Taiwan Centers For Disease Control Research Articles

Resurgence of influenza and enterovirus infections in Taiwan post-COVID-19: A nationwide surveillance study

BackgroundThe global impact of COVID-19 has prompted profound shifts in public health policies. The epidemiology of respiratory infectious disease may change in the post-covid era. This study investigates the repercussions of these policies on respiratory infectious diseases, specifically the resurgence of severe influenza and enterovirus infections in the post-COVID-19 era. MethodsExamining the period from January 2020 to December 2023, our nationwide study analyzes data from the Taiwan Centers for Disease Control and Our World in Data. Two distinct phases, containing (Week 1, 2020, to Week 43, 2022) and coexisting (Week 44, 2022, to Week 50, 2023), are scrutinized, emphasizing policy changes and their potential impact on epidemiology. ResultsEpidemiological trends reveal a decline in COVID-19 and all-cause pneumonia during the co-existing period but a notable rise in severe influenza and enterovirus infections. Interrupted time series analysis confirms the surge in severe influenza and enterovirus cases post-restriction ease. ConclusionThe post-COVID-19 era introduces challenges with the resurgence of traditional respiratory diseases, necessitating continuous surveillance, timely non-pharmaceutical interventions, and vaccination as crucial strategies. Vigilance and targeted measures by policymakers and healthcare providers are imperative to navigate the evolving landscape of respiratory infectious diseases in the aftermath of the pandemic.

The epidemiology and phylogenetic trends of Omicron subvariants from BA.5 to XBB.1 in Taiwan

BackgroundOmicron, a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant, entered Taiwan at the end of 2021. The Taiwanese government ended its "zero-COVID" policy in March 2022. Multiple coronavirus disease 2019 (COVID-19) outbreaks began in April 2022. We monitored the replacement of Omicron subvariants after BA.1/BA.2 and analyzed their correlation with COVID-19 outbreaks. MethodsWe collected SARS-CoV-2 real-time qRTPCR-positive nasopharyngeal swabs from Kaohsiung Medical University Hospital (KMUH), Kaohsiung City, Taiwan, and performed sequencing for specimens exhibiting a cytopathic effect in Vero E6 cells to determine their clades and lineages. We analyzed the medical records of COVID-19 patients and identified hospitalization risk factor(s). We retrieved SARS-CoV-2 sequences identified in Taiwan from GISAID and analyzed their correlation with COVID-19 data from the Taiwan Centers for Disease Control. ResultsWe analyzed the phylogenesis of KMUH-47 to KMUH-104 (SARS-CoV-2 isolates identified herein) and all of the Omicron subvariants from BA.5 to XBB.1 (n = 1930). Age and comorbidities were hospitalization risk factors. Men generally exhibited a greater fatality rate than women. COVID-19-related deaths predominantly occurred in individuals over 70 years old. The COVID-19-related case fatality rate increased as nucleotide (NT) and amino acid (AA) substitutions increased. The number of COVID-19-related cases and deaths progressively decreased with each outbreak between August 2022 and October 2023. ConclusionHospitalization was associated with age and the presence of comorbidities. COVID-19-related fatality was linked to sex, age, and the accumulation of NT and AA substitutions in emerging Omicron subvariants.

Prevalence estimates for COVID-19-related health behaviors based on the cheating detection triangular model

