Rapidly Containing the First Indigenous Outbreak of Chikungunya in Taiwan-Lessons Learned

The first indigenous outbreak of chikungunya in Taiwan occurred in New Taipei City, northern Taiwan, from August to October 2019. This study identified important containment strategies for controlling the outbreak. The outbreak investigation and ovitrap data were collected from the Department of Health, New Taipei City Government. A geographic information system (GIS) was applied for spatial analysis, and descriptive statistics were used to compute the demographic features and medical visits of confirmed cases. There were 19 residents infected during the outbreak. The source of this outbreak was a mountain trail with abundant Aedes albopictus. The atypical symptoms and lack of a rapid test led to multiple clinical visits by the patients (mean: 2.79; standard deviation: 1.65). The clinical symptoms of chikungunya are very similar to those of dengue fever. We noted that only eight patients were polymerase chain reaction (PCR)-positive in their first blood collection, and an average of 3.13 days between illness onset and PCR-positive results. The improved laboratory panel test, targeted and rapid insecticide spraying at the households and their communities, strict closure of the mountain trail, and ovitrap surveillance for evaluating intervention were important approaches to rapidly contain the outbreak.

Prevalence, risk factors, and optimized management of moderate-to-severe thirst in the post-anesthesia care unit

Post-operative thirst is common and may cause intense patient discomfort. The aims of this retrospective study conducted in a high-volume post-anesthesia care unit (PACU) were as follows: (1) to examine the prevalence of moderate-to-severe post-operative thirst—defined as a numerical rating scale (NRS) score of 4 or higher, (2) to identify the main risk factors for moderate-to-severe post-operative thirst, and (3) to maximize the efficacy and safety of thirst management through a quality improvement program. During a 1-month quality improvement program conducted in August 2018, a total of 1211 adult patients admitted to our PACU were examined. Moderate-to-severe thirst was identified in 675 cases (55.8%). The use of glycopyrrolate during anesthesia was associated with moderate-to-severe thirst (71.7% versus 66.4%, respectively, p = 0.047; adjusted odds ratio: 1.46, p = 0.013). Following a safety assessment, ice cubes, room temperature water, or an oral moisturizer were offered to patients. A generalized estimating equation model revealed that ice cubes were the most effective means for thirst management—resulting in an estimated thirst intensity reduction of 0.93 NRS points at each 15-min interval assessment (p < 0.001)—followed by room temperature water (− 0.92/time-point, p < 0.001) and the oral moisturizer (− 0.60/time-point; p < 0.001). Patient satisfaction (rated from 1 [definitely dissatisfied] to 5 [very satisfied]) followed a similar pattern (ice cubes: 4.22 ± 0.58; room temperature water: 4.08 ± 0.55; oral moisturizer: 3.90 ± 0.55, p < 0.001). The use of glycopyrrolate—an anticholinergic agent that reduces salivary secretion—was the main independent risk factor for moderate-to-severe post-operative thirst. Our findings may provide clues towards an optimized management of thirst in the immediate post-operative period.

Prognostic factors for mortality in patients hospitalized with influenza complications, in Taiwan

BACKGROUND

This study aims to assess factors associated with fatal hospitalized influenza with complications in Taiwan.

METHODS

We identified reports of complications and illness onset in patients hospitalized with influenza between week 26, 2009 and week 25, 2012 from the National Notifiable Disease Surveillance System. We used a multivariate logistic regression model to evaluate covariates that can be associated with in-hospital mortality.

RESULTS

Among 4735 patients (413 deaths), age ≥50 years (p<0.001), male (p=0.014), comorbidities (p<0.001), and delayed oseltamivir treatment (p<0.001) increased the likelihood of in-hospital mortality.

CONCLUSIONS

We recommend influenza vaccination and early antiviral treatment for at-risk populations.

Surveillance and vaccine effectiveness of an influenza epidemic predominated by vaccine-mismatched influenza B/Yamagata-lineage viruses in Taiwan, 2011-12 season

Introduction

The 2011−12 trivalent influenza vaccine contains a strain of influenza B/Victoria-lineage viruses. Despite free provision of influenza vaccine among target populations, an epidemic predominated by influenza B/Yamagata-lineage viruses occurred during the 2011−12 season in Taiwan. We characterized this vaccine-mismatched epidemic and estimated influenza vaccine effectiveness (VE).

