Abstract
In Taiwan, melioidosis is an emerging disease that suddenly increased in the Er-Ren River Basin, beginning in 2005 and in the Zoynan region during 2008–2012, following a typhoon. Additionally, the disease sporadically increased in a geography-dependent manner in 2016. Subcutaneous inoculation, ingestion, and the inhalation of soil or water contaminated with Burkholderia pseudomallei are recognized as the transmission modes of melioidosis. The appearance of environmental B. pseudomallei positivity in northern, central and southern Taiwan is associated with disease prevalence (cases/population: 0.03/100,000 in the northern region, 0.29/100,000 in the central region and 1.98/100,000 in the southern region). However, melioidosis-clustered areas are confined to 5 to 7.5 km2 hot spots containing high-density populations, but B. pseudomallei-contaminated environments are located >5 km northwestern of the periphery of these hot spots. The observation that the concentration of B. pseudomallei-specific DNA in aerosols was positively correlated with the incidence of melioidosis and the appearance of a northwesterly wind in a hot spot indicated that airborne transmission had occurred in Taiwan. Moreover, the isolation rate in the superficial layers of a contaminated crop field in the northwest was correlated with PCR positivity in aerosols collected from the southeast over a two-year period. The genotype ST58 was identified by multilocus sequence typing in human and aerosol isolates. The genotype ST1001 has increased in prevalence but has been sporadically distributed elsewhere since 2016. These data indicate the transmission modes and environmental foci that support the dissemination of melioidosis are changing in Taiwan.
Highlights
Melioidosis is an emerging and fatally infectious disease that is endemic to Southeast Asia and northern Australia [1]
As an emerging and fatally infectious disease, melioidosis occurs because of exposure to soil or water contaminated with B. pseudomallei
Over 50% (223/444) of melioidosis cases were successively clustered in the Er-Ren River Basin in 2005 and in the Zoynan region in 2008–2012, and cases were sporadically distributed throughout the Siaogang-Fengshan region in Taiwan
Summary
Melioidosis is an emerging and fatally infectious disease that is endemic to Southeast Asia and northern Australia [1]. In 2005, after a typhoon event, melioidosis cases were clustered in the Er-Ren River Basin of Taiwan during a three-month period [23]. In 2005, while 0.3 cases/100,000 population were infected throughout the entire population of Taiwan, the incidence of melioidosis reached 122 cases/100,000 population in the area downstream of the Er-Ren River Basin.
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