BackgroundSurvey studies in medical and health sciences predominantly apply a conventional direct questioning (DQ) format to gather private and highly personal information. If the topic under investigation is sensitive or even stigmatizing, such as COVID-19-related health behaviors and adherence to non-pharmaceutical interventions in general, DQ surveys can lead to nonresponse and untruthful answers due to the influence of social desirability bias (SDB). These effects seriously threaten the validity of the results obtained, potentially leading to distorted prevalence estimates for behaviors for which the prevalence in the population is unknown. While this issue cannot be completely avoided, indirect questioning techniques (IQTs) offer a means to mitigate the harmful influence of SDB by guaranteeing the confidentiality of individual responses. The present study aims at assessing the validity of a recently proposed IQT, the Cheating Detection Triangular Model (CDTRM), in estimating the prevalence of COVID-19-related health behaviors while accounting for cheaters who disregard the instructions.MethodsIn an online survey of 1,714 participants in Taiwan, we obtained CDTRM prevalence estimates via an Expectation-Maximization algorithm for three COVID-19-related health behaviors with different levels of sensitivity. The CDTRM estimates were compared to DQ estimates and to available official statistics provided by the Taiwan Centers for Disease Control. Additionally, the CDTRM allowed us to estimate the share of cheaters who disregarded the instructions and adjust the prevalence estimates for the COVID-19-related health behaviors accordingly.ResultsFor a behavior with low sensitivity, CDTRM and DQ estimates were expectedly comparable and in line with official statistics. However, for behaviors with medium and high sensitivity, CDTRM estimates were higher and thus presumably more valid than DQ estimates. Analogously, the estimated cheating rate increased with higher sensitivity of the behavior under study.ConclusionsOur findings strongly support the assumption that the CDTRM successfully controlled for the validity-threatening influence of SDB in a survey on three COVID-19-related health behaviors. Consequently, the CDTRM appears to be a promising technique to increase estimation validity compared to conventional DQ for health-related behaviors, and sensitive attributes in general, for which a strong influence of SDB is to be expected.

Syphilis and cardiovascular risk: a Taiwanese registry.

Studies on the impact of syphilis on the cardiovascular system in large populations are limited. This study investigated the effects of syphilis on cardiovascular outcomes. Medical records from 2010 to 2015 were retrieved from the Taiwan National Health Insurance Research Database, linked to the Notifiable Infectious Diseases database from the Taiwan Centers for Disease Control. Patients with syphilis were identified, excluding those with missing information, under 20 years of age, or with a history of human immunodeficiency virus infection, acute myocardial infarction, heart failure, aortic regurgitation, replacement of the aortic valve, aneurysm and/or dissection of the aorta, atrial fibrillation, ischaemic stroke, haemorrhagic stroke, and venous thromboembolism. Primary outcomes included new-onset acute myocardial infarction, heart failure, aortic regurgitation, aneurysm and dissection of the aorta, atrial fibrillation, ischaemic stroke, haemorrhagic stroke, venous thromboembolism, cardiovascular death, and all-cause mortality. A total of 28 796 patients with syphilis were identified from 2010 to 2015. After exclusions and frequency matching, 20 601 syphilis patients and 20 601 non-syphilis patients were analysed. The relative rate (RR) was utilized in the analysis, as the competing risk of death was not considered. Compared with patients without syphilis, patients with syphilis had increased risks of acute myocardial infarction (RR 38%, 95% confidence interval [CI] 1.19-1.60, P < .001), heart failure (RR 88%, 95% CI 1.64-2.14, P < .001), aortic regurgitation (RR 81%, 95% CI 1.18-2.75, P = .006), atrial fibrillation (RR 45%, 95% CI 1.20-1.76, P < .001), ischaemic stroke (RR 68%, 95% CI 1.52-1.87, P < .001), haemorrhagic stroke (RR 114%, 95% CI 1.74-2.64, P < .001), venous thromboembolism (RR 67%, 95% CI 1.23-2.26, P = .001), cardiovascular death (RR 155%, 95% CI 2.11-3.08, P < .001), and all-cause death (RR 196%, 95% CI 2.74-3.19, P < .001) but not for aneurysm and dissection of the aorta. This study demonstrates that patients with syphilis have a higher risk of cardiovascular events and all-cause mortality compared with those without syphilis.

Epidemiology of Murine Typhus in Taiwan from 2013 to 2020.

