Since May, 2011, Germany had reported a significantly increasing trend on cases of enterohaemorrhagic Escherichia coli (EHEC) infection and haemolyticuraemic syndrome (HUS). Afterward a number of European countries had reported cases linked to this outbreak, and most cases had travel history to Germany. As of June 15, Germany had reported 2,518 cases of EHEC infection (without HUS) and 786 HUS cases with 38 fatalities. Other European countries had reported a total of 69 EHEC cases and 36 HUS cases leading to one fatal [1]. Approximate 70% of cases were in females and most were in the group aged 20-49 years. The pathogen was identified as enteroaggregative verocytotoxin-producing Escherichia coli O104:H4 bacterium. According to epidemiological findings, German officials announced that the vehicle of infection was contaminated bean and seed sprouts. The current event represents the largest outbreak of EHEC infection in recent years that resulted in dozens of deaths, as well as made great economic loss due to difficulties in epidemiological investigations and fail in prompt determination of the infective source. This article will introduce the domestic and international situation in epidemiology and surveillance of enterohaemorrhagic Escherichia coli infection.
Taiwan initiated the implementation of national neonatal hepatitis B vaccination program in July 1986. This retrospective study on the epidemiological characteristics and prognosis of acute hepatitis B in the hepatitis B vaccinated cohort aims to provide background for prospective hepatitis B prevention and control policy-making. Identified from the Taiwan Centers for Disease Control Notifiable Disease Surveillance System (NDSS) database, 75 acute hepatitis B patients, born after July 1, 1986 and diagnosed between January 1, 2008 and March 31, 2012, were approached. After voluntary recruitment, the participants underwent a hepatitis B serum marker test and completed a questionnaire. The participants' family members were also tested for hepatitis B carriage status. Thirty-seven eligible patients (37/75, 49.3%) consented to the study, among whom 81.1% (30/37) received at least three doses, while those who had incomplete vaccination series or no vaccination record were mostly born between 1987 and 1990. Nine participants (9/37, 24.3%) had a family history of hepatitis B carriage, while no one had hepatitis B carrier siblings. The most common age of disease onset was 15-24 (N=32), among whom six were married to/ in partnership with a hepatitis B carrier. Second most common age of disease onset was under 1 (N=3), of whom all were born to hepatitis B carrier mothers. Prognosis based on hepatitis B serum marker profiles showed that HBsAg disappeared and Anti-HBs appeared in 21 participants (21/37, 56.8%), HBsAg disappeared without Anti-HBs appeared in 12 participants (12/37, 32.4%), 3 participant became hepatitis B carriers (3/37, 8.1%) whose age of hepatitis B disease onset was 8 months, 6 years and 19 years old respectively, and 1 participant died of fulminant hepatic failure in acute hepatitis B. This survey shows that the prognosis of acute hepatitis B patients of the hepatitis B vaccinated cohort is not always clearance of HBsAg in conjunction with appearance of Anti-HBs. Regarding the prevention and control of acute hepatitis B, except for certain reasons and mother-to-infant perinatal transmission which can not be fully prevented with vaccination, the disease risk is still present among the 15-24 age group. Therefore, work remains to be done on developing hepatitis prevention and control strategies for this group in order to achieve the target of hepatitis B elimination.
