encouraging and punishing measures. 

(iv)Emergency rehearsal on health in disaster shall be organized and carried out

　　The purpose of the rehearsal is to test the plans, perfect preparation, exercise the team, gear the mechanism and communicate and educate the public. The forms of rehearsal can be the following five: seminars, desktop deduction, demonstration and presentation, specific function rehearsal and overall rehearsal. 

V. Reserve of Emergency Materials and Resources

　　The reserve includes buildings and locales, communication facilities and equipments, emergency energy equipment and materials, means of transportation, individual protection apparatus, team symbols, health education materials and lab quick-testing equipment. The principle for reserve should be in line with local conditions, ensuring safety, cost-effectiveness and application. 

VI. Preparation for On-site Disposal Tools

(i) Development of quick assessing tools

　　This includes assessments on disaster, needs after disaster and risks of public hygiene after disaster. Different tools are applied in alignment with different conditions. 

(ii)Work handbook for disease control in seismic disaster

　　Keep following and compiling technical documents of disease control in seismic disaster. 

(iii)Handbook for on-site personal protection and safety.

　　  

　　  

Chapter III   Disease Prevention & Control at Post-disaster Emergency Stage

I. Post-disaster Rapid Response Action 

　　Disaster conditions shall be rapidly verified and evaluated, as well as immediately reported to relevant authorities; measures given in the plan shall be initiated to primarily define the emergency objectives; professional personnel and private entities shall be urgently mobilized for participating in the action; material allocation shall be arranged in an urgent manner for helping the fulfillment of determined objectives; a public health information communication platform shall be established for collecting public demands and giving relevant feedback; efforts shall be made to ensure the normal operation of the monitoring system and emergency laboratories and to verify their sound functions; works such as preparation of personal plan, upgrading of relevant contact data and roster shall be completed timely to facilitate subsequent utilization and inform of current tasks and problems to be solved; preparation for the state-and government- leadership’ on-the-spot relief assistant shall be done well; evaluation on health resource demands that have been satisfied and are required to be met shall be carried out; and energetic effort on logistics and psychological aids shall be made for rescue forces. 

II. On-site Coordination and Organization

　　Emphasis shall be placed on internal resources and relevant external resources for disease control & prevention, including management on personnel such as local human resource, external assistance, supervisors and volunteers, material management, information management and logistics management.   

III. Rapid Assessment on Current Situation and Demands on Public Health in Disaster Areas

(i) Principle of rapid assessment

　　According to the response, priority of contents to be assessed shall be determined, thus the assessment will be conducted based on available data as the response is giving. The principle is to ensure rapidness and conciseness rather than completeness and comprehensiveness.  

(ii)Contents to be assessed

　　The contents to be assessed shall include disaster situation, medical treatment capacity, risk sources, conditions of service objects and health service capacity.  

(iii)Methods and approaches for assessment

　　The information collection system and a temporary information collection platform shall be established; while the tools for assessment include assessment forms.  

(iv)Analysis and expression on assessment results and result expression channels

IV. Post-disaster Disease Surveillance

　　Emergency disease surveillance shall be implemented by making use of those surviving surveillance resources and based on demands; and if necessary, syndromic surveillance for special groups shall be carried out.  

V. Infectious Disease Risk Control and Epidemic Disease Prevention

(i)Drinking water health

　　Guidance and assistance shall be provided for searching, monitoring, publicizing, supervising and assessing the usable water supply. Simple, rapid and available means for observation and inspection as well as assessment parameters shall be adopted to preliminarily analyze risks of drinking water, determine criteria of emergency drinking water and give instruction opinions on potable water. In addition, guidance shall be given for taking necessary and feasible health measures to treat drinking water; and propaganda and education for clean and health drinking water shall be carried out. 

(ii)Food safety

　　Food risks shall be identified and eatable food types shall be determined; various food poisoning events shall be diagnosed and disposed in a timely manner; effort shall be made as much as possible to investigate the cause of food-poisoning for the purpose of preventing expansion and reoccurrence of food poisoning; management on food transportation, storage and processing shall be strengthen and propaganda and education for food-poisoning prevention shall be carried out.  