Murine typhus is a flea-borne disease caused by Rickettsia typhi infection. The disease is a notifiable infectious disease in Taiwan. Specimens from suspected cases are required to be sent to the Taiwan Centers for Disease Control and Prevention for laboratory diagnosis. In this study, 204 cases of murine typhus were identified by bacterial isolation, real-time polymerase chain reaction, or indirect immunofluorescence assay between 2013 and 2020. The average incidence rate was 0.11/100,000 person-years (95% CI: 0.08-0.13). Murine typhus occurred throughout the year, but it was most prevalent in summer (May to August). The majority of patients were males (75%), residents of Kaohsiung city (31%), and worked in agriculture, forestry, fishing, and animal husbandry (27%). Fever was the most common symptom, present in 95.6% of patients, followed by headache (41%), myalgia (33%), and liver dysfunction (33%). Only 13% of patients had a rash. Up to 80% of cases were among hospitalized patients, and 43% of patients developed severe manifestations. Serological assays also indicated coinfection events. Seven patients showed a 4-fold increase in antibody titers against Orientia tsutsugamushi (N = 2), Coxiella burnetii (n = 2), and Leptospira (N = 3). In conclusion, murine typhus is an endemic and important zoonotic rickettsial disease in Taiwan that cannot be ignored. Further epidemiological surveillance and clinical characteristics should be continuously investigated to prevent and control murine typhus.

‘Just Like Pandemic Prevention’: The Semiotic Flow That Interweaves Multimodality, Metaphor, and Narrativity

ABSTRACT This study investigates how COVID-19 advice is creatively delivered in a one-minute video produced by the Taiwan Centers for Disease Control in February 2022. It examines metaphors in verbal, visual, and multimodal modes, and illustrates how such metaphors interact with multimodal narrativity. Drawing on the insights of studies on multimodal metaphors, this paper seeks to identify which are the most pervasive metaphors or what dominant metaphor, if any, is used in the video. It finds that the metaphorical mappings between coping with the covid pandemic and handling olympic weightlifting are represented across modes and that the creative delivery of COVID-19 advice is woven from a warp of metaphors in various modes and a weft of narrativity across modes. Such metaphorical creativity is underpinned by the semiotic flow that features four interconnected configurations: moving between metaphorization, literalization, and re-metaphorization; somehow blurring the source-target boundary; expanding the range of functions that the multimodal representation can serve; and initiating a metaphorical thought from one or more contextual factors.

Epidemiological Characteristics of Zika Virus Infections Imported into Taiwan between 2016 and 2021

Background: Zika virus is a mosquito-borne virus that has resurfaced. It has been confirmed to cause microcephaly and Guillain–Barré syndrome. The number of Zika virus infections in South America has increased considerably since 2015. Aim: This study confirmed the epidemiological characteristics of the cases of Zika virus infections imported into Taiwan. Methods: Patients with travel history to areas at risk of Zika virus infections and had their blood, urine, or saliva samples tested positive for Zika virus through reverse transcription polymerase chain reaction by the Taiwan Centers for Disease Control were included in this study. Results: Taiwan reported its first case of Zika virus infection in January 2016, and it has reported 26 cases as of December 2021. Most of the patients were men (76.9%, 20/26), aged 20–59 years (73.1%, 19/26), and lived in Northern Taiwan (73.1%, 19/26). Most of the cases were reported in summer and autumn (76.9%, 20/26). The 26 patients included one 4-year-old girl and three teenage boys aged 15–19 years; 22 patients were from Southeast Asia, three patients were from the Americas, and one patient was from Africa. Conclusion: This study is the first to report on the epidemiological characteristics of Zika virus infections imported into Taiwan between 2016 and 2021. These findings can aid policymakers and clinical experts in developing prevention and control measures targeting Zika virus infections, which cause severe illness and imposes a considerable burden on the population.

Substantial discrepancies in dengue case estimates between the Global Burden of Disease Study and Taiwan Centers for Disease Control.