Methods

Influenza activity was monitored through sentinel viral surveillance, emergency department (ED) and outpatient influenza-like illness (ILI) syndromic surveillance, and case-based surveillance of influenza with complications and deaths. VE against laboratory-confirmed influenza was evaluated through a case-control study on ILI patients enrolled into sentinel viral surveillance. Logistic regression was used to estimate VE adjusted for confounding factors.

Results

During July 2011−June 2012, influenza B accounted for 2,382 (72.5%) of 3,285 influenza-positive respiratory specimens. Of 329 influenza B viral isolates with antigen characterization, 287 (87.2%) were B/Yamagata-lineage viruses. Proportions of ED and outpatient visits being ILI-related increased from November 2011 to January 2012. Of 1,704 confirmed cases of influenza with complications, including 154 (9.0%) deaths, influenza B accounted for 1,034 (60.7%) of the confirmed cases and 103 (66.9%) of the deaths. Reporting rates of confirmed influenza with complications and deaths were 73.5 and 6.6 per 1,000,000, respectively, highest among those aged ≥65 years, 50−64 years, 3−6 years, and 0−2 years. Adjusted VE was −31% (95% CI: −80, 4) against all influenza, 54% (95% CI: 3, 78) against influenza A, and −66% (95% CI: −132, −18) against influenza B.

Conclusions

This influenza epidemic in Taiwan was predominated by B/Yamagata-lineage viruses unprotected by the 2011−12 trivalent vaccine. The morbidity and mortality of this vaccine-mismatched epidemic warrants careful consideration of introducing a quadrivalent influenza vaccine that includes strains of both B lineages.

GaN/ZnO nanorod light emitting diodes with different emission spectra

Light emitting diodes (LEDs) consisting of p-GaN epitaxial films and n-ZnO nanorods have been fabricated and characterized. The rectifying behavior and emission spectra were strongly dependent on the electronic properties of both GaN film and ZnO nanorods. Light emission under both forward and reverse bias was obtained in all cases, and emission spectra could be changed by annealing the ZnO nanorods. The emission spectra could be further tuned by using a GaN LED epiwafer as a substrate. Both forward and backward diode behavior has been observed and the emission spectra were significantly affected by both the properties of the GaN substrate and the annealing conditions for the ZnO nanorods.

The influence of source material composition on morphology and optical properties of ZnO nanostructures

We investigated the influence of the composition of the source materials on the morphology and optical properties of ZnO nanostructures. The source materials consisted of a mixture of ZnO and carbon, or ZnO, carbon, and another metal oxide (In2O3, MnO2, or V2O5). The addition of a different metal oxide to the source materials is a commonly used method to achieve doping and/or alteration of the morphology of ZnO nanostructures. For each metal oxide additive, we investigated the influence of different forms of carbon (graphite, carbon nanofibers, and single wall carbon nanotubes). Obtained nanostructures were studied using scanning electron microscopy, transmission electron microscopy, energy dispersive X-ray spectroscopy, selected area electron diffraction, and photoluminescence. The morphology and the optical properties of the obtained nanostructures were strongly dependent on the source material composition. Possible reasons for observed differences are discussed.

Early detection of antibodies against various structural proteins of the SARS-associated coronavirus in SARS patients

