COVID-19 public health surveillance and response in Taiwan: From containment to mitigation.

Taiwan learned from its 2003 SARS experience and established multiple surveillance systems to be able to detect and respond to COVID-19. With the find, test, trace, isolate, and support (FTTIS) strategy, Taiwan was successful in containing SARS-CoV-2 from spreading for two years. During the surge of the Omicron variant in the community, COVID-19 control strategy shifted from containment to mitigation in April 2022, to reduce morbidity and mortality. Lessons learned from COVID-19 response re-emphasizes the importance of having sensitive public health surveillance and linking surveillance with public health actions.

Gender differences in risk exposures for acute hepatitis C infection in Taiwan: a nationwide case-control study.

BACKGROUND: In Taiwan, medical providers are required to report all acute hepatitis C (AHC) patients to National Notifiable Disease Surveillance System (NNDSS). Identifying factors associated with AHC may inform the strategies to prevent the spread of hepatitis C virus (HCV). We used the national surveillance data to assess gender difference in risk factors associated with AHC in Taiwan and propose control measures in at-risk groups. METHODS: We conducted a nationwide case-control study using data from NNDSS and AHC case investigation questionnaires, for the period of March 6, 2014-December 31, 2016. Cases were AHC confirmed in NNDSS; controls were reported AHC with negative HCV nucleic acid test and negative serum anti-HCV antibody. We used bivariate analysis to identify characteristics and risk exposures for AHC and conducted gender stratified analyses. RESULTS: We identified 602 AHC cases (66.9% males, median age 48 years) and 90 controls. Older age, male gender (OR: 1.85, 95% CI: 1.18-2.90), history of viral hepatitis (OR: 7.93, 95% CI:1.91-32.88), history of sexually transmitted infections (OR: 21.02, 95% CI: 2.90-152.43), and having healthcare-associated risk exposures (OR: 2.02, 95% CI: 1.25-3.25) were associated with AHC. Stratified analyses showed receiving intravenous infusion, history of hepatitis B, syphilis, and human immunodeficiency virus infection were risk factors for male AHC; receiving hemodialysis was risk factor for females. CONCLUSIONS: Our study demonstrates risk factors for AHC in Taiwan with gender difference. Proper infection control practices in healthcare settings and interventions targeting male patients with HIV and other STIs, remain crucial to prevent individuals from AHC.

Epidemiology of the first 100 cases of COVID-19 in Taiwan and its implications on outbreak control.

PURPOSE: To describe the epidemiology and outcome of the first 100 COVID-19 cases in Taiwan. METHODS: We included the first 100 patients with laboratory-confirmed SARS-CoV-2 infection in Taiwan. Demographic, clinical, epidemiological and laboratory data were extracted from outbreak investigation reports and medical records. RESULTS: Illness onset of the 100 patients was during January 11 to March 16, 2020. Twenty-nine (29%) had at least one underlying condition and ten (10%) were asymptomatic. Seventy-one were imported, including four clusters. Twenty-nine were locally-acquired, including four clusters. The median days from onset to report was longer in locally-acquired cases (10 vs 3 days). Three patients died (case fatality rate 3%) and all of them had underlying conditions. As of May 13, 2020, 93 had been discharged in stable condition; the median hospital stay was 30 days (range, 10-79 days). CONCLUSION: The first 100 cases of COVID-19 in Taiwan showed the persistent threat of imported cases from different countries. Even though sporadic locally-acquired disease has been identified, through contact investigation, isolation, quarantine and implementation of social distancing measures, the epidemic is contained to a manageable level with minimal local transmission.

Effects of land vs water jump exercise: Implications for exercise design targeting bone health.

