One of the possible ways to end the SARS-CoV-2 pandemic is to develop COVID-19 vaccine and effective vaccination strategies. Some COVID-19 vaccines have been authorized for emergency use in a number of countries, and are currently in use around the world. These include an adenovirus-based vaccine (Astra-Zeneca), and two messenger RNA (mRNA) vaccines (mRNA-1273, manufactured by Moderna; BNT162b2, manufactured by Pfizer-BioNTech). These vaccines have been shown to be adequate in preventing SARS-CoV-2 infection, minimizing disease incidence, severity and mortality, according to current pre-licensure vaccine efficacy research and post-licensure vaccine effectiveness evaluations. Specific local reactions are common adverse reactions after receiving these vaccinations, and serious adverse events occur infrequently. However, more data is required after global vaccination to estimate long-term efficacy and protection in real-world condition, as well as the effects of vaccine against virus variants. Currently, the majority of studies indicate that vaccination protects people from COVID-19 and the benefits outweigh the risks. To reduce COVID-19-related morbidity and mortality, we encourage people who are prioritized in the immunization program to get vaccines as soon as possible.
Since 2011 to 2013, Port of Kaohsiung had established core capacities for IHR designated port and had been assessed by experts from Japan and Australia. In 2017, the Executive Yuan issued ＂Project for Operation and Maintenance of Core Capacities at IHR Designated Port＂, which regulated that external assessment be conducted every 5 years. In 2018, European Union experts were invited to conduct the assessment, which included not only regular documents and sites review, but also evaluation of the capabilities of integration and responses of all authorities at Port of Kaohsiung. In responding to the experts' assessment, Port of Kaohsiung conducted series of improvements. These measures included correction of algorithm of incident reporting at port, assured notification of vector surveillance results and feedback from affected units, expansion of isolation and evacuation capacity, reinforcement of notification and return mechanism for radioactive containers, and a bunkered water safety plan including periodic residual chlorine and Legionella monitoring. After the improvement results were submitted to the panel experts as a required reference for final scoring, Port of Kaohsiung received full marks and was certified as a port with sustainable development and recognized its core capacities.
Facing the pandemic of emerging infectious diseases, in addition to non-pharmaceutical interventions, an effective drug can slow the spread of the epidemic and reduce the impact, which is an important weapon before the vaccine coming to fruition. Initially, the research of COVID-19 drug treatment was mainly based on the experience and development of the treatment for other coronavirus infections (SARS, MERS), for example, remdesivir, hydroxychloroquine/chloroquine, lopinavir/ritonavir and interferon. According to the result of the latest large randomized clinical trial, Taiwan Food and Drug Administration had conditionally approved remdesivir on May 30, 2020, for the treatment of severe SARS-CoV-2 infection. Although the virus was cleared in the initial small-scale studies of hydroxychloroquine/chloroquine treatment, a larger retrospective study found that hydroxychloroquine did not reduce the risk of death or intubation in patients with SARS-CoV-2 infections, furthermore, might cause side effects. Low-dose steroids (dexamethasone) was found to reduce the risk of mortality among patients with severe SARS-CoV-2 infections, which was currently the treatment option with the strongest scientific evidence. Before the best treatment evidence appears, medical personnel should avoid being affected by rumors or exaggerated messages, and should provide experimental treatments with the best available evidence, ethical approval and patient's informed consent. The government and scientific societies should also systematically collect patients' treatment information and effectively analyze these valuable treatment experiences.
The serious unique infectious pneumonia (COVID-19), caused by the new coronavirus (SARS-coV-2) in Wuhan, China in late 2019, has rapidly spread and become a global pandemic. It resulted in crises menacing people's health, lives, international engagement and economic systems. Thus, a vaccine holds most potential for a rapid means of resolving the pandemic before the end of 2021. There are 23 different candidate vaccines worldwide that have entered into clinical trials. Among them, the two that have progressed the fastest are Sinovac Biotech's inactivated vaccine and the recombinant vaccine (ChAdOx1-S) developed by Oxford University, which are already in the third phase of clinical trials. In late April 2020, WHO, EU and the Bill and Melinda Gates Foundation launched the ACT Accelerator Plan to acquire more COVID-19 tools. Also, GAVI, CEPI and WHO are jointly promoting the COVAX Facility, responsible for coordinating and integrating resources among worldwide vaccine developers and manufacturers. In addition to assuming risks of vaccine development, they also provide early investment in candidate vaccine products. These efforts increase chances of successful vaccine development as they expedite safe, efficient development and mass manufacturing of COVID-19 vaccines. This will result in the common goal of equitable distribution of vaccines for every nation.