Taiwan's dengue cases vary annually, peaking in infrequent epidemics, which differ substantially from the Global Burden of Disease Study's (GBD's) projections. Although the GBD study provides invaluable insights into global health trends, its modelling approach fails to capture the dynamic change of dengue transmission.

Rén qíng wèi (‘flavour of human feelings’) in the pragmeme of delivering Covid-19 directives

Previous studies on advice-giving in health contexts are largely based on face-to-face data or on issues related to target groups of individuals with specific health conditions. However, advice delivered in response to the coronavirus pandemic constitutes an unprecedented health context, as such advice is provided for the benefit of every individual in society. Based on the data of 30 1-min videos produced by the Taiwan Centers for Disease Control, this study investigates how directives are delivered and how rén qíng wèi (‘flavour of human feelings’), a Chinese term that encapsulates a composite of warm feelings, is manifested in the verbal delivery of Covid-19 directives. By conceptualising the delivery of Covid-19 directives as a pragmeme, this study investigates how the pragmeme is realised in Taiwan and examines how rén qíng wèi, an aggregate of culturally valued affectivity, is intertwined with directives, thereby strengthening the affective and cultural dimensions of pragmeme theory.

A-259 Detecting Human RNase P Gene Prevents False-Negative of SARS-CoV-2

Abstract Background Real-time Reverse transcriptase—polymerase chain reaction (RT-PCR) is a regular technique for detecting SARS-CoV-2 infection. Human RNase P sequence is using as internal control for PCR assay usually. This article discusses the correlation between SARS-CoV-2 PCR result and human RNase P gene result. Methods Nasopharyngeal swabs were collected from two patients within three consecutive days. We detected for SARS-CoV-2 target gene and human RNase P gene by using real-time RT-PCR assay, which SARS-CoV-2 target gene includes E gene, Rarp gene and N gene . And the threshold cycle values (Ct) were determined by cobas® z 480. Evaluate the results of SARS-CoV-2 and RNase P gene detection. All samples were also analysis for SARS-CoV-2 infection in Taiwan Centers for Disease Control. Results Results of SARS-CoV-2 PCR assay were consistent in both laboratories. SARS-CoV-2 target genes were detected from specimens of both patients on day1. Ct values of E gene were 29.63 and 29.50. Ct values of Rdrp gene were 32.23 and 32.50. Ct values of N gene were 33.09 and 32.68. Ct values of RNase P gene were 21.21 and 21.22. On day 2 and 3, all specimens were negative detected for SARS-CoV-2 PCR. Ct values of RNase P gene were 25.73 and 26.16 on day 2 and 29.82 and 30.28 on day 3. Conclusion The Ct values of human RNase P gene detection can be correlated with the numbers of collected cells. Comparing the results of two patients for three consecutive days, the Ct value of human RNase P gene related to SARS-CoV-2 PCR result. Collection technique can be a factor to affect Ct value of human RNase P gene detection. Develop acceptance range for Ct value of RNase P gene detection can be a quality standard for sample collection to prevent false-negative of SARS-CoV-2.

Epidemiological investigation of the first locally acquired case of COVID-19 identified by influenza surveillance-Taiwan, February 2020.

COVID-19 and influenza have similar clinical presentations that can range from mild to severe disease. The World Health Organization recommends that countries use existing influenza surveillance to monitor COVID-19 transmission in communities. We aim to describe the surveillance and investigation of COVID-19 at the early stage of the pandemic in Taiwan. In February 2020, the Taiwan Centers for Disease Control enhanced COVID-19 surveillance through its existing influenza surveillance. We retrospectively tested patients for SARS-CoV-2 who had symptoms of severe complicated influenza but were negative in influenza testing. We conducted an epidemiological investigation and contact tracing for the index patient and secondary cases to prevent virus transmission. We identified the first COVID-19 patient on February 15 through enhanced COVID-19 surveillance. He had no history of traveling abroad and an unclear history of contact with COVID-19 cases. He presented with influenza-like illness on January 27 and was hospitalized from February 3 to 15. We identified 39 close contacts of the index patient, including 11 family members and 28 healthcare workers. In total, four close family contacts of the index patient tested positive for SARS-CoV-2. An additional 84 close contacts of the four secondary cases were identified and traced; none was diagnosed with COVID-19. We recommend enhancing COVID-19 surveillance by testing patients with influenza-like illness. To prevent the spread of COVID-19, we recommend using appropriate personal protective equipment when in close contact with patients who present with influenza-like illness or when caring for patients with pneumonia of unknown etiology.