(iii)Environment health and disinfection

　　Endeavors shall be made to participate and instruct the disposal of human and animal excreta, garbage and cadaver as well as the protection of water sources; methods that local natives are ready to accept shall be adopted for the purpose of guiding the people in the disaster areas to form a proper health habit.   

(iv)Vector organism control

　　methods such as making use of personal sense organs or technical measures shall be applied to monitor the activities of various vector organisms such as mice, mosquitoes and flies; guidance shall be given for private entities’ correct disinfection activities so as to control the breeding of vector organisms; health education shall be carried out for the purpose of instructing the public’ personal protection.  

(v)Funeral service and handling of death cases

　　Rumors and misunderstanding of cadaver’s effect on transmission of infectious diseases shall be eliminated; according to the actual situation on the spot, assistance shall be provided to the relevant authorities for rapidly stipulating the process flow and precautions of cadaver disposal; resources required for cadaver disposal shall be estimated quickly; guidance shall be given for demonstrating humanistic care and respect during cadaver disposal; psychological assistance shall be offered for personnel engaging in cadaver disposal.  

VI. Prevention and Control of Infectious Diseases

(i)Outbreak treatment

　　Thresholds for outbreaks of specific infectious diseases shall be assessed in case of emergency; abnormal signals shall be monitored and confirmed quickly; outbreaks of infectious diseases shall be verified and confirmed via laboratory if necessary; field investigation shall be conducted for identifying infectious sources and modes of transmission; during on-the-spot control, exposure and infection shall be prevented, and measures shall be taken for disease prevention and death prevention.  

(ii)Emergency vaccination

　　A detailed emergency vaccination plan shall be prepared; and strategy of community vaccination shall be determined; assessment on vaccination risks and logistic demands shall be conducted; training shall be offered for personnel to be engaged in vaccination work; emphasis shall be placed on selection of vaccination spots, injection safety, vaccine cold chain and emergency vaccine supply.  

VII. Risk Source Management for Accidents

　　Risk sources such medical substances, radioactive substances, cancerogenous substance and teratogen (for example: asbestos in buildings) shall be identified; instruction on leakage inspection and exposure prevention shall be given; assistance shall be provided for leakage control and evacuation of affected persons; instruction on rescue and treatment as well as psychological consultation for persons exposed to risk sources shall be given.  

VIII. Health Propaganda and Risk Communication

　　Diagnosis in terms of health education sociology, epidemiology and behavioral science shall be carried out; propaganda shall be carried on via various modern communication means such as plane media (including propaganda column, picture poster and leaflet), radio and TV together with conventional forms such as giving lectures and oral communication, with propaganda emphasis placed on drinking water health, food safety, personal hygiene, prevention and protection from insect vector, disease knowledge and treatment guideline. Moreover, core information for media and public communication shall be determined, media propaganda columns shall be established positively and public health hotline shall be set.   

IX. Mental State Concern and Mental Crisis Rectification

　　Intervention objects shall be defined; intervention principles shall be followed; detailed work schemes shall be developed; mental health assessment shall be conducted; different field intervention measures for mental crisis shall be taken based on different mental health status; follow-up visits and assessment shall be carried out after intervention. 

X. Hygienic Management at Concentrated Settlement Places

　　Efforts shall be made to participate in and guide the establishment and construction of hygienic facilities at concentrated settlement places; instructions on assessment, collection and transportation of human and animal excreta, domestic and industrial waste water and solid waste at the settlement places shall be given, and vector control and environment disinfection shall be implemented; temporary health and anti-epidemic stations shall be established for implementing common diseases, registration and report of infectious diseases, surveillance and guidance on drinking water, food and environment hygiene, and propaganda of health and disease prevention, even registration and report of syndromic surveillance if necessary.  

XI. Safety and Protection for Professional Personnel

　　Training shall be provided for working personnel who will participate in emergency treatment with carry-on safety manuals; safety risks that might be encountered and necessary precautions shall be informed in advance; required personal protective equipment including personal protective clothing, protective goggles, respirator, gloves and disinfectant shall be provided; if necessary, vaccine injection and preventive medication can be implemented. 

