Absence of endemic measles transmission in a highly vaccinated population from 1999 to 2008: implications of sustained measles elimination in Taiwan

The association between the incidence of mumps and meteorological parameters in Taiwan

Mumps is caused by a paramyxovirus. It is an acute, but mild infectious disease. However, approximately 10% of patients with mumps can develop severe meningoencephalitis, disability, and death. Seasonal patterns in mumps vary across countries, but the reasons for this phenomenon remain unclear. The aim of this study was to assess the role of meteorological factors on mumps infection. We investigated the relationships between weather variability and the incidence of mumps in Taiwan using a Poisson regression analysis and case-crossover methodology. Between 2006 and 2011, 6,612 cases of mumps were reported to the Centers for Disease Control, Taiwan (Taiwan CDC). The incidence of mumps showed a significant seasonality in summertime (for oscillation, P < 0.001). The number of mumps started to increase at temperatures of 20°C (r(2) = 0.73, P < 0.001), and the case count of mumps began to decline when the temperatures were higher than approximately 25°C (r(2) = 0.24, p = 0.04), producing an inverted V-shaped relationship. Similarly, the number of mumps began to increase at a vapor pressure of 5-9 hPa (r(2) = 0.87, P < 0.005) and decreased at a vapor pressure higher than 25-29 hPa (r(2) = 0.21, p = 0.05). The number of mumps cases was positively associated with temperature and vapor pressure in the preceding period of the infection. In conclusion, this study showed that the occurrence of mumps is significantly associated with increasing temperature and vapor pressure in Taiwan. Therefore, these factors could be regarded as warning signals indicating the need to implement preventive measures.

The economic burden of childhood invasive pneumococcal diseases and pneumonia in Taiwan: Implications for a pneumococcal vaccination program

Invasive pneumococcal disease (IPD) and pneumonia are the major causes of morbidity and deaths in children in the world. The management of IPD and pneumonia is an important economic burden on healthcare systems and families. The aim of this study was to assess the economic burden of IPD and pneumonia among younger children in Taiwan. We used a cost-illness approach to identify the cost categories for analysis in this study according to various perspectives. We obtained data of admission, outpatient, and emergency department visit data from the National Health Insurance Research (NHIR) database for children <5 y of age between January 2008 and December 2008. A prospective survey was administered to the families of patients to obtain detailed personal costs. All costs are presented in US dollars and were estimated by extrapolating 2008 cost data to 2013 price levels. We estimated the number of pneumococcal disease cases that were averted if the PCV-13 vaccine had been available in 2008. The total annual social and hospital costs for IPD were US $4.3 million and US $926,000, respectively. The total annual social and hospital costs for pneumonia were US $150 million and US $17 million, respectively. On average, families spent US $653 or US $218 when their child was diagnosed with IPD or pneumonia, respectively. This cost is approximately 27%–81% of the monthly salary of an unskilled worker. In conclusion, a safe and effective pediatric pneumococcal vaccine is needed to reduce the economic burden caused by pneumococcal infection.

Epidemiologic features of mumps in Taiwan from 2006 to 2011: a new challenge for public health policy

BACKGROUND

The adoption of a second dose of the measles-mumps-rubella (MMR) vaccine among Taiwanese school children began in 2001. However, during that time, mumps cases continued to occur. The purpose of the present study was to assess the epidemiology and vaccination policy for mumps in Taiwan.

METHODS

We examined the data on mumps cases collected by the Taiwan Centers for Disease Control (Taiwan CDC) between 2006 and 2011.

RESULTS

During the 6-year study period, a total of 6612 cases of mumps were reported to the Taiwan CDC. Of the patients with known vaccination status, 62% received one dose of the MMR vaccine or no vaccine. The incidence of mumps ranged from 4.18 to 5.28 per 100 000 population and peaked in 2007. Males had a higher incidence of mumps than females (5.9 vs. 3.7 per 100 000 population; P=0.024). Children between 5 and 6 years of age had the highest incidence of mumps, and those 20 years and older had the lowest incidence. Compared to those who received two doses of the MMR vaccine, patients who were not vaccinated or received a single dose of the vaccine had a higher risk of suffering from complications and/or hospitalization.