Longitudinal neutralizing antibody responses after SARS-CoV-2 infection: A convalescent cohort study in Taiwan.

Understanding the neutralizing antibody (NAb) titer against COVID-19 over time is important to provide information for vaccine implementation. The longitudinal NAb titer over one year after SARS-CoV-2 infection is still unclear. The purposes of this study are to evaluate the duration of the neutralizing NAb titers in COVID-19 convalescents and factors associated with the titer positive duration. A cohort study followed COVID-19 individuals diagnosed between 2020 and 2021 May 15th from the COVID-19 database from the Taiwan Centers for Disease Control. We analyzed NAb titers from convalescent SARS-CoV-2 individuals. We used generalized estimating equations (GEE) and a Cox regression model to summarize the factors associated with NAb titers against COVID-19 decaying in the vaccine-free population. A total of 203 convalescent subjects with 297 analytic samples were followed for a period of up to 588 days. Our study suggests that convalescent COVID-19 in individuals after more than a year and four months pertains to only 25% of positive titers. The GEE model indicates that longer follow-up duration was associated with a significantly lower NAb titer. The Cox regression model indicated the disease severity with advanced condition was associated with maintaining NAb titers (adjusted hazard ratio: 2.01, 95% CI: 1.11-3.63) and that smoking was also associated with higher risk of negative NAb titers (adjusted hazard ratio: 0.55, 95% CI: 0.33-0.92). Neutralizing antibody titers diminished after more than a year. The antibody titer response against SARS-CoV-2 in naturally convalescent individuals provides a reference for vaccinations.

Use of YouTube by academic medical centres during the COVID-19 pandemic: an observational study in Taiwan

ObjectivesYouTube has been of immense importance in conveying essential information on COVID-19 and promoting the latest healthcare policies during the outbreak. However, there have been few studies that have focused...

Is the New Langya virus in China a threat to global health? A short communication.

The recently detected virus in eastern China in 2018 led to some health concerns, especially with the global trend of spreading viruses. As a new RNA-detected genus of the henipavirus family was found in Eastern China, the number of patients affected has reached 35 through zoonotic spread, with symptoms ranging from simple fever to fatal affection of vital organs such as the brain, liver, and kidneys. Researchers have found that shrew animals might be a potential reservoir for the Langya virus; however, data is still limited regarding human-to-human transmission. Current efforts by the Chinese Health Ministry and the Taiwan Centers for Disease Control and Prevention to deduct the spread of the virus and track its origin by trying to sequence the disease genome are evident. With all this in mind, the recommendation to face this new novel virus revolves around protecting the most vulnerable population at risk of being infected, such as farmers, and preventing the spread of the virus. Efforts must be directed toward screening animals for henipavirus and diving more deeply into the etiology of how this virus has spread to humans to help understand the spread of zoonotic viruses in the future.

