Strategies for supplying face masks to the population of Taiwan during the COVID-19 pandemic.

BACKGROUND: The use of face masks has become ubiquitous in Taiwan during the early COVID-19 pandemic. A name-based rationing system was established to enable the population of Taiwan to purchase face masks. This study is to assess the extent and fairness of face mask supply to the public in Taiwan. METHODS: The weekly face marks supplies were collected from name-based rationing system administrative statistics included national health insurance card and e-Mask selling record. National registered population statistics by age, gender, and district were collected from department of statistics ministry of the interior. The number of COVID-19 non-imported cases of Taiwan was collected from Taiwan centers of disease control. RESULTS: A total of 146,831,844 person times purchase records from February 6, 2020, to July 19, 2020, the weekly average face mask supply is 0.5 mask (per person) at the start of name-based rationing system, and gradually expanded to the maximum 5.1 masks (per person). Comparing the highest weekly total face mask supply (from Apr 9, 2020, to Apr 15, 2020) in aged 0-9 -, 10-19 -, 20-29 -, 30-39 -, 40-49 -, 50-59 -, 60-69 -,70-79 -, 80-89 -, 90-99, and > 100 years to the register population showed similar distribution between mask supplied people and total population (all standardized difference < 0.1). CONCLUSION: The masks supply strategies has gradually escalated the number of face masks for the public, it not only has dominant decreased the barrier of acquiring face mask, but a fair supply for total population use of Taiwan.

Taiwan's Annual Seasonal Influenza Mass Vaccination Program-Lessons for Pandemic Planning.

Rapid medical countermeasure (MCM) dispensing is an important intervention during a public health emergency. In the United States, MCM planning and exercising efforts have largely focused on dispensing therapeutics, with less emphasis on mass vaccination operations that would require additional specialized staff and infrastructure. Difficulties in distributing vaccines during the 2009 H1N1 influenza pandemic highlighted the need for enhanced planning and exercising of plans for conducting mass vaccination campaigns. In Taiwan, seasonal influenza mass vaccination campaigns are conducted annually, which both mitigate the effects of seasonal influenza and serve as functional exercises for mass vaccination operations during a pandemic. To identify lessons that can be applied to mass vaccination planning in the United States and elsewhere, we conducted an in-person observation and data review of Taiwan's annual seasonal influenza mass vaccination efforts in October 2017. We offer findings and recommendations for enhancing preparedness for seasonal and pandemic influenza and other public health emergencies that would require mass vaccination.

Stockpile Model of Personal Protective Equipment in Taiwan.

The Taiwan Centers for Disease Control (Taiwan CDC) has established a 3-tier personal protective equipment (PPE) stockpiling framework that could maintain a minimum stockpile for the surge demand of PPE in the early stage of a pandemic. However, PPE stockpiling efforts must contend with increasing storage fees and expiration problems. In 2011, the Taiwan CDC initiated a stockpile replacement model in order to optimize the PPE stockpiling efficiency, ensure a minimum stockpile, use the government's limited funds more effectively, and achieve the goal of sustainable management. This stockpile replacement model employs a first-in-first-out principle in which the oldest stock in the central government stockpile is regularly replaced and replenished with the same amount of new and qualified products, ensuring the availability and maintenance of the minimum stockpiles. In addition, a joint electronic procurement platform has been established for merchandising the replaced PPE to local health authorities and medical and other institutions for their routine or epidemic use. In this article, we describe the PPE stockpile model in Taiwan, including the 3-tier stockpiling framework, the operational model, the components of the replacement system, implementation outcomes, epidemic supports, and the challenges and prospects of this model.

Determinants of influenza vaccination among young Taiwanese children.

OBJECTIVE: According to the Health Belief Model (HBM), individual perceptions of susceptibility, severity, benefit, barrier, self-efficacy, and cues to action are associated with health actions. In this study, we investigated the perceptions and social factors that influence the intention to vaccinate children against influenza among parents of young Taiwanese children. METHODS: A nationwide survey was performed using stratified random sampling to explore the beliefs, attitudes, and intentions of parents/main caregivers with regard to vaccinating children aged 6 months to 3 years against influenza. A questionnaire was developed based on the HBM and multivariate logistic regression analyses of 1300 eligible participants were used to identify significant predictors of the intention to vaccinate. RESULTS: Greater perceived benefit, cues to action, and self-efficacy of childhood vaccination against influenza were positively associated with the intention to vaccinate. Children's experience of influenza vaccinations in the past year was also a positive predictor. However, perceived susceptibility, perceived severity regarding influenza and perceived barriers to vaccination were not predictive of the intention to vaccinate. CONCLUSION: In addition to perceived benefits and cues to action, self-efficacy of parents/main caregivers was significantly predictive of their intention to accept influenza vaccination for their young children. These components of the HBM could be used in formulating strategies aimed at promoting the use of influenza vaccine.

Safety of inactivated monovalent pandemic (H1N1) 2009 vaccination during pregnancy: a population-based study in Taiwan.