　　 　　  

Chapter IV Restoration and Reconstruction of Disease Prevention and Control

I. Definition and Work Focus of Restoration and Reconstruction Stage

　　The restoration and reconstruction stage means the stage when service system and capacity have not recovered yet.  The work focus during this stage is to restore the working order of disease prevention and control, gradually enhance working capacity of disease prevention and control, and alleviate and lighten the public health risks that might be brought by earthquake disasters.   

II. Assessment and Evaluation on Public Health Demands and Restoration Situation

　　Medical capacity and demands of health organizations in the disaster areas, current situation and demands at settlement spots in other aspects such as medical and health services, drinking water and environment hygiene, food safety and nutrition, surveillance and control of vector organism and health education, and health service demands of special groups (including the disabled, children, the old aged, pregnant women and breast feeding women) shall be assessed continuously; and strategies for restoration and reconstruction shall also be adjusted from time to time. In addition, evaluation on restoration project effect shall be carried out for enhancing project efficiency.   

III. Prevention and Control of Infectious Disease

(i) Surveillance and report of infectious disease

　　According to the actual situation in the disaster areas, a network of infectious disease surveillance shall be planed and designed in a scientific way, for the purpose of ensuring epidemic surveillance and report system covering all temporary and permanent medical units and communities. Through the restoration and reconstruction of the surveillance and report network, the capacity of infectious disease surveillance and early-warning can be enhanced continuously and case clusters or outbreak symptoms can be found and identified base on establishment of a system for instruction, training and supervision of infectious disease epidemic reports and for analysis and discussion of epidemic situation.     

(ii)Investigation and control of infectious disease outbreak

　　Endeavor shall be made to elevate technical means for identification of infectious disease outbreak and identification capacity; procedures and norms for investigation and control of infectious disease outbreak shall be improved; recruitment of professional personnel shall be carried out and timely training on epidemiology shall be provided in a timely manner; technical equipment for diagnosis and examination capacity of key infectious disease in laboratories shall be enhanced; technical reserve and capacity for integrated utilization of various means such as controlling infection sources, cutting routes of transmission, vaccination and public education shall be intensified; risk assessment on infectious disease and risk source control shall be carried out continuously for decreasing the frequency of infectious disease outbreak.  

(iii)Monitoring and control of insect vector and rodent

　　Routine plans and schemes for surveillance and control of vector organisms shall be developed; simple methods available in local areas for density surveillance on mosquitoes, flies and mice shall be selected and according to surveillance results, disinfection strategies can be adjusted from time to time; efforts shall be made to participate in planning and hygienic evaluation of buildings, allowance shall be made for proper configuration and management of toilets and garbage, so as to reduce the breeding places and breeding of mosquitoes and flies; the patriotic heath activity shall be advocated and carried out and technical support shall be provided; instruction on personal protection from vector organisms shall be given to the public.  

(iv)Nosocomial infection control

　　The nosocomial infection control shall be included in normal management and operation of organizations for nosocomial infection control shall be restored so as to carry out the routine nosocomial infection control; prevention and control of infectious disease in hospitals shall be strengthened, meanwhile the system of disinfection, separation and protection shall be strictly followed and medical waste and nosocomial sewage shall be treated according to relevant regulation; the comprehensive medical organizations shall be selected to establish infectious disease zones for giving medical treatment to infected patients in a concentrated way; the disinfectant rooms which could offer services to other medical organizations shall be provided or reconstructed in those comprehensive medical organizations; training on disinfection, separation and protection of medical staff shall be strengthened and health education for infected patients and caretakers shall be offered.  

IV. Public Health and Environmental Health

(i)Drinking water health

　　Efforts shall be made to instruct and participate in selection of permanent water sources and hygienic evaluation on facility construction; routine monitoring and assessment on key water supply facilities shall be carried out in a sustainable way; and popularization of knowledge about safe drinking water shall be promoted.   

(ii)Environmental health

　　Assessment on environmental health situation shall be conducted; instructions on water source protection, disposal of domestic garbage and excreta, environmental cleaning, disinfection, insect elimination and deratization shall be given for doing this work well; propaganda shall be carried out in the public for mobilizing and guiding the private entities to participate in protection of environmental health.   