Limited effect of reducing pulmonary tuberculosis incidence amid mandatory facial masking for COVID-19

Although the incidence and mortality rates associated with tuberculosis (TB) have been decreasing in many countries, TB remains a major public health concern. Obligatory facial masking and reduced health-care capacity because of COVID-19 may substantially influence TB transmission and care. The Global Tuberculosis Report 2021 published by the World Health Organization indicated a TB rebound at the end of 2020, which coincided with the COVID-19 pandemic. We explored this rebound phenomenon in Taiwan by investigating whether TB incidence and mortality are affected by COVID-19 because of their common route of transmission. In addition, we investigated whether the incidence of TB varies across regions with different incidences of COVID-19. Data (2010–2021) regarding annual new cases of TB and multidrug-resistant TB were collected from the Taiwan Centers for Disease Control. TB incidence and mortality were assessed in Taiwan’s seven administrative regions. Over the last decade, TB incidence decreased continually, even during 2020 and 2021, the years coinciding with the COVID-19 pandemic. Notably, TB incidence remained high in regions with low COVID-19 incidence. However, the overall decreasing trends of TB incidence and mortality remained unchanged during the pandemic. Facial masking and social distancing may prevent COVID-19 transmission but exhibit limited efficacy in reducing TB transmission. Thus, during health-related policymaking, policymakers must consider TB rebound, even in the post-COVID-19 era.

Epidemiological features and risk factors for measles and rubella in Taiwan during 2011 to 2020.

The risk of geographic transmission of infectious diseases due to air travel varies greatly. Our aim is to survey empirical data that provide a retrospective historical perspective on measles and rubella. This study used the open data website provided by the Taiwan Centers for Disease Control (TCDC) to extract the reported numbers of measles and rubella case between 2011 and 2020. There were 306 cases of measles and 135 cases of rubella. The incidence of measles and rubella per million population were 0 to 6.0 and 0 to 2.6, respectively. There was a gradual increase in the numbers of cases in those aged 20-39 years, and distinct duration patterns. It indicated that the risk of contracting rubella has significantly decreased in the last 5 years. Measles cases aged 20 to 39 years accounted for 72.5% of all cases. Rubella cases aged 20 to 39 years accounted for 59.3% of all cases. The male and residency in the Taipei metropolitan area or northern area were identified as potential risk factors for measles and rubella. Coverage with the first dose of the measles, mumps and rubella (MMR) vaccine in Taiwan increased from 97.31% to 98.86%, and the uptake rate of the second dose of the MMR vaccine increased from 95.73% to 98.39% between 2010 and 2020. Furthermore, the numbers of imported cases of measles (n = 0) and rubella (n = 0) reported during the coronavirus disease 2019 (COVID-19) pandemic were lower than those from 2011 to 2019. Measles and rubella cases were imported most frequently from Cambodia and Vietnam. This study represents the first report of confirmed cases of acquired measles and rubella from surveillance data of the TCDC between 2011 and 2020, also demonstrates that the numbers of cases of measles and rubella significantly decreased in Taiwan during the COVID-19 pandemic.

Maternal-Neonatal Outcomes of Obstetric Deliveries Performed in Negative Pressure Isolation Rooms during the COVID-19 Omicron Variant Pandemic in Taiwan: A Retrospective Cohort Study of a Single Institution.