PURPOSE: To quantify ground reaction force (GRF), osteogenic index (OI), muscle activity, and blood lactate levels during continuous jumping performed in water and on land. METHODS: Thirteen post-menopausal women (59.5 ± 6.8 years) performed two bouts of jumping, on land (LND) and in water at a depth of 1 m (WEX). Each 10-minute, 40-second bout consisted of 2 consecutive sets of squat, lunge, jumping jax, countermovement, and single legged jumps as intervals: 10 seconds maximal effort and 60 seconds recovery at 50% of heart rate reserve (HRR). Pre- and post-exercise lower extremity rate of perceived exertion (RPE) was recorded, and 10-µL earlobe blood samples were collected to assess lactate concentration. During exercise, data were collected for electromyography, GRF, and heart rate. Total GRF (TGRF) and total muscular activity (TMA) during each 10 seconds of jumping were measured. OI for one bout of continued jumps was determined by averaging GRF·ln (number of jumps + 1). RESULTS: There were no differences between WEX and LND for percent HRR and RPE. TGRF, OI, TMA, and lactate concentration on LND jumps were significantly higher than WEX. CONCLUSION: At similar cardiorespiratory and RPE levels, the lower impact loading of 10 minutes 40 seconds of interval continuous jumping exercise in 1-m depth was less osteogenic than on land. However, one daily bout of water jumping, 5 days per week resulted in a similar OI as 3 days of jumping on land. WEX might substitute or provide an adjunct to LND exercise to promote bone health.

Outbreak of hepatitis A virus infection in Taiwan, June 2015 to September 2017.

The Taiwan Centers for Disease Control (CDC) were notified of increasing acute hepatitis A (AHA) in June 2015. Serum and/or stool from AHA patients and sewage samples were tested for hepatitis A virus (HAV). We defined outbreak cases as AHA patients with illness onset after June 2015 and with an HAV sequence less than 0.5% different from that of the TA-15 outbreak strain. We analysed characteristics and food exposures between outbreak and non-outbreak cases between January 2014 (start of enhanced surveillance) and February 2016. From June 2015 to September 2017, there were 1,563 AHA patients with a median age of 31 years (interquartile range (IQR): 26-38); the male-to-female ratio was 8.8 and 585 (37%) had human immunodeficiency virus (HIV) infection. TA-15 was detected in 82% (852/1,033) of AHA patients, and 14% (74/540) of sewage samples tested since July 2015. Infection with the TA-15 strain was associated with having HIV, sexually transmitted infections (STI), recent oral-anal sex and men who have sex with men (MSM). The Taiwan CDC implemented an HAV vaccine campaign starting from October 2016 where 62% (15,487/24,879) of people at risk were vaccinated against HAV. We recommend HAV vaccination for at-risk populations and continuous surveillance to monitor control measures.

Ice-associated norovirus outbreak predominantly caused by GII.17 in Taiwan, 2015.

BACKGROUND: On 5 March 2015, Taiwan Centers for Disease Control was notified of more than 200 students with gastroenteritis at a senior high school during excursion to Kenting. We conducted an outbreak investigation to identify the causative agent and possible vehicle of the pathogen. METHODS: We conducted a retrospective cohort study by using a structured questionnaire to interview all students for consumed food items during their stay at the resort. Students were defined as a gastroenteritis case while having vomiting or diarrhea after the breakfast on 4 March. We inspected the environment to identify possible contamination route. We collected stool or vomitus samples from ill students, food handlers and environmental specimens for bacterial culture for common enteropathogens, reverse transcription polymerase chain reaction (RT-PCR) for norovirus and enzyme-linked immunosorbent assay (ELISA) for rotavirus. Norovirus PCR-positive products were then sequenced and genotyped. RESULTS: Of 267 students enrolled, 144 (54%) met our case definition. Regression analysis revealed elevated risk associated with iced tea, which was made from tea powder mixed with hot water and self-made ice (risk ratio 1.54, 95% confidence interval 1.22-1.98). Ice used for beverages, water before and after water filter of the ice machine and 16 stool and vomitus samples from ill students were tested positive for norovirus; Multiple genotypes were identified including GI.2, GI.4 and GII.17. GII.17 was the predominant genotype and phylogenetic analyses showed that noroviruses identified in ice, water and human samples were clustered into the same genotypes. Environmental investigation revealed the ice was made by inadequate-filtered and un-boiled water. CONCLUSIONS: We identified the ice made by norovirus-contaminated un-boiled water caused the outbreak and the predominant genotype was GII.17. Adequately filtered or boiled water should be strongly recommended for making ice to avoid possible contamination.