No cholera epidemics have occurred in Taiwan since a severe outbreak caused by V. Cholerae serogroup O1 occurred in 1962 [1]. Although, during the period 1962-2009, several cholera infections have occurred, only a few are cluster infections and most of the reported cases are sporadic. The infection sources for most of the indigenous cholera infections occurred during the late twentieth century had been epidemiologically associated with the consumption of soft shelled turtle raised from contaminated farm ponds. However, the infection sources of indigenous cholera cases occurred during the recent five years were all unable to be identified. In order to understand the possible infection sources and relevant risk factors associated with cholera infections, we have reviewed epidemiologic investigation reports on indigenous cholera infection occurred during 1997~2009 and analyzed data from environmental surveillance in domestic areas, field investigation in foreign countries, and from relevant researches. The study found that all cholera infections occurred during the recent 12 years are sporadic except two cluster infections; elderly people and those with underlying disease, such as gastrectomy and chronic diseases, are population susceptible to cholera infection; and poor personal hygiene practices and food sanitation are important risk factors to cholera infections. The reasons why infection sources for most of the cholera cases could not be identified are partly because the recognition of infection sources for sporadic case has always been difficult and the insufficient information on food consumption during the incubation period of disease provided by patients. If physicians could keep vigilance and sensitivity over diagnosis of suspected cholera cases and promote notification efficiency, it would be useful for investigation of infection sources. Experiences from developed countries showed that the strains of toxigenic V. cholerae exist in natural environments, usually spread through the contamination of food, and cause infection in immuno-compromised hosts [2]. The study recommends that: 1. Local governments with cases occurred should strengthen health education directed at the susceptible population and the education of physicians on diagnosis and notification of suspected cases. 2. Investigators should do their best to collect detail information on food origin, food preparation, eating utensil, food storage, and eating habits of the reported cases, and health status of close contacts and neighborhood people. 3. National laboratory should establish data bank for native strains to facilitate the comparative analysis with strains from other countries. 4. Agriculture authority periodically conduct survey on environment and fishery of farm ponds; food sanitation authority routinely monitor on safety of marketed marine product; and authorities in charge of agriculture, food sanitation, and disease control should establish a channel for mutual communication and work together to assure citizen’s health and safety. 5. Department of disease control will have to collect and obtain information on environmental surveillance and risk assessment for coastal areas along Taiwan, Penghu, Kinmen, and Matzu.
The first probable variant Creutzfeldt-Jakob disease (vCJD) case was reported by Taiwan's Department of Health in 2010 and provoked extensive public discussion. This article elaborates current strategies and future prospects for the prevention and control of Creutzfeldt-Jakob Disease (CJD) by reviewing the management of recent probable vCJD case, history of CJD prevention in Taiwan, case reporting system, investigation procedures, disease prevention measures, case publishing standard and autopsy examination scenarios. The reporting and investigation procedures for CJD are very much alike in Taiwan and in other developed countries. This patient is the first probable vCJD case and was under investigation by our neurological experts. Based on the clinical presentation and related academic journal references, they determined this patient as a probably vCJD case. It is necessary to establish a collaborative consultation platform with England, for example, WHO Reference Laboratories and related international experts.
Since December 21, 2019, on-board inspection had been implemented on direct flights from Wuhan, China, marking the beginning of boarder quarantine challenges in respond to COVID-19 pandemic. In line with the development of the international epidemic, the Central Epidemic Command Center gradually expanded entry restrictions and post-entry quarantine requirements. Since March 19, 2020, all foreign nationals had been prohibited from entering Taiwan. Passengers eligible for entry were required to undergo home quarantine for 14 days. Upon arrival, passengers were required to declare their symptoms and travel history, and to receive fever screening and health assessment. Throat swab specimens were collected from those who presented symptoms at the airport or in the hospital, and then these passengers stayed in a centralized quarantine facility to wait for testing results. In addition, aiming at reducing risks originated from crowds and frequent movement, only aircrafts from five airports in China were allowed to enter Taiwan. Also, all connecting flights were suspended, and cruises and cross-strait passenger liners were banned from calling at ports of Taiwan. For front-line officers at ports of entry, health monitoring and protection guidelines were developed to protect their safety. In order to ensure safety and security of air and sea transport, the competent authorities in charge of transportation have established an epidemic prevention and management mechanism for air and sea transport respectively. Over 184,000 home quarantine notices had been issued by border quarantine authorities. More than 80% of the inbound travelers completed the declaration via Entry Quarantine System, greatly improving timeliness and accuracy of information required for further epidemic prevention and control in community. With on-board quarantine and health surveillance system for entry, not only the first confirmed case in Taiwan, but also more than one-third of imported cases were detected through border quarantine, sparing more capacity for domestic response and preparedness for medical resources and medical systems and therefore alleviating pressure on epidemic prevention and control in the community. Despite continuous and serious epidemic and significant challenges ahead, Taiwan keeps on implementing various quarantine measures in accordance with the principle of ＂strict risk control at border ＂ to comprehensively protect border security.
