Taiwan CDC Research Articles

Spectrum and Incidence of Adverse Reactions Post Immunization in the Taiwanese Population (2014-2019): An Analysis Using the National Vaccine Injury Compensation Program.

Background: Post-marketing surveillance is crucial for gathering data on vaccine reactogenicity, enhancing public trust in immunization, and promoting vaccine uptake. This study aims to characterize adverse events following immunization (AEFIs) and estimate the incidence rates of adverse reactions (ARs) associated with vaccines included in Taiwan's Expanded Program on Immunization (EPI). This study utilizes data from Taiwan's Vaccine Injury Compensation Program (VICP). Methods: Vaccine injury claims submitted to the VICP between 2014 and 2019 were analyzed. ARs were defined as AEFIs adjudicated as "related" or "indeterminate" by the VICP committee. Data on the annual number of vaccine doses administered were obtained from the Taiwan CDC, which helped calculate the AR incidence rates. Results: A total of 491 AEFI claims were reviewed, with 327 (66.6%) categorized as ARs. The AEFIs were mainly associated with the Bacillus Calmette-Guérin (BCG) vaccine (43.4%) and the seasonal influenza vaccine (22.0%). Most EPI vaccines demonstrated low AR incidence rates, ranging from 1.68 to 13.6 per million doses, with the exception of BCG, which exhibited 162.5 ARs per million doses. Shifting BCG immunization from below 5 months to at least 5 months reduced osteomyelitis incidence significantly, from 41.4 to 7.9 (p = 0.0014), but increased abscess and lymphadenitis cases. Conclusions: EPI vaccines in Taiwan are highly safe, with minimal AR incidences in the general population. The BCG vaccine remains an exception, occasionally causing severe ARs like osteomyelitis. Adjusting the immunization schedule to an older age may mitigate some of these adverse effects.

Immunity Debt Regarding the Aspect of Influenza in the Post-COVID-19 Era in Taiwan.

Immunity debt for various viral infections was reported globally in the post-COVID-19 era, but the data about influenza are lacking. This study collected data from Taiwan's CDC Open Data Portal. We analyzed the weekly number of influenza hospitalizations from January 2017 to May 2024. We divided the study period into four phases: the pre-COVID-19 without influenza epidemics, pre-COVID-19 with an influenza epidemic, COVID-19 pandemic lockdown control, and COVID-19 pandemic unlock periods. The Wilcoxon rank-sum test and interrupted time series analysis were used. The median case numbers of the four time periods were 174 (IQR = 98), 431 (IQR = 160), 8, and 155 (IQR = 175), respectively. Under the COVID-19 pandemic lockdown control, the weekly influenza hospitalization case number decreased by 90.2% (p < 0.001). The non-pharmaceutical intervention (NPI) policies during the COVID-19 pandemic helped Taiwan reduce influenza hospitalizations significantly. Till now, a comparison of the prevalence of influenza pre-COVID-19 and post-COVID-19 has yet to be reported. In our study, with the pandemic unlocking, it increased by 20-fold (p < 0.001), but the case number was still significantly lower than that pre-COVID-19. Amongst other factors, this may be associated with continuing self-induced NPIs in Taiwan.

The first case of monkeypox virus infection detected in Taiwan: awareness and preparation

ObjectivesMonkeypox has recently been detected outside African countries. This study aimed to report and analyze the first case of monkeypox virus infection in Taiwan.MethodsThe global epidemiological information was collected from the World Health Organization (WHO) and US Centers for Disease Control and Prevention (CDC). The data from the first confirmed Taiwanese monkeypox case was obtained from Taiwan Centers for Disease Control. Monkeypox diagnosis and prevention strategies were obtained from WHO guidelines on monkeypox. Phylogenetic tree analysis and sequence alignment and comparison were used to identify the phylogeny and single nucleotide polymorphism (SNP) characterization.ResultsEpidemiological data indicated that since 2013, monkeypox has caused outbreaks outside African countries through contact with infected animals and international travels. Recently, two confirmed monkeypox cases were reported in Singapore and South Korea. On June 24, 2022, Taiwan CDC reported the first confirmed case of monkeypox virus infection in a 20-year-old man who returned from Germany, from January to June 2022. This is the third confirmed case of an imported monkeypox infection in Asia. Phylogenetic analysis demonstrated that this imported monkeypox virus belonged to the West African clade and is clustered with the 2022 European outbreak monkeypox isolates. Full-length sequence analysis indicates that this virus contains 51 SNPs, and has five variant SNPs compared with the recent outbreak strains.ConclusionThis study suggests that active surveillance, enhancing border control, and the development of vaccines and antiviral drugs are urgently required to prevent and control the burden of monkeypox disease.