Neuromuscular Activity and Muscular Oxygenation Through Different Movement Cadences During In-water and On-land Knee Extension Exercise.

Chien, K-Y, Kan, N-W, Liao, Y-H, Lin, Y-L, Lin, C-L, and Chen, W-C. Neuromuscular activity and muscular oxygenation through different movement cadences during in-water and on-land knee extension exercise. J Strength Cond Res 31(3): 750-757, 2017-The purpose of this study was to determine the influence of various knee extension exercise cadences on neuromuscular activation and hemodynamic properties of the quadriceps muscle in water and on land. Seventeen young women participated in this study, and the subjects were randomly allocated to perform loaded knee extension exercises in water and on land at 4 different cadences of 30, 50, 70, and 90 b·min. Heart rate (HR), blood flow (BF), total saturation index (TSI) of oxygen, electromyography (EMG) for the extent of muscular activity, and rate of perceived exertion (RPE) were measured. Response values of HR, BF, TSI, and RPE at each cadence were obtained by subtracting the resting values from the indicator values measured at the respective cadences. We observed that BF, EMG, and RPE in water at 90 b·min were comparable with those on land. The HR and TSI changes were higher in water compared with on land (p = 0.004 and p = 0.013, respectively). In conclusion, we demonstrate that the neuromuscular activity when performing knee extension exercises at 90 b·min in water was comparable with that on land. However, exercising in water at the same cadence evoked higher TSI responses and greater cardiovascular challenges. A knee extension exercise at 90 b·min is the recommended operating speed of rehabilitation in water.

An outbreak of norovirus gastroenteritis associated with asymptomatic food handlers in Kinmen, Taiwan.

BACKGROUND: In February 2015 an outbreak of gastroenteritis occurred in a distillery in Kinmen, Taiwan. At least 450 affected employees developed the symptoms of diarrhea and vomiting after attending a lunch banquet on 6 February. Epidemiological, laboratory and environmental investigations were conducted to identify the agent and source of this outbreak. METHODS: A case-control study was carried out among lunch attendees from the distillery. Using a semi-structured questionnaire, food and beverage consumption in the lunch banquet was assessed, as well as demographic and clinical data of the exposed people. An outbreak case was defined as a diner who developed at least three following symptoms: diarrhea, vomiting, abdominal pain, nausea, chills and/or weakness in the 72 h following the lunch. Controls were defined as lunch attendees who did not have any of the above symptoms. Rectal swabs or stool samples of the symptomatic exposed diners and food handlers as well as food and environmental samples were collected to test potential bacteria and viruses. Norovirus was detected by reverse transcription-polymerase chain reaction and sequence analysis. An environmental assessment, including environmental inspection of the restaurant and a review of work practices of food workers, was undertaken. RESULTS: Of 363 respondents with complete data, 169 met the case definition and 111 met the control definition. Consumption of pork liver in cold appetizers (adjusted odd ratio (aOR) 3.23; 95 % confidence interval (CI): 1.26-8.30) and lamb chops (aOR: 3.98, 95 % CI: 1.74-9.11) were each associated with increased risk of illness. No cases but two asymptomatic food handlers who prepared or cooked the implicated foods tested positive for norovirus genotype I.6. Food and environmental samples were negative for any bacteria. Environmental assessment indicated that hand washing facilities were not properly accessible to food handlers. Inappropriate hygiene practices in food handlers may have contributed to food contamination. CONCLUSION: Our investigation suggests that etiological agent of this outbreak was norovirus. The food vehicles were pork liver and lamb chops, which may have been contaminated by asymptomatic infected food handlers. Strict adherence to hand hygiene practices and access to hand washing facilities should be reinforced to prevent such foodborne outbreaks.

Impaired kidney function among young healthcare workers with long working hours and night work.

