传染病防治法:两次疫情突发促成立法和修法
张立
2009年09月18日12:20 来源:《检察日报》

陕西宁陕县开展修订后的《传染病防治法》宣传活动。 |
眼下,全国各地正在开展甲型H1N1流感防控工作。9月7日,卫生部通报,目前中国内地31个省区市已全部报告甲型H1N1流感确诊病例。由于防控、治疗措施得当,没有发生一件因甲型H1N1流感所致的死亡病例。
中国政法大学卫生法研究中心的刘鑫教授对此表示:“在咱们这样一个13亿人口的大国中,经济水平不是很高,医疗资源不是十分充沛且分布不均,能够取得这样的防控效果,这与修改后的《传染病防治法》有很大关系。”
上海爆发甲肝促成立法
“医院里来了很多病人,走廊里也加了床。有的人排队排到一半就晕倒了,没有力气排队,晕倒的就先抬进来,场面真的很可怕。”上海一名内科医生回想起1988年1月18日的情景记忆犹新。那天医院里一共来了34例有着类似症状的病人,他们大多伴有身体发热、呕吐、厌食、乏力、脸色发黄等症状。第二天,病人增至134例。其他医院也涌入大量此类病人。后来证实,他们患的是急性病毒性甲型肝炎,即甲肝。
在随后短短一个月时间里,上海市区有30多万人传染上了甲肝,大部分是青壮年,其中11人死亡。一时间,人们“谈肝色变”,公共汽车站和公共食堂很少看到拥挤的情景,人们排队打饭或上车时会主动保持一定的距离,而更多的市民选择留在家里,尽量减少出行,少在餐馆吃饭,以避免感染细菌的机会。调查发现,这场甲肝大爆发是由于上海人生食被甲肝病毒污染的毛蚶所致。上海市政府紧急部署,开展防治甲肝的总动员。
北京大学医学伦理与法律研究中心副主任王岳介绍说,1988年我国还没有制定《传染病防治法》,开展传染病防治所依靠的法律主要是国务院颁布的《急性传染病管理条例》。此外,还有卫生部颁布的《卫生部关于将六种检疫传染病改为四种的通知》、《国境口岸传染病监测试行办法》、《全国法定传染病漏报调查方案》、《卫生部关于控制肠道传染病工作的通知》等配套文件。
王岳说,上海爆发甲肝后,我国应对急性传染病流行的立法缺陷显露出来,为了更好地防控传染类疾病,在总结防治上海甲肝防控经验与教训的基础上,1989年《传染病防治法》应运而生,成为我国预防、控制和消除传染病的发生与流行、保障公众健康的一部重要法律。
修法源于抗击“非典”
2003年,突如其来的“非典”疫情把《传染病防治法》的修改推到了前台。
通过反思“非典”事件,社会各界对《传染病防治法》的条文提出了大量意见。315位十届全国人大代表提出议案,建议全国人大常委会修订《传染病防治法》。全国人大常委会将修订《传染病防治法》列入2004年立法计划,指定国务院负责《传染病防治法(修订草案)》的起草工作。2003年6月,国务院法制办和卫生部组成联合起草小组,开始修订工作。
“从表面上看,抗击‘非典’成为修订《传染病防治法》的推动因素,其实修订该法也是我国经济社会发展的新需要。”王岳表示,《传染病防治法》颁布实施后,随着经济社会的发展,医学科学不断进步,对一些疾病认识不断加深,公民对健康的需求不断增加,我国传染病防治形势发生了很大变化,出现了许多新情况、新问题。例如,国家对传染病爆发流行的监测、预警能力较弱;疫情信息报告、通报渠道不畅;医疗机构对传染病病人的救治能力、医院内交叉感染控制能力薄弱;传染病爆发流行时采取紧急控制措施的制度不够完善,疾病预防控制的财政保障不足等。这些问题在防治“非典”中暴露得比较充分。
修订过程中,世界一些国家爆发了人感染高致病性禽流感。考虑到英国、澳大利亚、新西兰等国以及我国香港、台湾地区都把人感染高致病性禽流感列入法定传染病管理,世界卫生组织也建议各国将人感染高致病性禽流感列入甲类传染病管理,所以修订后的《传染病防治法》将“非典”和人感染高致病性禽流感一同列为乙类传染病,从而使列入法律的法定传染病由原来的35种增至37种,其中甲类2种,乙类25种,丙类10种。
修订后的法律内容增加一倍
修订后的《传染病防治法》条文从41条增加到80条,文字篇幅增加了一倍。刘鑫表示,这是因为1989年的《传染病防治法》比较粗放,很多内容规定不具体,有的制度没有涉及。在总结抗击“非典”的基础上,传染病防控的一线部门确实感受到了这其中的不足,因而对法律的内容进行了大量增加。
尤其突出的是,修订后的《传染病防治法》吸收了抗击“非典”的经验和教训。