160 Halved incidence of scrub typhus after travel restriction to confine a surge of COVID-19 in Taiwan in 2021

Scrub typhus is a rickettsial disease that is usually transmitted by mite exposure. Infected patients may present with a fever, fatigue, headache, and muscle pain. A blackish skin lesion, called eschar, is pathognomic. The mortality rate in untreated cases is high. The first case of scrub typhus in Taiwan was reported in 1908 during the Japanese colonization. In this article, using the National Infectious Disease Statistics System (NIDSS) from the Taiwan CDC, we analyzed the dynamic incidence of scrub typhus from 2016 to 2021, both seasonally and geographically.

The Most Common Location of Schools with Viral Upper Respiratory Tract Infection Clusters in Taiwan, 2011-2019.

Clusters of acute upper respiratory tract infections are mainly caused by type A or B influenza virus. Numerous factors modify the risk of upper respiratory tract infection (URTI) cluster transmission. The purpose of this study was to investigate the epidemiological characteristics, differences, and epidemic trends in influenza viruses and in non-influenza respiratory pathogens, and the distribution of the sites of URTI cluster events in Taiwan from 2011 to 2019. We examined the publicly available annual summary data on 1864 confirmed URTI clusters in the Taiwan Centers for Disease Control (Taiwan CDC) from 2011 to 2019. URTI clusters were mainly divided into 1295 clusters of influenza virus infections, 149 clusters of non-influenza respiratory pathogen infections, 341 clusters of pathogens not detected by routine tests, and 79 clusters of unchecked samples. There were statistically significant differences (p < 0.001) in the event numbers of URTI clusters among influenza and non-influenza respiratory pathogens between 2011 and 2019. There were statistically significant differences (p = 0.01) in instances of URTI clusters among non-influenza respiratory pathogens between 2011 and 2019. There were also statistically significant differences (p < 0.001) in instances of URTI clusters in different locations between 2011 and 2019. In all the pathogens of URTI clusters (odds ratio (OR) = 1.89–2.25, p = 0.002–0.004), most single infections were influenza A viruses (64.9%, 937/1444). Respiratory syncytial virus single infections were most numerous (43.0%, 64/149) among the non-influenza respiratory pathogens of URTI clusters. Of the institutions where URTI clusters occurred, schools had the most cases (50.1%, 933/1864) (OR = 1.41–3.02, p < 0.001–0.04). After the categorization of isolated virus strains by gene sequencing, it was found that, of the seasonal influenza A viruses, the H1N1 subtype viruses were predominantly A/California/07/2009, A/Michigan/45/2015, and A/Brisbane/02/2018, and the H3N2 subtype viruses were predominantly A/Hong Kong/4801/2014, A/Singapore/INFIMH-16–0019/2016, and A/Switzerland/8060/2017, during 2017–2019. Of the influenza B viruses, B/Brisbane/60/2008 (B/Vic) was the dominant type, and some were B/Massachusetts/02/2012 (B/Yam) and B/PHUKET/3073/2013 (B/Yam). This study is the first report of confirmed events of URTI clusters from surveillance data provided by the Taiwan CDC (2011–2019). This study highlights the importance of long-term, geographically extended studies, particularly for highly fluctuating pathogens, for understanding the implications of the transmission of URTI clusters in Taiwanese populations. Knowledge gaps and important data have been identified to inform future surveillance and research efforts in Taiwan.

