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.

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.

Ertapenem in the treatment of bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli: a propensity score analysis.

OBJECTIVE: This study assessed the impact of ertapenem and other carbapenems on mortality in patients with monomicrobial extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) bacteremia. METHODS: This non-concurrent prospective study included adult patients with ESBL-EC bacteremia during a 2.5-year period at a 2200-bed teaching hospital. We used a multivariate logistic regression model and Cox's proportional hazards model including propensity score analysis to assess variables associated with 30-day mortality. RESULTS: Of 71 patients who met the study criteria, nine died within 3 days. Among the 62 remaining patients who received definitive antimicrobial therapy, 13 died within 30 days. Male gender, ICU stay, solid tumor, and primary bacteremia were independent predictors of 30-day mortality, whereas definitive antimicrobial therapy using either ertapenem or imipenem/meropenem was protective (p<0.001 and p=0.002, respectively). Adjustment by propensity score found that ertapenem appeared to exhibit more favorable outcomes, but the difference fell short of statistical significance (hazard ratio 0.02, p=0.06). Inappropriate initial therapy was not a significant predictor of mortality. CONCLUSIONS: ICU stay, but not initial choice of empirical antimicrobial therapy, was a major predictor of mortality. Using a carbapenem as definitive therapy was a protective factor for 30-day mortality. The choice of ertapenem is reasonable for less severely-ill patients who are at risk of ESBL-EC bacteremia and unlikely to have infection due to Pseudomonas aeruginosa.

Social and economic impact of school closure resulting from pandemic influenza A/H1N1.

OBJECTIVES: On May 23, 2009, a school was closed for one week plus mass chemoprophylaxis to contain the pandemic after a kindergartener tested positive for pandemic influenza A/H1N1. We evaluated the impact of school closure on the students, families, and the school. METHODS: Households were surveyed using a questionnaire to obtain information on adherence to, socio-economic impact by and inconveniences of school closure. The school principal was interviewed to assess the impact on the staff. Compliance and adverse events of chemoprophylaxis were assessed. RESULTS: Of the 232 (14%) households surveyed, 29 (13%) went to public places or gatherings at least once during the closure. Sixty-one (27%) of 229 respondents reported workplace absenteeism, and 42 (18%) of 231 respondents had wage loss. In total, 194 working days lost and 6433 US dollars wage lost were noted. The school put in 6573 h of manpower during the period. For chemoprophylaxis, 6 (6%) kindergartners missed at least one dose; and 6 (6%) reported adverse events, but none sought medical care. Overall, 169 (73%) families were at least moderately supportive of school closure. CONCLUSIONS: With assistance from the school, short-term school closure was supported by the majority of families despite economic inconvenience to the households.

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.

Dimeric iron n-confused porphyrin complexes.

A dimeric iron N-confused porphyrin, [Fe(NCTPP)]2 was obtained from the anaerobic reaction of Fe(NCTPP)Br with NaSePh while under aerobic conditions a hydroxo bridged iron dimer with Na bridging the outer-N atoms was obtained and oxygenation occurred on the inner core pyrrolic carbon to form a novel ONCTPP porphyrinic ring.