Measles immunity in medical center staff after changes in national and local hospital vaccination policies.

BACKGROUND: Measles vaccination was introduced in Taiwan in 1978, and the disease was declared eliminated in Taiwan in 2007. However, new cases have been reported unpredictably since then. Hospital medical staff are at particularly high risk for measles. We evaluated the immunity status of hospital medical staff after changes in national and local hospital vaccination policies. METHODS: This retrospective study was conducted in a tertiary care medical center from January 2008 to June 2018. Data were retrieved from all healthcare workers receiving employment medical examinations. Those with a full medical record including the geometrical mean titer (GMT) of anti-measles IgG were included. Age and sex differences in the GMT were analyzed by Student's t-tests and Chi-squared tests. Univariate and multivariate logistic regression analysis were used to determine the odds of immunity. RESULTS: The IgG positive rate increased with age group (p < 0.001). Seropositive rates for the birth before 1977 and after 1978 groups were 94.8% and 70.2% (p < 0.001). The odds ratio was also significantly different between both cohorts (1.000 vs. 0.423, p = 0.002). Staff in the examination department showed the lowest positive percentage of 70.3% (95% CI: 66.9-73.7%), whereas staff in preventive and long-term care services disclosed the highest positive percentage of 83.2% (95% CI: 76.1-90.2%). Subgroups 2015, 2017, and 2018 (p = 0.046, 0.046, 0.049), after the vaccination booster policy was launched, showed significant increases in seropositivity. CONCLUSIONS: Immunity efficacy is better in birth groups before 1977, which was highly related to natural infection before national policy launched. The policy of vaccination is an effective method, but medical staff attains inadequate protective antibody levels for maintenance of herd immunity. A pre-employment policy of screening a third booster vaccine of measles (or MMR) is recommended to lower the incidence of disease spreading and avoid outbreaks.

Prevalence of Postpartum Depression and Associated Predictors Among Taiwanese Women in a Mother-Child Friendly Hospital.

Postpartum depression (PPD) is a highly prevalent disorder characterized by increased vulnerability to morbidity and mortality. This study explores the predictors and prevalence of PPD among Taiwanese women. A total of 914 postpartum women was recruited from a mother-child-friendly hospital. These participants completed self-report questionnaires at 1 month postpartum, and their medical records were also examined for relevant information. Multivariate analyses were used to identify independent predictors of PPD. At 1 month postpartum, 18.8% had developed PPD. Multivariate analysis showed that the odds ratios for PPD were significantly lower among women who were breastfeeding, had more family support, and attended a postpartum care center, while those who were younger, primiparous, and who experienced gestational complications had a higher prevalence of PPD. Meanwhile, structural equation modeling showed that family support from partners, parents, and parents-in-law diminished depression scores through direct effects.

Varicella Seroprevalence in Healthcare Workers at a Medical Center Following Changes in National and Local Hospital Vaccination Policies.

BACKGROUND: Varicella seroprevalence in healthcare workers at a tertiary care hospital in Taiwan was assessed following the inclusion of varicella zoster vaccination in the national vaccination schedule in 2004 and was made a hospital policy in 2008. METHODS: Seroprevalence data were extracted from records of pre-employment health check-ups performed between 2008 and 2018 at a single medical center. Staff with complete medical records and anti-varicella zoster virus immunoglobulin G (VZV IgG) titers were included. Sex and age group differences in terms of geometric mean titer (GMT) were compared using analysis of variance and chi-squared tests. The significance of the correlation between age and the anti-VZV IgG titer was tested by linear regression. The odds of significant associations among age, sex, vocation, and the years of national and hospital adoption of vaccination were determined using univariate and multivariate analyses. p < 0.05 was considered statistically significant. RESULTS: Of the 7314 eligible participants, 5625 (76.90%) were women, and the mean patient age was 26.80 ± 8.00 years. The lowest VZV-positivity rates were in 18-20-year-old women (85.16%; GMT, 362.89 mIU/mL) and men (87.59%; GMT, 288.07 mIU/mL). VZV positivity increased with age (p < 0.001). Participants born before 2002 were more likely to be seropositive than those born after 2003 (odds ratio, 2.51 vs. 1.0; p < 0.001). The lowest seropositive rate was found in the nursing staff (88.91%; 95% confidence interval, 87.74%-90.05%). Varicella vaccine boosters have been required at pre-employment health check-ups since 2008 if anti-VZV antibodies were not detectable. A follow-up evaluation found marginal significant differences in the odds ratios of seropositivity after 2007 (p = 0.052), especially in 2008 and 2014 (p < 0.05) after the hospital policy launched. CONCLUSIONS: Despite public health efforts, a small number of healthcare workers were inadequately protected, and antibody titers were lower than required to maintain herd immunity. For effective prevention of nosocomial infection, VZV IgG status should be documented for all HCWs, and susceptible HCWs should be vaccinated to avoid outbreaks. Pre-employment screening and vaccination have increased immunity and need to be conducted to ensure protection of vulnerable patients.

Postpartum Weight Retention Risk Factors in a Taiwanese Cohort Study.

OBJECTIVE: Excess postpartum weight retention (PPWR) is related to long-term weight gain. Therefore, this study was conducted to identify the risk factors for PPWR to provide guidance for preventive strategies. METHODS: This cohort study surveyed 461 women who gave birth at a medical center between March 2014 and March 2016. The participants completed a questionnaire within 1 month of delivery, and their 6-month postpartum weight was tracked. RESULTS: The results showed that the mean pre-pregnancy BMI was 21.4 ± 3.3 kg/m2, and the mean gestational weight gain (GWG) was 12.8 ± 4.1 kg. The mean PPWR was 4.6 ± 3.5 kg at 1 month and 2.1 ± 3.3 kg at 6 months. Multivariate analysis revealed that GWG (adjusted OR: 1.92 (1.70-2.17)), pre-pregnancy BMI (adjusted OR: 0.85 (0.77-0.94)), and exclusive breastfeeding (adjusted OR: 0.55 (0.32-0.94)) were significantly correlated with a 1-month PPWR higher than the median value. In addition, GWG (adjusted OR: 1.30 (1.22-1.39)) and exclusive breastfeeding (adjusted OR: 0.37 (0.24-0.58)) were significantly correlated with a 6-month PPWR higher than the median value. CONCLUSION: Our findings indicate that the key to reducing PPWR is to control GWG and engage in exclusive breastfeeding.