An outbreak of SARS-CoV-2 infections among people living with HIV and its successful containment—Taiwan, May to August 2021

In Taiwan, 14,308 locally acquired COVID-19 cases among customers and employees in Sexy Tea shops were the first cases from May 9–August 28, 2021 (weeks 19–34). Nine weeks after the community spread of COVID-19 began, the proportion of people living with HIV (PLHIV) among the COVID-19 patients peaked at 35.7%, affecting 192 HIV patients, while the prevalence of HIV infection was 0.15%. In addition to a nationwide Level 3 epidemic alert, the Taiwan Centers for Disease Control (Taiwan CDC) launched four strategies to contain this outbreak among PLHIV in this prevaccine era, including improving the quality of contact tracing, delivering health information via peer navigators, expanding SARS-CoV-2 screening and encouraging vaccination, and addressing hesitancy. The outbreak of COVID-19 related to Alpha strain among PLHIV in 2021 ceased four weeks after peaking and lasted eight weeks.

Infection Control Improvement of a Negative-Pressurized Pediatric Intensive Care Unit.

The COVID-19 pandemic caused by the novel SARS-CoV-2 virus raises alarming concern around the healthcare facilities due to the significant increase in patient inflow. Negative-pressurized isolation rooms have been utilized in various health care facilities to isolate the patients from active community contact. Several studies have highlighted isolation rooms improvement. However, limited knowledge is available regarding the isolation room facilities for pediatric intensive care units (PICU) to accommodate more than one pediatric patient. In this aspect, this study investigates a negative-pressurized isolation facility in PICU with minimal design modifications with the possibility that it can accommodate more than one pediatric patient. The field measurement tests were conducted to ensure the design compliance of Taiwan CDC. Then, computational fluid dynamics (CFD) was further utilized to numerically evaluate the HVAC system role and the ventilation performance towards infection control. A protected air-jet curtain system with a new ventilation layout was proposed through this study to enhance the protection for both pediatric patients and medical staff. The concentration decay was monitored and recorded within 900 s to evaluate the performance. The concentration can be reduced to 504 ppm for case 1, 620 ppm for case 2, 501 ppm for case 3, and 486 ppm for case 4. In addition, the injected bioaerosol particles could be well diluted dealing with two patients presents a good performance. The results revealed that this proposed configuration could feasibly accommodate two patients with a significant contamination control to protect the medical staff and patients.

Halved Incidence of Scrub Typhus after Travel Restrictions to Confine a Surge of COVID-19 in Taiwan.

Scrub typhus is a rickettsial disease that is usually transmitted by mite exposure. Infected patients may present with a fever, fatigue, headache, and muscle pain. A blackish skin lesion, called eschar, is pathognomic. The mortality rate in untreated cases is high. The first case of scrub typhus in Taiwan was reported in 1908 during the Japanese colonization. In this article, using the National Infectious Disease Statistics System (NIDSS) from the Taiwan CDC, we analyzed the dynamic incidence of scrub typhus from 2016 to 2021, both seasonally and geographically. In addition, we asked whether the recent travel restrictions and social distancing policy in Taiwan (19 May to 27 July 2021), implemented due to the COVID-19 outbreak, would change the incidence of scrub typhus. The results showed that scrub typhus was most common in summer, with an incidence almost twofold greater than that in winter or spring. Most cases were identified in rural regions. Interestingly, there was a significant 52% reduction in the summer incidence in 2021, compared to the average summer incidence of the past 5 years. This reduction coincided with the countrywide lockdown measures and travel restrictions. The restricted measures for outdoor activities may have contributed to the reduced incidence of scrub typhus.

The incidence of mumps in Taiwan and its association with the meteorological parameters: An observational study.

Mumps is an acute and common childhood disease caused by paramyxovirus. It has been reported that the occurrence of mumps is influenced by seasonality. However, the role of meteorological variables in the incidence of mumps remains unclear. The purpose of this study was to explore the relationship between meteorological factors and the incidence of mumps infection. Poisson regression analysis was used to study the relationship between weather variability and the incidence of mumps in Taiwan. Between 2012 and 2018, 5459 cases of mumps cases were reported to the Centers for Disease Control, Taiwan (Taiwan CDC). The occurrence of mumps virus infections revealed significant seasonality in the spring and summer seasons in Taiwan. The incidence of mumps virus infections began to increase at temperatures of 15°C and started to decline if the temperature was higher than 29°C (r2 = 0.387, P = .008). Similarly, the number of mumps cases began to increase at a relative humidity of 65% to 69% (r2 = 0.838, P < .029). The number of mumps cases was positively associated with temperature and relative humidity during the period preceding the infection. This study showed that the occurrence of mumps is significantly associated with increasing temperature and relative humidity in Taiwan. Therefore, these factors could be regarded as early warning signals and indicate the need to strengthen the intervention and prevention of mumps.