Severe acute respiratory syndrome (SARS), a new disease with symptoms similar to those of atypical pneumonia, raised a global alert in March 2003. Because of its relatively high transmissibility and mortality upon infection, probable SARS patients were quarantined and treated with special and intensive care. Therefore, instant and accurate laboratory confirmation of SARS-associated coronavirus (SARS-CoV) infection has become a worldwide interest. For this need, we purified recombinant proteins including the nucleocapsid (N), envelope (E), membrane (M), and truncated forms of the spike protein (S1-S7) of SARS-CoV in Escherichia coli. The six proteins N, E, M, S2, S5, and S6 were used for Western blotting (WB) to detect various immunoglobulin classes in 90 serum samples from 54 probable SARS patients. The results indicated that N was recognized in most of the sera. In some cases, S6 could be recognized as early as 2 or 3 days after illness onset, while S5 was recognized at a later stage. Furthermore, the result of recombinant-protein-based WB showed a 90% agreement with that of the whole-virus-based immunofluorescence assay. Combining WB with existing RT-PCR, the laboratory confirmation for SARS-CoV infection was greatly enhanced by 24.1%, from 48.1% (RT-PCR alone) to 72.2%. Finally, our results show that IgA antibodies against SARS-CoV can be detected within 1 week after illness onset in a few SARS patients.

Serologic and molecular biologic methods for SARS-associated coronavirus infection, Taiwan

Severe acute respiratory syndrome (SARS) has raised a global alert since March 2003. After its causative agent, SARS-associated coronavirus (SARS-CoV), was confirmed, laboratory methods, including virus isolation, reverse transcriptase-polymerase chain reaction (RT-PCR), and serologic methods, have been quickly developed. In this study, we evaluated four serologic tests ( neutralization test, enzyme-linked immunosorbent assay [ELISA], immunofluorescent assay [IFA], and immunochromatographic test [ICT]) for detecting antibodies to SARS-CoV in sera of 537 probable SARS case-patients with correlation to the RT-PCR. With the neutralization test as a reference method, the sensitivity, specificity, positive predictive value, and negative predictive value were 98.2%, 98.7%, 98.7%, and 98.4% for ELISA; 99.1%, 87.8%, 88.1% and 99.1% for IFA; 33.6%, 98.2%, 95.7%, and 56.1% for ICT, respectively. We also compared the recombinant-based western blot with the whole virus-based IFA and ELISA; the data showed a high correlation between these methods, with an overall agreement of >90%. Our results provide a systematic analysis of serologic and molecular methods for evaluating SARS-CoV infection.

Development of a method for the determination of pyrimethamine concentrations in feeds by ion-pairing high-performance liquid chromatography

An ion-pairing reversed-phase high-performance liquid chromatography (HPLC) method with diode array detection at 280 nm was developed to determine pyrimethamine concentrations in feed for laying hens. Pyrimethamine was extracted with a mixture of 5% isobutanol and 95% benzene, and the extract was cleaned up on an alumina column. The drug was eluted from an Intersil ODS-3V column (250 by 4.6 mm) with a mixture of 25% acetonitrile and 75% water (vol/vol) containing 0.01 M tetramethylammonium chloride as an ion-pairing agent and adjusted with acetic acid to pH 3.5. The flow rate was 1.0 ml/min. Mean recovery of pyrimethamine from supplemented feeds at concentrations of 2, 4, and 5 microg/g of feed were 100.5, 103.5, and 100.8%, respectively. Precision within a day ranged from 4.3 to 7.0% for the three concentrations, and day-to-day precision was 5.3% for feed supplemented at a concentration of 4 microg/g. No chromatographic interference was detected from other 2,4-diaminopyrimidine compounds or other major drugs used in poultry.

Evaluation of two concentration methods for detecting Giardia and Cryptosporidium in water

The cartridge filtration method and membrane filtration method based on the fluorescent antibody procedure were evaluated for their recovery efficiencies and detection limits of Giardia and Cryptosporidium. We assessed the performances of the two concentration methods for water samples collected from Taiwan water treatment plants. The membrane filtration method was characterized by higher recovery rate and detection limit comparing with the cartridge filtration method. The occurrences of both parasites, and the relationships of parasite concentrations with indicator microorganisms show inconsistency between the two methods. It was discovered that water turbidity reduced the recovery efficiencies, and raised the detection limits for both parasites regardless of the method used.