OBJECTIVES: We aimed to evaluate the association between long working hours, night work, and estimated glomerular filtration rate (eGFR) among young healthcare workers. METHODS: We conducted a retrospective cohort study among healthcare workers in a tertiary medical center in Taiwan from 2002 to 2021. Other than physicians, all hospital employees aged 20-65 years with documented yearly working hours and an annual blood test including creatinine were eligible. We excluded participants with eGFR <60 ml/min/1.73 m2 and proteinuria at enrollment to focus on early renal impairment. Total working hours, night working hours, and eGFR in each year were collected. We assessed the relationship of total working hours and night and non-night working hours with eGFR using the generalized linear mixed model, adjusting for demographic, comorbidities, and laboratory profiles. RESULTS: The study included 10 677 participants with a mean age of 27.2 (standard deviation 7.1) years. The mean follow-up duration was 6.2 years. For every 10-hour increase in total weekly working hours, the eGFR decreased by 0.86 [95% confidence interval (CI) 0.61-1.11] ml/min/1.73 m2. For every 10-hour increase in weekly night working hours, the eGFR decreased by 0.25 (95% CI 0.07-0.42) ml/min/1.73 m2. In stratified analysis, the negative associations between total working hours and eGFR remained in the subgroups of individuals aged <40 years and those without hypertension or diabetes, with a P-value for interaction of <0.05. CONCLUSIONS: Longer working hours and night work were associated with lower eGFR among healthcare workers.

Relationship of long working hours and night shift working hours with incident diabetes: a retrospective cohort study in Taiwan.

PURPOSE: The relationship among long working hours, night shift working hours, and diabetes is still unclear. We aimed to evaluate the association of long working hours and night shift working hours with diabetes among health care workers. METHODS: We conducted a retrospective cohort study among health care workers in a tertiary medical center in Taiwan from 2002 to 2019. We compared the risk of diabetes among tertiles of total working hours (35-41, 42-45, and ≥46 h per week) and evaluated the relationship between long working hours and diabetes risk. We divided participants into three work patterns: day work only, evening shift workers, and night shift workers. In night shift workers, we further evaluated night shift working hours and incident diabetes using tertiles of night shift working hours (<17, 17-45, and ≥46 h per month). We estimated hazard ratios and 95% confidence intervals for incident diabetes using multivariable Cox proportional hazards models. RESULTS: The study included 7081 participants. There were 301 incident cases of diabetes during 52,454 person-years. The adjusted hazard ratio (95% confidence interval) for participants who worked greater than or equal to 46 working hours per week was 3.45 (1.27, 9.39) compared with those who worked 35-41 hours. Compared with night shift workers who worked less than 17 h, the adjusted hazard ratios (95% confidence interval) for those who worked 17-45 and ≥46 night shift working hours per month were 2.26 (1.08, 4.75) and 2.60 (1.27, 5.33), respectively. CONCLUSIONS: Long working hours and night shift working hours increased the risk of diabetes.

Epidemiology and risk factors of Japanese encephalitis in Taiwan, 2010-2022.

INTRODUCTION: Taiwan introduced a two-dose inactivated Japanese encephalitis (JE) mouse brain-derived (JE-MB) vaccine into routine childhood immunization in 1968, with booster vaccination implemented in 1974 and 1983. In 2017, JE-MB vaccine was replaced by a two-dose live-attenuated chimeric vaccine (JE-CV). After implementation of JE vaccination programs, JE cases have shifted from children to adults. In this study, we described the JE epidemiology and identify high-risk groups to further inform vaccine policy. METHODOLOGY/PRINCIPAL FINDINGS: We extracted data from Taiwan's notifiable disease surveillance database, vital statistics, and employment statistics from 2010 to 2022. Diagnosis of JE was confirmed by JE seroconversion, a four-fold increase in virus-specific antibodies, a positive JE viral nucleic-acid test, or JE virus isolation. From 2010 to 2022, a total of 313 cases of JE were diagnosed, resulting in an overall incidence rate of 0.10 cases per 100,000 person-years and a mortality rate of 0.006 per 100,000 population per year. Among these patients, 64% were male, and the median age was 51 years (range 0-82). Compared with people born in or after 1976 (vaccinated with four doses of JE-MB vaccine or two doses of JE-CV), those born in or before 1962 (unvaccinated) and those born during 1963-1975 (vaccinated with two or three doses of JE-MB vaccine) had a 4.2-fold (95% confidence interval [CI] 3.0-5.7) and 5.9-fold (95% CI 4.3-8.1) higher risk of JE, respectively. The relative risk of working in agriculture, forestry, fishing, or animal husbandry, compared to other occupations, was 5.0 (95% CI 3.5-7.0). CONCLUSIONS/SIGNIFICANCE: In Taiwan, individuals born before 1976 and those employed in agriculture, forestry, fishing, or animal husbandry had a higher risk of JE. We recommend JE vaccination for people in these high-risk groups who have not been fully vaccinated or have an unknown vaccination history.