Approaching precision public health by automated syndromic surveillance in communities

BackgroundSentinel physician surveillance in communities has played an important role in detecting early signs of epidemics. The traditional approach is to let the primary care physician voluntarily and actively report diseases to the health department on a weekly basis. However, this is labor-intensive work, and the spatio-temporal resolution of the surveillance data is not precise at all. In this study, we built up a clinic-based enhanced sentinel surveillance system named “Sentinel plus” which was designed for sentinel clinics and community hospitals to monitor 23 kinds of syndromic groups in Taipei City, Taiwan. The definitions of those syndromic groups were based on ICD-10 diagnoses from physicians.MethodsDaily ICD-10 counts of two syndromic groups including ILI and EV-like syndromes in Taipei City were extracted from Sentinel plus. A negative binomial regression model was used to couple with lag structure functions to examine the short-term association between ICD counts and meteorological variables. After fitting the negative binomial regression model, residuals were further rescaled to Pearson residuals. We then monitored these daily standardized Pearson residuals for any aberrations from July 2018 to October 2019.ResultsThe results showed that daily average temperature was significantly negatively associated with numbers of ILI syndromes. The ozone and PM2.5 concentrations were significantly positively associated with ILI syndromes. In addition, daily minimum temperature, and the ozone and PM2.5 concentrations were significantly negatively associated with the EV-like syndromes. The aberrational signals detected from clinics for ILI and EV-like syndromes were earlier than the epidemic period based on outpatient surveillance defined by the Taiwan CDC.ConclusionsThis system not only provides warning signals to the local health department for managing the risks but also reminds medical practitioners to be vigilant toward susceptible patients. The near real-time surveillance can help decision makers evaluate their policy on a timely basis.

Minimize Risk of Intra-Hospital Acquired Transmission to Confront Pandemic COVID-19 in Taiwan

Since December 2019, the COVID-19 confirmed case number has increased rapidly in China. Subsequently has spread globally. Since late January 2020, Taiwan CDC and government have took measures early and quick response to Covid-19, take action to develop strategies to manage epidemic crisis and community spread in early stage. Taiwan has aware importance of design of isolation route from emergency department, outpatient, intensive care unit, ordinary ward and isolation rooms in health care facilities. For yearly hospital evaluation has been assessed elements that related functional capacity of hospital safety, which aims to examine the level of preparedness of hospital staffs for major emergencies or disaster.

Sapoviruses detected from acute gastroenteritis outbreaks and hospitalized children in Taiwan

Sapoviruses (SaVs) become important pathogens causing both sporadic and outbreaks of acute gastroenteritis (AGE) after rotavirus vaccination era worldwide. SaVs were included in AGE screening items when norovirus and rotavirus were negative in Taiwan CDC since 2008. However, no complete SaV genome sequence of any genotype detected in Taiwan was determined. This study aimed to investigate SaVs infection and complete genome sequences detected in Taiwan. This prospective survey, SaVs samples with untyped or weak PCR result were selected for testing the new design qRT-PCR assay from AGE hospitalized children during 2008-2011, 2016-2017 and AGE outbreak in 2012-2014. Those were genetically characterized using long RT-PCR with different primer combinations as well as primer independent deep sequencing and with 5' RACE and 3' terminal region targeting RT-PCR. Overall, 14 SaV-AGE hospitalized children and 4 SaV-AGE outbreaks were enrolled in this study. In addition to the AGE symptoms, 6 children also showed URI symptoms (cough, pharyngitis, rhinorrhea and nasal congestion). The detected 19 SaVs were classified as eight genotypes (GI.1, GI.2, GI.3, GII.2, GII.3, GII.5, GII.8, and GIV.1) and the complete genome sequence of representative strain for each genotype were determined except GI.3. The GII.3 was the most major genotype following GI.1 and GIV.1. Our result confirmed that SaV is one of the pathogens detected from Taiwanese AGE patients. Multiple SaV genotype strains would associate with AGE as similar to those detected in different countries/areas. The whole genome of SaV strains detected including rarely reported GII.8 was firstly determined.