Antioxidant and hepatoprotective effects of punicalagin and punicalin on acetaminophen-induced liver damage in rats

Punicalagin and punicalin were isolated from the leaves of Terminalia catappa L., a Combretaceous plant distributed throughout tropical and subtropical beaches, which is used for the treatment of dermatitis and hepatitis. Our previous studies showed that both of these compounds exert antioxidative activity. In this study, the antihepatotoxic activity of punicalagin and punicalin on acetaminophen-induced toxicity in the rat liver was evaluated. After evaluating the changes of several biochemical functions in serum, the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were increased by acetaminophen administration and reduced by punicalagin and punicalin. Histological changes around the hepatic central vein and oxidative damage induced by acetaminophen were also recovered by both compounds. The data show that both punicalagin and punicalin exert antihepatotoxic activity, but treatment with larger doses enhanced liver damage. These results suggest that even if punicalagin and punicalin have antioxidant activity at small doses, treatment with larger doses will possibly induce some cell toxicities.

Antioxidant and free radical scavenging effects of the tannins of Terminalia catappa L

Reactive oxygen species (ROS) react with biological molecules and destroy the structure of cells and eventually cause free radical-induced disease such as inflammation and cancer. Previous studies showed that an aqueus extract of Terminalia catappa L. exhibited superoxide radical scavenger activity and modification of mitomycin C-induced clasto-genicity. In order to investigate the multiple antioxidant effect of the tannin components of T. catappa L., their ability to prevent lipid peroxidation, superoxide formation and their free radical scavenging activity were evaluated. The results indicated that all of these components showed potent antioxidant activity. Punicalagin and punicalin were the most abundant components and had the strongest anti-oxidative effects of this group of tannins.

Effects of punicalagin and punicalin on carrageenan-induced inflammation in rats

Punicalagin and punicalin were isolated from the leaves of Terminalia catappa L. In this study, we evaluated the anti-inflammatory activity of punicalagin and punicalin carrageenan-induced hind paw edema in rats. After evaluation of the anti-inflammatory effects, the edema rates were increased by carrageenan administration and reduced by drug treatment. After 4 hr of carrageenan administration, the best effect group was the punicalagin (10 mg/kg) treated group (inhibition rate was 58.15%), and the second was the punicalagin (5 mg/kg)-treated group (inhibition rate was 39.15%). However, even if the anti-inflammatory activity of punicalagin was the same as punicalin at the 5 mg/kg dose, the inhibition effect from larger doses of punicalagin was increased, but there was a decrease with a larger dose of punicalin. The data showed that both punicalagin and punicalin exert anti-inflammatory activity, but treatment with larger doses of punicalin may induce some cell damages.

Antioxidant activity of tannin components from Vaccinium vitis-idaea L

Reactive oxygen molecules have been implicated as important pathological mediators in many clinical disorders and periodontal disease. To provide possible alternative treatment of periodontal disease, six tannins isolated from Vaccinium vitis-idaea L. were evaluated for anti-lipid peroxidation, anti-superoxide formation and free radical scavenging activity. The results showed that cinnamtannin B1 displayed the strongest anti-lipid peroxidation activity, proanthocyanidin A-1 displayed the strongest superoxide scavenging activity, and epicatechin-(4beta--> 6)-epicatechin-(4beta-->8, 2beta-->O--> 7)-catechin had the strongest anti-superoxide formation effect. We conclude that tannins isolated from V. vitis-idaea L. exhibited multiple antioxidant activity, and could be used for the treatment of periodontal disease.

Antioxidant and hepatoprotective activity of punicalagin and punicalin on carbon tetrachloride-induced liver damage in rats

Punicalagin and punicalin, isolated from the leaves of Terminalia catappa L., are used to treat dermatitis and hepatitis. Both compounds have strong antioxidative activity. The antihepatotoxic activity of punicalagin and punicalin on carbon tetrachloride (CCl4)-induced toxicity in the rat liver was evaluated. Levels of serum glutamate-oxalate-transaminase and glutamate-pyruvate-trans-aminase were increased by administration of CCl4 and reduced by drug treatment. Histological changes around the liver central vein and oxidation damage induced by CCl4 also benefited from drug treatment. The results show that both punicalagin and punicalin have anti-hepatotoxic activity but that the larger dose of punicalin induced liver damage. Thus even if tannins have strong antioxidant activity at very small doses, treatment with a larger dose will induce cell damage.