Continuing and future challenges of infectious diseases in primary care

William C W Wong 黃志威
Guest Editor

HK Pract 2007;29:121-122

Four years after Severe Acute Respiratory Syndrome (SARS) the ripples of this epidemic that took away the lives of 299 people in Hong Kong begin to fade away. Given the continuous threat of other emerging infectious diseases such as the avian influenza, it is a high time to remind the health professionals and the general public the price to pay for if we let down our guard against infectious diseases. In this issue with a special theme dedicated to infectious diseases in primary care, Dr J Yeung and Professor TW Wong reviewed the literature on handwashing (page 157). It is the most basic preventive method of infectious diseases in the clinical setting first proposed by Semmelweis in 1847 but surprisingly there is no clear guideline of what family doctors should do, let alone work on the evaluation of its effectiveness conducted in primary care.

Contrary to our common belief, influenza vaccination of the elderly was not shown to reduce the incidence of influenza or influenza-like illness and complications during the influenza outbreaks in a retrospective cohort study (page 123). Rather, environmental factors might play a more significant role. In fact, there is increasing evidence - including those from systematic reviews - to show that inactivated vaccines have little or no effect on the effects of influenza. Furthermore, most studies on this subject are of poor methodological quality and the impact of confounders is high.¹

We will also revisit the behavioural changes, both rational and irrational, that were adopted by parents of kindergarten pupils one year after the SARS outbreak (page 146). In that study, interactions between fear, stigma, and roles of the government and media were highlighted. Indeed, another study from the Chinese University of Hong Kong showed that family doctors from Hong Kong were much less satisfied with the way the government had handled SARS compared to their counterparts in Toronto (23.1% vs. 72.5%; p<0.005).² In Hong Kong, doctors who put high value on SARS information from television but put low value on information from the HKMA website/circular were significantly more likely to be in the higher anxiety group.

For health experts who are trained in scientific rigor, risk communication is often an ignored field and as a result health professionals are often blamed for the confusing messages during an infectious disease crisis. Dr T Tsang, the Controller of Centre for Health Protection will take us through some guidelines on health risk communication and point out some potential pitfalls (page 164). We as frontline doctors must understand the "expert" power we hold.³ We should use it effectively and appropriately and be more engaged with the media to assert influences and help shape health policies around us.

We cannot practise medicine outwith the cultural and social context in which we live and practice. I still remember how absurd I felt when I heard the reports of "boiling vinegars" to rid an unknown pneumonia in Guangzhou, which later turned out to be SARS. From Dr T K Cheung's paper, it tells us that 38.1% of all patients attended their family doctors had tried at least 1 type of Traditional Chinese Medicine (TCM) during the last episode of upper respiratory tract infection (page 134). A quarter of them used western medicine and TCM either simultaneously (11.3%) or in the recovery stage of their illness (11.8%). As he quite rightly concludes, all family doctors should be aware that a significant proportion of their patients are using TCM while taking prescribed medications.

This special issue on infectious diseases is by no means a fully comprehensive one. It merely provides an overview of the scope of the topic and the range of methods used to answer these questions. There are many more topics, such as the newly introduced vaccines against human papillovirus in the prevention of cervical cancer and the growing significance of HIV infection among certain population groups in Hong Kong, that deserve our attention. However, I hope at least it will serve to demonstrate how important it is to keep this topic alive and stimulate some thought and debate among both academic and practicing family doctors.