Establishment of a Serological Panel for In Vitro Diagnostics of Severe Acute Respiratory Syndrome

Severe acute respiratory syndrome (SARS) is an infectious disease with a high mortality rate. Because SARS suddenly disappeared after an approximately 1-year-long pandemic period (November 2002 to July 2003), insufficient data was available for the development of in vitro diagnostics for SARS (SARS IVD). To rapidly identify cases in the event of future epidemics, it is necessary to establish a SARS serological panel. In this study, 20 SARS convalescent sera and 20 normal sera from the Taiwan CDC were used to establish a SARS serological panel. This can be used as a standard for the Taiwan FDA to evaluate the effectiveness of SARS IVDs during the premarket approval process. To characterize the immunological activity, protein extracts containing SARS coronavirus (SARS-CoV) proteins, synthetic viral peptide fragments and recombinant viral proteins, were used to detect antibody reactivity. Results demonstrated that synthetic S, M, N peptide fragments and whole SARS-CoV protein extracts had stronger antigenicity than individual recombinant viral proteins. Moreover, results of the ELISA and the immunofluorescence assay indicated that our SARS panel had no cross-reactivity with the human coronavirus 229E, and displayed weak cross-reactivity with human coronavirus OC43. These findings suggested that our SARS serological panel is suitable for evaluating SARS IVDs.

Optimization of the CDC Protocol of Molecular Diagnosis of COVID-19 for Timely Diagnosis

Coronavirus disease 2019 (COVID-19), the current uncontrolled outbreak of infectious disease, has caused significant challenges throughout the world. A reliable rapid diagnostic test for COVID-19 is demanded worldwide. The real-time reverse transcriptase polymerase chain was one of the most quickly established methods in the novel viral pandemic and was considered as the gold standard for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this report, we illustrate our experience of applying a protocol from the Taiwan CDC and achieving assay optimization in the immediate circumstances to meet the urgent medical and public health needs.

The outbreak of COVID-19: An overview.

In late December 2019, a previous unidentified coronavirus, currently named as the 2019 novel coronavirus#, emerged from Wuhan, China, and resulted in a formidable outbreak in many cities in China and expanded globally, including Thailand, Republic of Korea, Japan, United States, Philippines, Viet Nam, and our country (as of 2/6/2020 at least 25 countries). The disease is officially named as Coronavirus Disease-2019 (COVID-19, by WHO on February 11, 2020). It is also named as Severe Pneumonia with Novel Pathogens on January 15, 2019 by the Taiwan CDC, the Ministry of Health and is a notifiable communicable disease of the fifth category. COVID-19 is a potential zoonotic disease with low to moderate (estimated 2%–5%) mortality rate. Person-to-person transmission may occur through droplet or contact transmission and if there is a lack of stringent infection control or if no proper personal protective equipment available, it may jeopardize the first-line healthcare workers. Currently, there is no definite treatment for COVID-19 although some drugs are under investigation. To promptly identify patients and prevent further spreading, physicians should be aware of the travel or contact history of the patient with compatible symptoms.