BACKGROUND: Pregnant women were prioritized for H1N1 vaccination during the 2009-2010 pandemic. Safety concerns exist with vaccinating pregnant women, particularly in their first trimesters. METHODS: We linked computerized data on H1N1 vaccination, National Health Insurance, and Taiwan Birth Registry and identified events of spontaneous abortions (SABs) and all singleton births that occurred/delivered during November 1, 2009-September 30, 2010. The observation period for each case of SAB (6-19 weeks gestation) was divided into period at risk (1-28 days after vaccination) and control periods (the remaining person-days until SAB). The self-controlled case series method for truncated observational periods assessed the incidence rate ratio (IRR) of SAB during the 1-28 days compared with those in the control period. The case-control design matched each case of adverse fetal outcomes to up to 10 controls on fetal sex and year/month of pregnancy onset, and calculated matched odds ratio (OR) on H1N1 vaccination at <14 or ≥14 weeks gestation. RESULTS: Sixty-five women with SAB had received H1N1 vaccination at 6-19 weeks gestation. The IRR of SAB for the risk period 1-28 days was 1.03 (95% confidence interval [CI] 0.55-1.93). Among the 147,294 live births and 1354 stillbirths, maternal H1N1 vaccine receipt at <14 weeks gestation was associated with significantly reduced likelihood of small for gestational age (SGA) birth (OR 0.72, 95% CI 0.61-0.84) and birth defect (OR 0.46, 95% CI 0.22-1.00), whereas receipt at ≥14 weeks gestation was associated with significantly reduced likelihood of stillbirth (OR 0.63, 95% CI 0.46-0.86), prematurity (OR 0.90, 95% CI 0.83-0.97), low birth weight (OR 0.81, 95% CI 0.74-0.88), and SGA birth (OR 0.90, 95% CI 0.84-0.97). CONCLUSIONS: H1N1 vaccination during pregnancy did not increase risk of SAB or adverse fetal outcomes.

Effectiveness of the influenza vaccination program for the elderly in Taiwan.

BACKGROUND AND OBJECTIVES: Since 1998, an influenza vaccination program has been implemented by the Taiwan government targeting people aged ≥65 years. However, the evidence of the effectiveness of this program in preventing influenza, which is based on the nation-wide database, is lacking. This study attempted to estimate the effectiveness of the influenza vaccination program in preventing influenza- and pneumonia-associated outpatient visits and hospitalization in the elderly. METHODS: Randomly sampled data of 1 million claims from the National Health Insurance Research Database compiled into seven consecutive cohorts were used to perform this analysis. Elderly claimants aged ≥65 years were included in each cohort. To decrease potential bias between vaccinated and unvaccinated subjects, the propensity score method was applied. Logistic regression and zero-inflated negative binominal regression were used to examine the effectiveness of vaccination in preventing influenza- and pneumonia-associated outpatient visits and hospitalization. RESULTS: A significant decrease in both the risk and frequency of hospitalization was observed in elderly people who received influenza vaccination compared with those who did not. No similar decrease was observed in the risk and frequency of outpatient visits for influenza and pneumonia. CONCLUSION: Vaccination against influenza reduced hospitalization for influenza and pneumonia in elderly Taiwanese people. These results are meaningful for the promotion of vaccination policy. Annual influenza vaccination of the elderly should be encouraged.

Safety of pandemic (H1N1) 2009 monovalent vaccines in taiwan: a self-controlled case series study.

In Taiwan, new H1N1 monovalent vaccines without adjuvant and with MF59® adjuvant were used in the nationwide vaccination campaign beginning on November 1, 2009. From November 2009 through February 2010, the authors identified recipients of H1N1 vaccines who were diagnosed with adverse events of special interest (AESIs) in a large-linked safety database, and used the self-controlled case series (SCCS) method to examine the risk of each AESI in the 0-42 days after H1N1 vaccination. Of the 3.5 million doses of H1N1 vaccines administered and captured in the linked database, the SCCS analysis of Guillain-Barré syndrome (GBS) found an incidence rate ratio of 3.81 (95% confidence interval 0.43-33.85) within 0-42 days after nonadjuvanted H1N1 vaccination and no cases after MF59®-adjuvanted H1N1 vaccination. The risks of other AESIs were, in general, not increased in any of the predefined postvaccination risk periods and age groups. The databases and infrastructure created for H1N1 vaccine safety evaluation may serve as a model for safety, effectiveness and coverage studies of licensed vaccines in Taiwan.

Assessing personality features and their relations with behavioral problems in adolescents: Tridimensional Personality Questionnaire and Junior Eysenck Personality Questionnaire.

This study examines the applicability for adolescents of the Tridimensional Personality Questionnaire (TPQ), which was originally designed for adults, as compared to the Junior Eysenck Personality Questionnaire (JEPQ). The study also evaluates their inter-relationship and associations with various behavioral problems as reported by parents using the Child Behavior Checklist (CBCL). In a representative community sample of 905 adolescents, the results of internal consistency, test-retest reliability, and factor analysis showed that both the Harm Avoidance (HA) and the Novelty Seeking (NS) scales of the TPQ have sound construct validity, although the Reward Dependence (RD) scale has less so. The intercorrelation and factor analysis of the two questionnaires showed that the TPQ and the JEPQ are not simply alternative descriptions of the same construct of personality. In their associations with various behavioral problems, the scales of the TPQ are relatively more specifically associated with behavioral problems than the scales of the JEPQ. Our results provide empirical support for the applicability of the NS and the HA scales of the TPQ in adolescents, particularly in relation to behavioral problems.