CONCLUSIONS

In Taiwan, more than 60% of mumps cases received either no dose or one dose of the MMR vaccine. Monitoring mumps through biological testing and instituting a second dose of the MMR vaccine for children is needed for the elimination of mumps in Taiwan.

The epidemiology of imported malaria in Taiwan between 2002-2013: the importance of sensitive surveillance and implications for pre-travel medical advice

The purpose of this study was to assess the epidemiology of imported malaria in Taiwan between 2002 and 2013. We analyzed the national data recorded by the Taiwan Centers for Disease Control (Taiwan CDC). Malaria cases were diagnosed by blood films, polymerase chain reaction, or rapid diagnostic tests. The risk of re-establishment of malarial transmission in Taiwan was assessed. A total of 229 malaria cases were included in our analysis. All of the cases were imported. One hundred and ninety-two cases (84%) were diagnosed within 13 days of the start of symptoms/signs; 43% of these cases were acquired in Africa and 44% were acquired in Asia. Plasmodium falciparum was responsible for the majority (56%) of these cases. Travel to an endemic area was associated with the acquisition of malaria. The malaria importation rate was 2.36 per 1,000,000 travelers (range 1.20–5.74). The reproductive number under control (R_c) was 0. No endemic transmission of malaria in Taiwan was identified. This study suggests that a vigilant surveillance system, vector-control efforts, case management, and an educational approach focused on travelers and immigrants who visit malaria endemic countries are needed to prevent outbreaks and sustain the elimination of malaria in Taiwan.

Epidemiological features of intestinal infection with Entamoeba histolytica in Taiwan, 2002-2010

Amebiasis remains an important public health problem worldwide, and immigration and an increase in international travel have affected the incident cases of the disease. The purpose of this study was to assess the prevalence of Entamoeba histolytica in Taiwan between 2002 and 2010. We analyzed data from surveillance programs run by the Centers for Disease Control, Taiwan (Taiwan CDC), and only laboratory-confirmed cases were analyzed. In total, 1796 cases with E. histolytica infections were included in our analysis. Among them, 788 (44%) of the cases were imported, and 1008 (56%) were locally acquired. The average annual incidence rate of E. histolytica infections was 0.49 and 9.26 per 100,000 for local patients and immigrants/foreign workers from endemic countries, respectively. The annual incidence of E. histolytica infections among immigrants/foreign workers was significantly higher than among Taiwanese who had not traveled abroad (P < 0.0001). Travelers to E. histolytica-endemic areas (e.g., Southeast countries) had a higher risk acquiring an E. histolytica infection. This study emphasized that E. histolytica infection is an important intestinal infectious disease in Taiwan. The risk of infection with E. histolytica for travelers was higher for those with destinations in South and Southeast Asia. To control E. histolytica infections in Taiwan, a sensitive surveillance system needs to be established, and the amebiasis-screening program for immigrants/foreign workers from endemic countries should be enforced.

The clinical epidemiology of pediatric patients with measles from 2000 to 2009 in shanghai, china

Measles remains a leading vaccine-preventable cause of child mortality worldwide. The incidence has increased recently in some areas. The authors retrospectively analyzed the epidemiological and clinical characteristics of 2473 measles patients in Shanghai from 2000 to 2009. There were 1909 measles cases during 2005-2009 (group II), whereas only 564 cases were reported during 2000-2004 (group I). In total, 60.87% patients in group II were younger than 9 months, which was significantly higher than that in group I (35.28%; P < .001). More complications, death cases, and less atypical rashes were found in recent years. In addition, 2181 of all the 2473 patients (88.19%) and 1112 of 1328 hospitalized children (83.73%) had not been vaccinated; most of them were immigrants. The results indicated that the rising number of immigrants accounted for the increased measles morbidity in Shanghai. The tendency of more young patients and increased complications suggest that some adjustments might be needed in vaccination administration and therapeutic strategy.