Improved appropriateness of anti-tuberculosis prescription by the expert prescription review program in Taiwan

A nationwide program initiated by Taiwan CDC was conducted by the Taiwan Society of Tuberculosis and Lung Disease to improve the appropriateness of anti-TB prescriptions in Taiwan. All anti-TB prescriptions from 12 hospitals across Taiwan were reviewed by experienced pulmonologists, according to the 2011 Taiwan TB treatment guidelines, between May and October 2013. The investigation period was divided into three stages: May to June, July to August, and September to October. The concordance rates between anti-TB prescriptions and the guidelines were compared among the three stages and between medical centers and regional hospitals. A total of 2574 new anti-TB prescriptions were reviewed. The appropriateness of anti-TB prescriptions was 82.0%. The most dominant error was inappropriate dosage of anti-TB medications. The appropriateness improved significantly with prescription review, and the concordance rates were 78.7%, 80.6%, and 87.6% in stages 1, 2, and 3, respectively (P<0.001). The inappropriateness of medication dosage also improved significantly, with the rates of inappropriate dosage dropping from 10.2% in stage 1-5.4% in stage 3 (Odds ratio 0.491, P<0.001). The appropriateness rates showed no significant difference between regional hospitals and medical centers (82.5% vs. 81.3%, Odds ratio 0.915, P=0.393), but the improvement of prescription appropriateness was significant in regional hospitals but not in medical centers. Prescription review by TB experts is an effective approach to improve the appropriateness of anti-TB prescriptions.

Investigation of a salmonellosis outbreak linked to French toast sandwich with the use of surveillance camera, Taiwan, 2018.

Salmonella is a leading cause of foodborne outbreaks in Taiwan. On 27 April 2018, a salmonellosis outbreak among customers of a restaurant was reported to the Taiwan CDC. We investigated the outbreak to identify infection sources and prevent further transmission. We interviewed ill customers and their dining companions. We conducted a case-control study to identify foods associated with the illness. Case-patients were those who had diarrhoea within 72 h after eating at the restaurant during 16-27 April 2018. Specimens, food samples and environmental samples were collected and tested for enteric pathogens. Salmonella isolates were analysed with pulse-field gel electrophoresis and whole-genome sequencing. We inspected the restaurant sanitation and reviewed kitchen surveillance camera recordings. We identified 47 case-patients, including one decedent. Compared with 44 controls, case-patients were more likely to have had a French toast sandwich (OR: 102.4; 95% CI: 18.7-952.3). Salmonella Enteritidis isolates from 16 case-patients shared an indistinguishable genotype. Camera recordings revealed eggshell contamination, long holding time at room temperature and use of leftovers during implicated food preparation. Recommendations for restaurant egg-containing food preparation are to use pasteurised egg products and ensure a high enough cooking temperature and long enough cooking time to prevent Salmonella contamination.

PCV155 COST-EFFECTIVENESS OF SECOND-LINE CEFTAZIDIME-AVIBACTAM IN PATIENTS WITH HOSPITAL-ACQUIRED PNEUMONIA INCLUDING VENTILATOR-ASSOCIATED PNEUMONIA IN TAIWAN

This study evaluates the cost-effectiveness of ceftazidime-avibactam (CAZ-AVI), a novel combination antibiotic, as first-line therapy for patients with hospital-acquired pneumonia (HAP) including ventilator-associated pneumonia (VAP) in Taiwan. A previously developed patient-level simulation model evaluating the cost-effectiveness of CAZ-AVI in complicated urinary tract infections, complicated intra-abdominal infections, and HAP (incl. VAP), was localized to Taiwan. HAP (incl. VAP)-causing pathogens E. coli, K. pneumonia, E. Cloacae, and P. aeruginosa were included using prevalence rates from the 2015 Taiwan Nosocomial Infections Surveillance report. CAZ-AVI was evaluated as first-line treatment compared against meropenem, second-line treatment with colistin + tigecycline was used for both arms. Pathogen-specific resistance and effectiveness rates for each antibiotic were sourced from a mix of the REPROVE trial, the literature, a report from the Taiwan CDC, or KOL opinion. The model considered costs for antibiotics, hospitalizations, and recurrence, which were localized to Taiwan. Costs and benefits were discounted at 3%, over the 5-year time horizon, and the model took the perspective of the Ministry of Health and Welfare (MoHW). Compared to meropenem arm, the CAZ-AVI was associated with higher incremental costs (NT$82,856), and quality-adjusted life years (QALYs) (0.06) resulting in an incremental cost-effectiveness ratio of NT$1,328,745 per QALY gained. Incremental total costs were primarily driven by higher costs associated with antibiotics (NT$87,073). However, a decrease in incremental hospitalization costs of NT$4,216 was observed. CAZ-AVI reduced the percentage of patients resistant to first-line therapy and mortality by 6.84%, and 1.02%, respectively. The percentage of patients with overall clinical cure increased by 2.56% in the CAZ-AVI arm compared to the meropenem arm. CAZ-AVI was cost-effective as a first-line treatment for patients with HAP (incl. VAP) in Taiwan.