Epidemiological investigation of the first locally acquired case of COVID-19 identified by influenza surveillance-Taiwan, February 2020.

BACKGROUND: COVID-19 and influenza have similar clinical presentations that can range from mild to severe disease. The World Health Organization recommends that countries use existing influenza surveillance to monitor COVID-19 transmission in communities. We aim to describe the surveillance and investigation of COVID-19 at the early stage of the pandemic in Taiwan. METHODS: In February 2020, the Taiwan Centers for Disease Control enhanced COVID-19 surveillance through its existing influenza surveillance. We retrospectively tested patients for SARS-CoV-2 who had symptoms of severe complicated influenza but were negative in influenza testing. We conducted an epidemiological investigation and contact tracing for the index patient and secondary cases to prevent virus transmission. RESULTS: We identified the first COVID-19 patient on February 15 through enhanced COVID-19 surveillance. He had no history of traveling abroad and an unclear history of contact with COVID-19 cases. He presented with influenza-like illness on January 27 and was hospitalized from February 3 to 15. We identified 39 close contacts of the index patient, including 11 family members and 28 healthcare workers. In total, four close family contacts of the index patient tested positive for SARS-CoV-2. An additional 84 close contacts of the four secondary cases were identified and traced; none was diagnosed with COVID-19. CONCLUSIONS: We recommend enhancing COVID-19 surveillance by testing patients with influenza-like illness. To prevent the spread of COVID-19, we recommend using appropriate personal protective equipment when in close contact with patients who present with influenza-like illness or when caring for patients with pneumonia of unknown etiology.

Community outbreak of adenovirus, Taiwan, 2011.

In 2011, a large community outbreak of human adenovirus (HAdV) in Taiwan was detected by a nationwide surveillance system. The epidemic lasted from week 11 through week 41 of 2011 (March 14-October 16, 2011). Although HAdV-3 was the predominant strain detected (74%), an abrupt increase in the percentage of infections caused by HAdV-7 occurred, from 0.3% in 2008-2010 to 10% in 2011. Clinical information was collected for 202 inpatients infected with HAdV; 31 (15.2%) had severe infection that required intensive care, and 7 of those patients died. HAdV-7 accounted for 10%, 12%, and 41% of infections among outpatients, inpatients with nonsevere infection, and inpatients with severe infection, respectively (p<0.01). The HAdV-7 strain detected in this outbreak is identical to a strain recently reported in the People's Republic of China (HAdV7-HZ/SHX/CHN/2009). Absence of circulating HAdV-7 in previous years and introduction of an emerging strain are 2 factors that caused this outbreak.

Accelerometer-based prediction of ground reaction force in head-out water exercise with different exercise intensity countermovement jump.