(iii)Food safety

　　Post-disaster food inspection and safety risk assessment for key objects such as catering industry, cooked food processing industry, settlement spots and canteens of external aid teams shall be carried out; participation in disposal of food-poisoning events shall be realized; and instructions on proper dining habits shall be given to the public.  

V. Restoration of Basic Medical Care & Health Services (Project) 

(i)Public health laboratory

　　Public health laboratories shall be reconstructed and restored gradually, for the purposes of conducting inspection of serious infectious diseases and inspection of drinking water and food and providing laboratory supports for post-disaster disease prevention and control.  

(ii)TB prevention and control

　　TB prevention and control shall be recovered in disaster areas, for the purpose of ensuring the subsequent treatment and management of TB patients who were under treatment before disaster; newly infected TB patients shall be identified and reported in time so as to standardize medical treatment and management.  

(iii)Immunization service of children

　　Comprehensive assessment on immunization planning shall be conducted regularly; management on immunization planning materials shall be restored; efforts shall be made to restore and reconstruct immunoprophylaxis and vaccination stations equipped with vaccination personnel, restore cold chain operation and promote quick restoration of children’s immunization services; surveillance on vaccine-preventable diseases shall be implemented and mass vaccination or strengthened immunization shall be organized and carried out in time.  

(iv)Prevention and control of AIDS

　　Medical treatment of AIDS patients who have accepted antivirus treatment and methadone out-patients shall be given a priority; follow-up survey and intervention on existing persons infected with HIV and AIDS patients shall be carried out from time to time; construction and network direct report shall be restored.   

(v)Maternal and child health

　　A rapid assessment on material and child health resources and service object demands shall be conducted; reconstruction of a network system of basic maternal and child health service shall be completed as soon as possible and especially the restoration of basic maternal and child health care services shall be given a priority; personnel recruitment and training on medical knowledge and skills shall be carried out; materials for education on maternal and child health care shall be prepared for the purpose of carrying out public health education on maternal and child health; the information network of maternal and child health shall be recovered or reestablished.  

(ⅵ). Nutrition Improvement and Health

　　Surveillance and assessment on nutrition status of key groups such as children, pregnant women shall be carried out so as to put forward appropriate measures for guarantee and intervention.  

VI. Restoration of Other Health Management Orders

(i)Prevention and management of chronic non-communicable disease

　　data of patients of chronic diseases such as hypertension and diabetes shall be sorted and registered; instructions on rational use of medicine shall be given to patients for cultivating a healthy lifestyle; services such as measuring of blood pressure and blood sugar shall be offered to key objects; Propaganda education on proper diet, mental health and abstention from smoking and alcohol shall be carried out for forming a supporting environment conducive to the healthy lifestyle.  

（ii）Mental health care

　　In settlement places and schools, mass mental health education shall be carried out in forms of giving lessons, lectures, propaganda materials and entertainment; training shall be provided for teachers, medical staff and management personnel at settlement spots to enhance their capacity of identifying mental barriers; and those persons who need further mental intervention shall be treated by psychiatrists or accredited psychotherapists. 

(iii) Prevention and control of injury

　　Public propaganda and education shall be carried out, for the purposes of strengthening the awareness of preventing various accident injury resulted from traffic accidents, heat stroke, dog bite, carbon monoxide poisoning and fire-fighting power utilization; safety measures such as advocating dog management, disinfectant management, high-temperature working management, care of the old aged and kids, safety railing along water body and warning setting on dangerous zones in buildings shall be taken.  

VII. Health Promotion and Community Participation

　　A mechanism of health education at counties, towns, villages and concentrated settlement spots in disaster areas shall be established and improved; assessment shall be conducted to determine health problems to be solved in priority, targeted groups and core information for spreading.   

VIII. Hygienic Evaluation on Restoration Projects

　　Efforts shall be made to participate in hygienic evaluation on key public facilities and construction projects.   

IX. Carrying out Study on Health Impact Caused by Earthquake and Post-disaster Health Emergency Assessment 

　　Post-disaster public health risks shall be monitored and tracked for a long term; a scientific analysis of direct and indirect effects on public health in disaster areas caused by earthquake shall be carried out and relevant risk factors shall be identified; a comprehensive assessment and summary of experience and lessons about post-disaster emergency health rescue shall be conducted; and a further specific assessment and study shall also be carried out.