为了解决实践中疫情报告不及时、传染病防治专业人员获取信息不畅通、掌握疫情信息的有关主管部门和单位沟通不够等问题,修订后的法律对传染病疫情报告和公布制度作了完善,设立了传染病疫情信息通报制度,增加了传染病疫情通报制度,并规范了传染病疫情公布制度,隐瞒、谎报、缓报传染病疫情者会依法受到惩处。新法还增加规定,对已经发生甲类传染病病例的场所或者该场所内的特定区域的人员,可以由县级以上地方政府实施隔离,这使得隔离有了法律依据。
2004年4月,北京和安徽再现“非典”疫情。卫生部成立专家调查小组,调查认定这次“非典”疫情源于实验室内感染,是一起因实验室安全管理不善,执行规章制度不严,技术人员违规操作,安全防范措施不力,导致实验室污染和工作人员感染的重大责任事故。据此,修订后的《传染病防治法》增加了实验室的管理条款,要求疾病预防控制机构、医疗机构的实验室和从事病原微生物实验的单位,建立严格的监管制度,严防传染病病原体的实验室感染和病原微生物的扩散。
修订后的《传染病防治法》还凸显了立法之人文关怀。王岳介绍说,1989年《传染病防治法》没有规定保护传染病个人隐私,修订后的法律规定疾病预防控制机构、医疗机构不得泄露涉及个人隐私的有关信息和资料,对于疾病预防控制机构、医疗机构故意泄露传染病病人、病原携带者、疑似传染病病人、密切接触者涉及个人隐私的有关信息和资料的,轻则给予警告,造成严重后果的,将依法给予负有责任的主管人员和其他直接责任人员降级、撤职、开除的处分,构成犯罪的依法追究刑事责任。
确立了“非歧视原则”
1985年我国发现首例艾滋病患者,由于不了解,人们往往谈“艾”色变,1989年《传染病防治法》第二十四条将艾滋病人与甲类传染病人规定在一起,要求隔离治疗。2004年修改时调整为按照一般乙类传染病管理。
对此,刘鑫说,从表面上看,这似乎是对艾滋病管理的放松,事实上并非如此。艾滋病是一类非常特殊的疾病,危害性大,但传播方式特殊,按照甲类传染病的管理方式未必见效。针对艾滋病的特殊情况,修订后的《传染病防治法》第二十四条专门强调了防控艾滋病的要求,要求各级政府应当加强艾滋病的防治工作,采取预防、控制措施,防止艾滋病的传播,并授权国务院制定专门的条例,这就为后来国务院制定《艾滋病防治条例》提供了法律依据。
“非典”病人以及“非典”疑似病人曾受到歧视,而乙肝病人在就业工作中遭受到不公正待遇,也曾成为社会关注的焦点。1989年《传染病防治法》只规定:“传染病病人、病原携带者和疑似传染病病人,在治愈或者排除传染病嫌疑前,不得从事国务院卫生行政部门规定禁止从事的易使该传染病扩散的工作。”而修订后的法律确立了“非歧视原则”,即“国家和社会应当关心、帮助传染病病人、病原携带者和疑似传染病病人,使其得到及时救治。任何单位和个人不得歧视传染病病人、病原携带者和疑似传染病病人”。正是由于这条规定,新法颁布时,多家媒体发表报道,在标题里写道:“乙肝携带者不再受歧视”。王岳表示,“非歧视原则”的确立彰显了立法者以人为本的理念。
Communicable Disease Prevention Act: two sudden outbreak led to legislation and amending the law
Zhang
At 12:20 on September 18, 2009 Source: "Procuratorial Daily"
Shaanxi Ningshan counties revised "Infectious Diseases Prevention Law" campaign.
For now, all over the country is carrying out the work of Influenza A H1N1 influenza prevention and control. September 7, the Ministry of Health informed the current 31 provinces and autonomous regions in Mainland China have all reported confirmed cases of Influenza A H1N1 influenza. As the prevention and control, appropriate treatment measures, did not happen due to an influenza caused by H1N1 influenza deaths.