Background: There were more than 16,000 cases of acute hemorrhagic conjunctivitis (AHC) reported through the Syndromic Surveillance System between September 27 and October 30, 2007. The outbreak started in the north (Keelung) and west (Yunlin), and soon spread to Taipei City, Taipei county (north), and Chiayi (west). Methods: Conjunctival swabs were collected from 91 patients for laboratory testing. Virus isolation on cell lines including RD, HeLa, and Hep-2C cells were used. Direct determination of virus serotype from clinical specimens by employing a molecular method (semi-nested RT-PCR) was used. Indirect immunofluorescence antibody (IFA) staining was applied to identify the isolate after appearance of cytopathic effect (CPE). Phylogenetic analysis by using a MEGA program was conducted to determine the genetic make-up and evolution of the virus isolates. Results: The virus isolation rate from cell cultures was 67% (61/91) of the specimens. The IFA test using a CVA-24 antiserum confirmed that the etiologic agent Coxsackievirus A24 was present in 98.4% (60/61) of the isolates. Determination of the serotype directly from clinical swabs by examining the partial VP1 gene sequences revealed 79.1% (72/91) was CVA 24. Phylogenetic analysis of partial VP1 genome (288 bps) from these isolates showed 99–100% of nucleotide identity among them, indicating the outbreak might have been initiated from a single focus. When compared to the sequences from other countries, our strains are closer to the strains from Singapore (2005) but more distinct from China (2002), Korea (2002), Tunisia (2003), Guiana/Guadeloupe (2003), or Brazil (2004). Conclusions: We have determined by IFA staining and molecular techniques identified the etiologic agent of the 2007 hemorrhagic conjunctivitis outbreak as CVA24v.
Vibrio spp. is naturally found in sea water and estuary. Taiwan is located in subtropical area and surrounded by ocean, which is suitable for growth of Vibrio spp. National Quarantine Service (one of the antecedents of Taiwan Centers for Disease Control) proceeded an investigation from 1991 to 1998 and revealed that Vibrio cholerae existed in all coastal harbors, including pathogenic (non-O1, non-139) and non-pathogenic serotypes (O1). Vibrio parahaemolyticus was also noted. Extensive environmental investigation of these pathogens is necessary in order to update the database established a decade ago. In this study, samples were collected from 17 harbors located in northern, central, southern and eastern Taiwan areas. From 204 collected samples, 476 Vibrio spp. were isolated. In which, Vibrio parahaemolyticus was the most commonly found strain (181 strains, 38%), followed by Vibrio alginolyticus (154 strains, 32.4%), Vibrio vulnificus (94 strains, 19.7%), Vibrio metschnikovii (21 strains, 4.4%), Vibrio fluvialis (18 strains, 3.8%) and Aeromonas sobria (7 strains, 1.5%). No Vibrio cholerae was isolated. The results indicated that the isolation rate of Vibrio parahaemolyticus and Vibrio vulnificus was higher than 10 years ago. On the contrary, the Vibrio cholerae used to have high isolation rate was not found in this investigation. There was no statistical difference in isolation of each Vibrio spp. in all areas. However, there was statistical difference in the isolation of Vibrio parahaemolyticus, Vibrio vulnificus and Vibrio metschnikovii in different seasons. Furthermore, statistical difference was also noted in isolation of Vibrio vulnificus comparing temperature and salinity. We recommend authorities of public health, environmental protection and fishery should monitor the environmental risk of Vibrio spp. in coastal areas around Taiwan regularly, and general public should be informed on the related information. Moreover, database of environmental, clinical bacterial strains, bacterial gene mapping and drug resistance should be established and compared with related data from overseas. This investigation updated environmental monitoring data and also provided a reference for disease prevention and food hygiene policy.
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