Takeda Y, Nomura T
Funabashi Public Health Center.
Kansenshogaku Zasshi. 2000 Sep;74(9):687-93. doi: 10.11150/kansenshogakuzasshi1970.74.687.
As of April 1, 1999, the new Infectious Diseases Control Law became effective in Japan. Under the new law, there are three types of category for medical care systems such as "Specified Infectious Disease Medical Hospital", "Category 1 Infectious Disease (Ebola virus hemorrhagic fever, Marburg disease, Lassa fever, Crimean-Congo hemorrhagic fever and plague) Designated Hospital" and "Category 2 Infectious Disease (Cholera, Sigellosis, Typhoid fever, Paratyphoid fever, Poliomyelitis and Diphtheria) Designated Hospital". In these categories, "Category 1 Infectious Disease Designated Hospital" should be designated by prefectural governments, one hospital per prefecture. Recently some papers indicated that (1) whether each government should arrange a category 1 hospital, (2) whether strict isolation with precautions against airborne spread including negative air pressure with anterior-room should be required, (3) plague is not a dangerous disease and the patient with plague is not required of Category 1 hospital but Category 2 hospital for medical care and infection control. The purpose of this article is, including a counterargument for these opinion, to summarize the point of view for the new medical care system under the new law and to search for the future medical care system in Japan. First of all, medical care for patients with infectious diseases should not be a special one but the extension of the general one. Second, we understand that one of the purposes for Category 1 hospital is the core hospital concerning the therapy, pre/post education and research for infectious diseases in each prefectures. Third, the constructive standard for Category 1 hospital should be a strict one including negative air pressure rooms with an anterior-room and an outside hall, and the air should not be recirculated. Under the big chance of enforcement of this new Infectious Diseases Control Law in Japan, we should try to restruct about medical care system for patients with infectious diseases in a long-range plan.
自1999年4月1日起，新的《传染病控制法》在日本生效。根据新法律，医疗体系分为三种类型，即“特定传染病医院”、“1类传染病（埃博拉病毒出血热、马尔堡病、拉沙热、克里米亚-刚果出血热和鼠疫）指定医院”以及“2类传染病（霍乱、志贺氏菌病、伤寒、副伤寒、脊髓灰质炎和白喉）指定医院”。在这些类型中，“1类传染病指定医院”应由各县政府指定，每个县一家医院。最近一些论文指出：（1）每个政府是否应安排一家1类医院；（2）是否应要求进行严格隔离，包括设置前室以防止空气传播，且前室需保持负压；（3）鼠疫并非危险疾病，鼠疫患者不需要在1类医院而是在2类医院接受医疗护理和感染控制。本文的目的是，包括对这些观点进行反驳，总结新法律下新医疗体系的观点，并探寻日本未来的医疗体系。首先，传染病患者的医疗护理不应是特殊的，而应是普通医疗护理的延伸。其次，我们认为1类医院的目的之一是成为各县传染病治疗、教育前后和研究的核心医院。第三，1类医院的建设标准应严格，包括带有前室和外厅的负压病房，且空气不应循环。在日本大力执行这部新《传染病控制法》的大背景下，我们应尝试从长远规划的角度重组传染病患者的医疗体系。