China University of Political Science Research Center, Health Law Professor Liu Xin have said: "Let such a country with a population of 1.3 billion, the economic level is not high, not very abundant medical resources, and uneven distribution of prevention and control can achieve such an effect , which amended the "Communicable Disease Prevention Act" has a great relationship. "
Shanghai contributed to the outbreak of hepatitis A legislative
"Many patients come to the hospital, the corridor has also added a bed. Some people lining up half of the faint, and no effort queuing, fainted on the first lifts come in, and the scene is really terrible." Shanghai 1 Physicians recalled January 18, 1988 remember the scene. Come to the hospital that day a total of 34 cases of patients with similar symptoms, most of them accompanied by body fever, vomiting, anorexia, fatigue, his face yellow and other symptoms. The next day, the patients increased to 134 cases. Other hospitals also influx of such patients. It was later established that they are suffering from acute viral hepatitis A, or hepatitis.
A short period of time in the next month, the Shanghai district more than 30 million people infected with the hepatitis A, mostly young adults, in which 11 people were killed. For a time, people "talk about the liver pale", bus stations and public canteens you rarely see a crowded scene, people line up on the car will take the initiative Dafan or maintain a certain distance, and more people choose to stay at home, to minimize travel, less eating in restaurants in order to avoid bacterial infection. The survey found that this outbreak was due to hepatitis A Shanghai life, polluted water are hepatitis A virus caused by the gross subcrenata. The urgent deployment of the Shanghai municipal government to carry out prevention and control of hepatitis A general mobilization.
Peking University Research Center for Medical Ethics and Law, said Wang Yue, deputy director in 1988, China has not yet developed, "Infectious Diseases Prevention Law" to carry out the law on infectious disease prevention is mainly by the State Council promulgated the "Regulations of acute infectious disease." In addition, the Ministry of Health promulgated the "Ministry of Health concerning the six kinds of infectious diseases into four kinds of quarantine notice," "Trial Procedures for communicable disease surveillance frontier ports", "omission of the National Notifiable Diseases Survey Program," "Ministry of Health the work on the control of intestinal infectious diseases, "and other supporting documents.
Wang Yue said that the outbreak of hepatitis A, after Shanghai, China's legislative response to acute infectious diseases prevalent flaws exposed, in order to better prevent and control infectious diseases, in summarizing the prevention and treatment of hepatitis prevention and control of Shanghai, based on experiences and lessons learned, 1989 " Infectious Diseases Prevention Law "came into being, and has become the prevention, control and elimination of the incidence and prevalence of infectious diseases to safeguard public health, an important law.
Amending the law, from the fight against "SARS"
In 2003, the sudden "SARS" epidemic of "Infectious Diseases Prevention Law" amendment to the fore.
Through reflection "SARS" incident, the community of "Communicable Disease Prevention Law" provisions in a large number of observations. 315 Tenth National People's Congress proposed a motion amend the NPC Standing Committee, "Communicable Disease Prevention Act." The NPC Standing Committee will be revised, "Infectious Diseases Prevention Law" included in the legislation plan of 2004 designated the State Department, "Communicable Disease Prevention Law (Revised Draft)" in the drafting process. In June 2003, the State Council Legislative Affairs Office and the Ministry of Health formed a joint drafting group to begin revision.
"On the surface, the fight against 'atypical pneumonia' a revision of the" Infectious Diseases Prevention Law "motivating factor, in fact, to amend the law is also China's economic and social development of the new needs." Wang Yue said, "Infectious Diseases Prevention Law" was promulgated, the With the economic and social development, medical science advances in a number of diseases, a growing awareness of citizens on the health of the increasing demand, our communicable diseases prevention and control situation has undergone great changes, there have been many new situations and new problems. For example, the state outbreak of infectious disease surveillance, early warning capability is weak; epidemic information reporting, poor communication channels; medical institutions for treatment of patients with infectious diseases capacity of hospital cross-infection control is weak; infectious disease outbreak to take urgent inadequate system of control measures, disease prevention and control of financial security is inadequate. These issues in the fight against "SARS" was more exposed to the full.
Revision process, the world in some countries a person infected with the outbreak of highly pathogenic avian influenza. Taking into account the United Kingdom, Australia, New Zealand and other countries, as well as China's Hong Kong, Taiwan, regarded the inclusion of human infection with highly pathogenic avian influenza management of legal infectious diseases, the WHO also recommended that countries of human infection with highly pathogenic avian influenza included in the A infectious diseases management, so amended the "Communicable Disease Prevention Act" would "SARS" and the people are infected with highly pathogenic avian influenza as a Category B infectious diseases, so that the statutory infectious diseases included in the law from the original 35 species to 37 species, of which two kinds of A and B 25, C 10.