BACKGROUND: Water jumping exercise is an alternative method to achieve maintenance of bone health and reduce exercise injuries. Clarifying the ground reaction force (GRF) of moderate and high cardiopulmonary exercise intensities for jumping movements can help quantify the impact force during different exercise intensities. Accelerometers have been explored for measuring skeletal mechanical loading by estimating the GRFs. Predictive regression equations for GRF using ACC on land have already been developed and performed outside laboratory settings, whereas a predictive regression equation for GRF in water exercises is not yet established. The purpose of this study was to determine the best accelerometer wear-position for three exercise intensities and develop and validate the ground reaction force (GRF) prediction equation. METHODS: Twelve healthy women (23.6 ± 1.83 years, 158.2 ± 5.33 cm, 53.1 ± 7.50 kg) were recruited as participants. Triaxial accelerometers were affixed 3 cm above the medial malleolus of the tibia, fifth lumbar vertebra, and seventh cervical vertebra (C7). The countermovement jump (CMJ) cadence started at 80 beats/min and increased by 5 beats per 20 s to reach 50%, 65%, and 80% heart rate reserves, and then participants jumped five more times. One-way repeated analysis of variance was used to determine acceleration differences among wear-positions and exercise intensities. Pearson's correlation was used to determine the correlation between the acceleration and GRF per body weight on land (GRFVLBW). Backward regression analysis was used to generate GRFVLBW prediction equations from full models with C7 acceleration (C7 ACC), age, percentage of water deep divided by body height (PWDH), and bodyweight as predictors. Paired t-test was used to determine GRFVLBW differences between values from the prediction equation and force plate measurement during validation. Lin's CCC and Bland-Altman plots were used to determine the agreement between the predicted and force plate-measured GRFVLBW. RESULTS: The raw full profile data for the resultant acceleration showed that the acceleration curve of C7 was similar to that of GRFv. The predicted formula was - 1.712 + 0.658 * C7ACC + 0.016 * PWDH + 0.008 * age + 0.003*weight. Lin's CCC score was 0.7453, with bias of 0.369%. CONCLUSION: The resultant acceleration measured at C7 was identified as the valid estimated GRFVLBW during CMJ in water.

Accuracy of the Electronic Nose Breath Tests in Clinical Application: A Systematic Review and Meta-Analysis.

(1) Background: An electronic nose applies a sensor array to detect volatile biomarkers in exhaled breath to diagnose diseases. The overall diagnostic accuracy remains unknown. The objective of this review was to provide an estimate of the diagnostic accuracy of sensor-based breath tests for the diagnosis of diseases. (2) Methods: We searched the PubMed and Web of Science databases for studies published between 1 January 2010 and 14 October 2021. The search was limited to human studies published in the English language. Clinical trials were not included in this review. (3) Results: Of the 2418 records identified, 44 publications were eligible, and 5728 patients were included in the final analyses. The pooled sensitivity was 90.0% (95% CI, 86.3-92.8%, I2 = 47.7%), the specificity was 88.4% (95% CI, 87.1-89.5%, I2 = 81.4%), and the pooled area under the curve was 0.93 (95% CI 0.91-0.95). (4) Conclusion: The findings of our review suggest that a standardized report of diagnostic accuracy and a report of the accuracy in a test set are needed. Sensor array systems of electronic noses have the potential for noninvasiveness at the point-of-care in hospitals. Nevertheless, the procedure for reporting the accuracy of a diagnostic test must be standardized.

Compassionate use of linezolid for adult Taiwanese patients with bone and joint infections.

BACKGROUND: Compassionate use of linezolid for bone and joint infections has been reported and hematological adverse reactions are a cause for concern. A similar experience in Asian people has not been reported. METHODS: Adult cases that received linezolid for bone and joint infections at 3 Taiwanese medical centers from 2002 to 2006 were analyzed. We investigated factors associated with treatment outcome and hematological adverse reactions. RESULTS: Of the 51 cases that received linezolid for more than 3 days, 41 (80.4%) had a favorable outcome and 10 had a failed outcome. Based on univariate analysis, patients with renal/urinary tract diseases, gastrointestinal diseases, higher WBC counts, a higher alanine aminotransferase level, or a higher creatinine level prior to linezolid treatment were significantly associated with a failed outcome. Based on multivariate analysis, underlying gastrointestinal disease was the only significant factor for a failed outcome. Six patients stopped linezolid use due to adverse reactions. A failed outcome was significantly associated with anemia caused by linezolid. CONCLUSION: Linezolid is an effective salvage agent for bone and joint infections. However, adverse effects, especially hematological reactions, may cause drug discontinuation.

Measles transmission at an international airport - Taiwan, March-April 2018.