Objective: To investigate the maternal–neonatal outcomes of obstetric deliveries performed in negative pressure isolated delivery rooms (NPIDRs) during the coronavirus disease 2019 (COVID-19) omicron variant pandemic period in a single tertiary center in northern Taiwan. Methods: Confirmed positive and suspected-positive COVID-19 cases delivered in NPIDRs and COVID-19-negative mothers delivered in conventional delivery rooms (CDRs) in the period of 1 May 2022 to 31 May 2022 during the COVID-19 omicron variant pandemic stage were reviewed. The maternal–neonatal outcomes between the two groups of mothers were analyzed. All deliveries were performed following the obstetric and neonatologic protocols conforming to the epidemic prevention regulations promulgated by the Taiwan Centers for Disease Control (T-CDC). Multiple gestations, deliveries at gestational age below 34 weeks, and major fetal anomalies were excluded from this study. Results: A total of 213 obstetric deliveries were included. Forty-five deliveries were performed in NPIDRs due to a positive COVID-19 polymerase chain reaction (PCR) test (n = 41) or suspected COVID-19 positive status (n = 4). One hundred and sixty-eight deliveries with negative COVID-19 PCR tests were performed in CDRs. There was no statistical difference in maternal characteristics between the two groups of pregnant women. All COVID-19-confirmed cases either presented with mild upper-airway symptoms (78%) or were asymptomatic (22%); none of these cases developed severe acute respiratory syndrome. The total rate of cesarean section was not statistically different between obstetric deliveries in NPIDRs and in CDRs (38.1% vs. 40.0%, p = 0.82, respectively). Regardless of delivery modes, poorer short-term perinatal outcomes were observed in obstetric deliveries in NPIDRs: there were significant higher rates of neonatal respiratory distress (37.8% vs. 10.7%, p < 0.001, respectively), meconium-stained amniotic fluid (22.2% vs. 4.2%, p < 0.001, respectively) and newborn intensive care unit admission (55.6% vs. 8.3%, p < 0.001, respectively) in obstetric deliveries performed in NPIDRs than in CDRs. Maternal surgical outcomes were not significantly different between the two groups of patients. There was no vertical transmission or nosocomial infection observed in COVID-19 confirmed cases in this study period. Conclusions: Our study demonstrates that obstetric deliveries for positive and suspected COVID-19 omicron-variant cases performed in NPIDRs are associated with poorer short-term perinatal outcomes. Reasonable use of personal protective equipment in NPIDRs could effectively prevent nosocomial infection during obstetric deliveries for pregnant women infected with the COVID-19 omicron variant.

Risk Factors Associated with Passengers with Imported Dengue Fever at International Airports in Taiwan.

Dengue fever (DF) is a mosquito-borne disease prevalent in the tropics (e.g., sub-Saharan Africa, Asia, and Central and South America) and a common cause of febrile illness in travelers. The high incidence of imported DF in Taiwan has led to a domestic outbreak. This study explored the risk factors associated with individuals given diagnoses of imported DF at international airports in Taiwan. The results may serve as a reference for DF prevention. In this retrospective study, data from the symptom notification system database of the Taiwan Centers for Disease Control (TCDC) were used. These data concerned travelers who returned to Taiwan from DF-endemic areas with suspected DF symptoms. The epidemiological characteristics of the cases were analyzed, and 28 variables related to DF infection were included in the multivariate logistic regression analysis. In 2018–2019, there were 8656 cases (451 positive and 8205 negative cases). The results revealed DF symptoms and a 16–30-day stay in endemic areas to be independent risk factors and the presence of three respiratory symptoms and <10 days of short-term travel to be protective factors. These results may enable the accurate assessment of symptoms in travelers with DF as well as the risk factors associated with imported DF, lowering the risk of indigenous DF outbreaks caused by imported DF.

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.

Bisphosphonate Use Is Not Associated With Tuberculosis Risk Among Patients With Osteoporosis: A Nationwide Cohort Study.

Bisphosphonates are considered an effective inhibitor of glutamine synthetase and thus can be used for treating tuberculosis (TB). However, its clinical benefit in TB remains unknown. We conducted a population-based cohort study by using the Taiwan National Health Insurance Research Database and TB databases of the Taiwan Centers for Disease Control. Patients with osteoporosis and a history of bone fracture from 2007 to 2014 were identified. Among them, bisphosphonate users and propensity score-matched nonusers were selected. A stratified multivariable Cox proportional hazard regression model was employed to investigate the independent predictors of TB. Among 218908 patients with osteoporosis and bone fracture, 46842 bisphosphonate users and 46842 propensity score-matched nonusers were selected. Within the 2-year follow-up, 723 patients-348 in the user group and 375 in the nonuser group-developed TB. Bisphosphonate use was not an independent predictor of TB in the multivariable Cox proportional hazard model (adjusted hazard ratio, 0.86; 95%CI, 0.71-1.04); however, male sex, older age, being bedridden, and steroid use were independent risk factors. The real-world data revealed that bisphosphonate use did not protect patients with osteoporosis against TB.