The revised legal content doubled
The revised "Communicable Disease Prevention Act" provision from 41 to 80, word length doubled. Liu Xin said that this is because in 1989 the "Communicable Disease Prevention Act" more extensive, a lot of content requirements are not specific, some system is not involved. In summing up the fight against "SARS" based on the first line of prevention and control of infectious diseases department truly felt that this lack of them, and thus the content of the law has increased significantly.
In particular, notably, the revised "Infectious Diseases Prevention Law" to absorb the fight against "SARS" the experiences and lessons learned.
In order to address the epidemic in practice report is not timely, infectious disease prevention and control professionals to access information does not flow, control the epidemic information relevant competent departments and units of a lack of communication and other issues, the revised law on infectious disease reporting and disclosure system was perfect, the establishment of communications system for outbreaks of infectious diseases, an increase of infectious diseases notification system, and standardize the disclosure systems for infectious diseases, concealment, false, and delaying the report outbreaks of infectious diseases who will be brought to justice. The new law also added provisions that have taken place A place where cases of communicable diseases or the establishment of a specific area of personnel that can be isolated from the local governments above the county level, which makes isolation has legal basis.
In April 2004, Beijing and Anhui reproduction of "SARS" epidemic. The Ministry of Health set up an expert panel of inquiry finds that the "SARS" outbreak originated from a laboratory infection, laboratory safety was a result of mismanagement, lax implementation of rules and regulations, technical violations, inadequate safety precautions, leading to laboratory Pollution and staff infection in serious accidents. Accordingly, the revised "Communicable Disease Prevention Act" to increase the management of the laboratory terms of disease prevention and control require agencies, medical institutions, laboratories and experimental units of pathogenic microorganisms involved in the establishment of a stringent regulatory system and guard against infectious pathogens laboratory infection and the spread of pathogenic microorganisms.
The revised "Communicable Disease Prevention Act" also highlights the legislation of the humanistic care. Wang Yue said that in 1989, "Infectious Diseases Prevention Law" does not provide for the protection of privacy of infectious diseases, the amended law disease prevention and control institutions, medical institutions not to disclose information about personal privacy and data, for disease prevention and control institutions, medical agencies intentionally leaked patients with communicable diseases, pathogen carriers, suspected patients with communicable diseases, close contact with the relevant information involving personal privacy and data, ranging from a warning, causing serious consequences, will be responsible according to law by officers and other persons directly responsible demotion, dismissal, expulsion punishment constitutes a crime shall be prosecuted for criminal liability.
Established a "non-discrimination principle"
In 1985 the first case of AIDS patients in China found that, due to lack of understanding, people often talk about "Ai" pale, 1989, "Infectious Diseases Prevention Law" 24th of the AIDS epidemic were provided together with the CPI to require isolation and treatment. Amended in 2004, when adjusted in accordance with generally B disease management.
In this regard, Liu Xin said that from the surface, this seems to be to relax the management of AIDS, in fact not the case. AIDS is a very special kind of disease, caused great harm, but the mode of transmission of the special management of infectious diseases in accordance with the CPI may not bear fruit. The special circumstances for AIDS, the revised "Infectious Diseases Prevention Law" 24th Article of the prevention and control of AIDS with specific emphasis on the requirements of all levels of government should strengthen AIDS prevention and control work, to take preventive and control measures to prevent the spread of AIDS, and to authorize the State Council has formulated specific regulations, which the State Department for the later development of "AIDS Prevention Act," provides a legal basis.
"SARS" patients and "SARS" suspected patients had been subjected to discrimination, while employment in hepatitis B patients subjected to unjust treatment, has become the focus of attention. In 1989, "Communicable Disease Prevention Act" only stipulates that: "patients with communicable diseases, pathogen carriers and suspected patients with communicable diseases, in the cure of infectious diseases or to exclude a suspect before, not to engage in health administrative department under the State Council, prohibited from engaging in making the infectious disease-prone the proliferation of work. "while the amended law establishes a" non-discrimination principle "that" the state and society should be concerned to help patients with communicable diseases, pathogen carriers and suspected patients with communicable diseases so that timely treatment. any unit or individual not discriminate against patients with infectious diseases, pathogen carriers and suspected patients with communicable diseases. " It is precisely because of this provision, the new law was promulgated, several media reports, wrote in the title: "Hepatitis B carriers will no longer be discriminated against." Wang Yue said that the "non-discrimination principle" underlines the legislators to establish a people-centered concept.
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