During March-April 2018, an infectious measles index case traveling from Thailand led to two successive generations of measles transmission in Taiwan, with 21 cases confirmed. The median patient age was 30.5 years (range 22-47 years); six (27%) had documented receipt of one (n=3) or more (n=3) previous measles-containing vaccine doses at age ≥12 months. Epidemiological investigation and sequence analysis found that most (n=16, 76%) measles transmissions had occurred in airport and flight settings; secondary and tertiary cases included cabin crew (n=7), airport staff (n=2), and passengers who had been at the same airport or on the same flight (n=7). This investigation serves as a reminder that an international airport can be a hotspot for measles transmission. International travelers, airline cabin crew, and airport employees are recommended to check their vaccination status and ensure that they are fully vaccinated against measles. Furthermore, it is recommended that airline and airport employers have an occupational health vaccination program in place to ensure appropriate pre-employment assessment of measles immunity and vaccination.

Spinal epidural abscess due to Staphylococcus aureus: clinical manifestations and outcomes.

BACKGROUND AND PURPOSE: Despite advances in diagnosis and treatment, spinal epidural abscess due to Staphylococcus aureus remains a challenge to clinicians. In this study, we describe the clinical features and outcomes of patients with spinal epidural abscess due to S. aureus. METHODS: Thirty one cases of spinal epidural abscess due to S. aureus treated at the National Taiwan University Hospital from January 2001 to December 2006 were retrospectively reviewed, using a standardized case collection form. Spinal epidural abscess was diagnosed by computed tomography or magnetic resonance imaging of the spine. RESULTS: The median age of subjects was 55 years (range, 20 to 90 years) and the male-to-female ratio was 4.2. All patients had spine pain and 18 (58.1%) had fever. Lumbar or lumbosacral region was the most frequently involved site of spinal epidural abscess (61.3%), and 83.9% of the patients also had vertebral osteomyelitis. Sixteen patients (51.6%) were treated successfully with antibiotics alone for a median duration of 70 days (range, 23 to 274 days), whereas the median duration of antibiotic therapy in patients undergoing surgical intervention was 102 days (range, 40 to 227 days). Renal failure, malignancy or underlying comorbid illness estimated by Charlson score was predictive of a poor prognosis with treatment failure or mortality. CONCLUSION: Although medical treatment alone might benefit selected patients with spinal epidural abscess due to S. aureus and minimal neurologic sequelae, close monitoring of the evolution of neurologic deficits with radiographic imaging follow-up is necessary, since the rate of progression of neurologic impairment is difficult to predict.

Containing influenza outbreaks with antiviral use in long-term care facilities in Taiwan, 2008-2014.

BACKGROUNDS: Influenza can spread rapidly in long-term care facilities (LTCFs), and residents are usually at higher risk for influenza infections. OBJECTIVE: Our study aimed to evaluate the effectiveness of antiviral interventions on outbreak control. METHODS: Taiwan Centers for Disease Control used a syndromic surveillance system to monitor outbreaks in LTCFs. Local public health authorities verified those outbreaks and logged reports to the Epidemic Investigation Report Files Management System (EIRFMS). We conducted a retrospective cohort study by reviewing EIRFMS reports of influenza outbreaks in LTCFs during 2008-2014. An influenza outbreak was defined as 3 or more cases of influenza-like illness occurring within a 48-hours period with ≥1 case of real-time RT-PCR-confirmed influenza in the same LTCF. Antiviral interventions included providing antiviral treatment for patients and antiviral prophylaxis for contacts during outbreaks. RESULTS: Of 102 influenza outbreaks, median days from onset of the first patient to outbreak notification was 4 (range 0-22). Median attack rate was 24% (range 2.2%-100%). Median influenza vaccination coverage among residents was 81% (range 0%-100%); 43% occurred during the summer months. Even though antiviral treatment was provided in 87% of the outbreaks, antiviral prophylaxis was implemented in only 40%. Starting antiviral treatment within 2 days of outbreak onset was associated with keeping attack rates at <25% (OR 0.29, 95% CI: 0.12-0.71). CONCLUSIONS: Early initiation of antiviral treatment may reduce the magnitude of influenza outbreaks. Clinicians should identify patients with influenza and start antiviral use early to prevent large outbreaks in LTCFs.