PIN16 COST-EFFECTIVENESS OF CEFTAZIDIME-AVIBACTAM + METRONIDAZOLE AS A FIRST-LINE TREATMENT IN PATIENTS WITH COMPLICATED INTRA-ABDOMINAL INFECTIONS IN TAIWAN

This study evaluates the cost-effectiveness of ceftazidime-avibactam (CAZ-AVI), a novel combination antibiotic, as a first-line therapy for patients in Taiwan with cIAI caused by either E. coli, K. pneumonia, or P. aeruginosa. A previously developed patient-level simulation model evaluating the cost-effectiveness of CAZ-AVI in cIAIs, complicated urinary tract infections, and hospital-acquired pneumonia, was localized to Taiwan. cIAI-causing pathogens E. coli, K. pneumonia, or P. aeruginosa were included in the model using prevalence rates from the literature. CAZ-AVI + metronidazole was evaluated as a first-line therapy and compared against meropenem. In both arms, colistin + high dose meropenem (HDM) + tigecycline was the second-line therapy for all pathogens except P. aeruginosa, where colistin + HDM was used. Pathogen-specific resistance and effectiveness rates for each antibiotic were sourced from the RECLAIM trial, the literature, a report from the Taiwan CDC, or KOL opinion. The model considered costs for antibiotics, hospitalizations, and recurrence, which were localized to Taiwan. Costs and benefits were discounted at 3%, over the 5-year time horizon, and the model took the perspective of the Ministry of Health and Welfare (MoHW). CAZ-AVI + metronidazole was cost-effective as a first-line therapy compared to meropenem for patients with cIAI with an incremental cost-effectiveness ratio of NT$1,376,211 per quality-adjusted life-year (QALY) gained, respectively. Incremental total costs and QALYs were NT$78,683 and 0.06, respectively. Incremental costs were driven by an increase in antibiotic costs (NT$85,981) and partially offset by a reduction in hospitalization costs (-NT$6,888) and recurrence costs (-NT$411). CAZ-AVI + metronidazole reduced the percentage of patients resistant to first-line therapy by 6.9% and increased the percentage of patients with an overall clinical cure by 3.04%. CAZ-AVI was cost-effective as a first-line intervention for patients with cIAI caused by E. coli, K. pneumonia, or P. aeruginosa in Taiwan.

Epidemiologic features of shigellosis and associated climatic factors in Taiwan.

The consistent, sporadic transmission of shigellosis in Taiwan necessitates an exploration of risk factors for the occurrence of shigellosis. The purpose of this study was to study the epidemiologic characteristics and the relationship between climatic factors and the incidence of shigellosis in Taiwan. We collected data from cases of shigellosis reported to the Taiwan Centers for Disease Control (Taiwan CDC) from 2001 to 2016. Climatic data were obtained from the Taiwan Central Weather Bureau. The relationships between weather variability and the incidence of shigellosis in Taiwan were determined via Poisson regression analyses. During the 16-year study period, a total of 4171 clinical cases of shigellosis were reported to the Taiwan CDC. Among them, 1926 (46.2%) were classified as confirmed cases. The incidence of shigellosis showed significant seasonality, with the majority of cases occurring in summertime (for oscillation, P < .001). The number of shigellosis cases started to increase when temperatures reached 21°C (r2 = 0.88, P < .001). Similarly, the number of shigellosis cases began to increase at a relative humidity of 70–74% (r2 = 0.75, P < .005). The number of shigellosis cases was positively associated with the mean temperature and relative humidity in the period preceding the infection. In conclusion, the occurrence of shigellosis is significantly associated with increasing temperature and relative humidity in Taiwan. Therefore, these factors could be regarded as warning signals indicating the need to implement preventive measures.