Real-time dengue forecast for outbreak alerts in Southern Taiwan.

Dengue fever is a viral disease transmitted by mosquitoes. In recent decades, dengue fever has spread throughout the world. In 2014 and 2015, southern Taiwan experienced its most serious dengue outbreak in recent years. Some statistical models have been established in the past, however, these models may not be suitable for predicting huge outbreaks in 2014 and 2015. The control of dengue fever has become the primary task of local health agencies. This study attempts to predict the occurrence of dengue fever in order to achieve the purpose of timely warning. We applied a newly developed autoregressive model (AR model) to assess the association between daily weather variability and daily dengue case number in 2014 and 2015 in Kaohsiung, the largest city in southern Taiwan. This model also contained additional lagged weather predictors, and developed 5-day-ahead and 15-day-ahead predictive models. Our results indicate that numbers of dengue cases in Kaohsiung are associated with humidity and the biting rate (BR). Our model is simple, intuitive and easy to use. The developed model can be embedded in a "real-time" schedule, and the data (at present) can be updated daily or weekly based on the needs of public health workers. In this study, a simple model using only meteorological factors performed well. The proposed real-time forecast model can help health agencies take public health actions to mitigate the influences of the epidemic.

A comparative epidemiologic analysis of SARS in Hong Kong, Beijing and Taiwan.

BACKGROUND: The 2002-2003 Severe Acute Respiratory Syndrome (SARS) outbreak infected 8,422 individuals leading to 916 deaths around the world. However, there have been few epidemiological studies of SARS comparing epidemiologic features across regions. The aim of this study is to identify similarities and differences in SARS epidemiology in three populations with similar host and viral genotype. METHODS: We present a comparative epidemiologic analysis of SARS, based on an integrated dataset with 3,336 SARS patients from Hong Kong, Beijing and Taiwan, epidemiological and clinical characteristics such as incubation, onset-to-admission, onset-to-discharge and onset-to-death periods, case fatality ratios (CFRs) and presenting symptoms are described and compared between regions. We further explored the influence of demographic and clinical variables on the apparently large differences in CFRs between the three regions. RESULTS: All three regions showed similar incubation periods and progressive shortening of the onset-to-admission interval through the epidemic. Adjusted for sex, health care worker status and nosocomial setting, older age was associated with a higher fatality, with adjusted odds ratio (AOR): 2.10 (95% confidence interval: 1.45, 3.04) for those aged 51-60; AOR: 4.57 (95% confidence interval: 3.32, 7.30) for those aged above 60 compared to those aged 41-50 years. Presence of pre-existing comorbid conditions was also associated with greater mortality (AOR: 1.74; 95% confidence interval: 1.36, 2.21). CONCLUSION: The large discrepancy in crude fatality ratios across the three regions can only be partly explained by epidemiological and clinical heterogeneities. Our findings underline the importance of a common data collection platform, especially in an emerging epidemic, in order to identify and explain consistencies and differences in the eventual clinical and public health outcomes of infectious disease outbreaks, which is becoming increasingly important in our highly interconnected world.

Prognostic factors for fatal adult influenza pneumonia.

OBJECTIVES: To elucidate the prognostic factors for fatal adult influenza pneumonia. METHODS: Complicated influenza pneumonia is a notifiable disease in Taiwan. In this retrospective nationwide cohort, medical records were reviewed in 38 qualifying cases from 2001 to 2007. In-hospital mortality was the primary endpoint of this study. RESULTS: The median patient age was 52 years, with the in-hospital mortality rate of 44.7%. Influenza A virus was found in 25 patients and influenza B was in 13 patients. Fifty percent of patients had no comorbidities. More than half of the patients developed sepsis, septic shock, respiratory failure or acute respiratory distress syndrome. The median duration from symptom onset to hospital visit was 3 days, and from hospital visit to death was 4 days. A univariate analysis demonstrated poor prognosis in patients with shock, respiratory rate > or =25/min, arterial pH<7.35, creatinine> or =2mg/dL and Pneumonia Severity Index IV or V. A multivariate analysis showed an association with mortality in patients with APACHE II score > or =20 (hazard ratio 5.941, p=0.024) or PaO(2)/FiO(2) ratio <150 (hazard ratio 4.194, p=0.017). CONCLUSIONS: Clinical knowledge of identified prognostic factors for mortality may aid management of adult influenza pneumonia.