To understand the epidemiological and clinical characteristics of patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in Taiwan, we analyzed data from the National Notifiable Disease Surveillance System and epidemiological case investigation reports. We included all real-time reverse-transcription polymerase chain reaction (real-time RT-PCR) confirmed cases of coronavirus disease-2019 (COVID-19) from Jan 21 to Feb 14, 2020, and followed up until Feb 27, 2020. Eighteen cases were confirmed and all survived. Median follow-up period was 24.5 days (range: 14-35). Of them, 16 (88.9%) were imported cases, and 2 (11.1%) were infected by imported cases within household. Their median age was 52 years (range: 21-74); 8 (44.4%) were men, and 9 (50%) had comorbidities. Symptoms included cough (72.2%), fever (66.7%), rhinorrhea (22.2%) and diarrhea (11.1%); one patient (5.5%) was asymptomatic. According to the WHO definition of clinical syndromes associated with SARS-CoV-2, there were 8 (44.4%), 9 (50.0%), and 1 (5.6%) categorized as mild, moderate, and severe illness, respectively. At the end of follow-up, 9 cases met the criteria of discontinuation of isolation and 8 of them were discharged. The median time from admission to discontinuation of isolation was 21 days (range: 13-31) and the median duration of persistent RT-PCR positivity was 14 days (range: 4- 22) and 15 days (range: 4-24) for upper and lower respiratory samples, respectively. The first 18 cases of COVID-19 in Taiwan were all imported or importation related, which were related to the early phase of COVID-19 epidemic. Because viral clearance may take more than 2 weeks, management plans for patients with mild illness is necessary to ensure the best use of medical care capacities during the ongoing COVID-19 pandemic.
In late 2019, the novel coronavirus 2019 (COVID-19) outbreak was first identified in Wuhan, China, and subsequently spread worldwide. By July 11, 2020, the number of confirmed COVID-19 cases reached 12,881,555 (including 599,146 deaths) in 187 countries/ territories. The pandemic has not reach its peak yet. The situations of epidemics in the United States, Central and South Americas, and South Asia were still serious. Some countries faced re-surging epidemic after lifting restrictions. In Taiwan, the first imported case and the indigenous case were reported on January 21, and 28, respectively. As of July 12, the cumulative number of confirmed cases was 451, including 360 imported cases, 55 indigenous cases, and another 36 cases of naval crew members aboard the Panshi fast combat support ship. Currently the COVID-19 cases in Taiwan were still sporadic imported cases. No locally-acquired case was found for more than 8 weeks. Based on the current epidemic status, the risks of imported cases are still high. The high transmissibility of the virus and the potential of community outbreak remained as a threat to Taiwan's health system and society. Therefore, the overall risk of COVID-19 is considered high domestically.
On January 30, a 44-year-old female without a history of traveling from China was confirmed as a COVID-19 patient. The patient reported fever, cough, myalgia, and headache on January 27. Her 44-year-old husband, who just returned from Wuhan, China on January 12, had mild upper respiratory symptoms on January 21. On January 30, the Taiwan Centers for Disease Control conducted epidemiological investigation to explore the source and magnitude of this outbreak. Of 31 close contacts (10 from households, 19 from hospital, and 2 other contacts), six (19%) developed symptoms during the 14-day postexposure follow-up period, but none were tested positive for SARS-CoV-2. This cluster comprised two cases of COVID-19, with transmission by infector from Wuhan (the husband). We recommend that suspected COVID-19 patients from epidemic region should be notified, isolated and tested promptly. Close contacts of confirmed COVID-19 cases, particularly household contacts, should be quarantined and tested as early as possible to detect COVID-19 infection and prevent community spreading.
Macau is a tiny city with a highly dense population and a high volume of cross-border human flows Furthermore, Macau borders on mainland China and has a large number of migrant workers It is essential for Macau to control imported COVID-19 cases This article described the preventive strategies taken by Macau government in border control Travelling by air, land and sea between Macau and the outside world was substantially reduced after the controlling measures were complemented quickly and extensively Although the reported cases of COVID-19 in Macau were mostly imported, the overall infection rate in Macau has remained very low and no community transmissions were detected, showing the effectiveness of the border controls By comparing with border control measures in Hong Kong and Taiwan, the article further identified the strengths and weaknesses of preventive strategies in Macau to contain imported COVID-19 cases
COVID-19 is an emerging infectious disease occurred in Wuhan, China at the end of 2019 The epidemic began to spread in early 2020 and had become a global pandemic In order to prevent the disease from entering the community and causing continuous transmission, Taiwan had successfully curbed the spread of COVID-19 through rigid community defense lines Relevant measures included strengthening the notification of suspected cases, launching an expanded community surveillance program, detecting submerged cases effectively, and following by prompt isolation and adequate treatment, monitoring cases progression throughout the whole medical process Furthermore, to implement home isolation and home quarantine policy, the Central Epidemic Command Center (CECC) established appropriate tracking and following up systems on persons at risk of infection with smart technology and inter-ministerial cooperation In addition, the CECC published epidemic prevention guidelines and provided advices for crowded places or activities to strengthen epidemic prevention at those with high risks of infection Moreover, through multiple channels and platforms, the CECC established communication with the public regarding risks of infection and raised the public’s awareness of epidemic prevention among our people Thanks to the collective efforts of the public and strict border controls, the epidemic was under stable situation The CECC substantially lifted the restrictions since June 7, so that the public and industries could return to normalcy Lastly, to be prepared for the future border controls adjustments, personal health behaviors must be cultivated and rooted deeply in our daily lives In addition to closely monitoring the epidemic situations and trends, The CECC continues to encourage our people to implement the ＂Epidemic New Life Movement＂ and timely adjust the epidemic prevention strategies according to the epidemic status of COVID-19 Most importantly, the CECC will make every efforts to reduce the risks of community transmission and protect the health of our people
Since December 21, 2019, on-board inspection had been implemented on direct flights from Wuhan, China, marking the beginning of boarder quarantine challenges in respond to COVID-19 pandemic. In line with the development of the international epidemic, the Central Epidemic Command Center gradually expanded entry restrictions and post-entry quarantine requirements. Since March 19, 2020, all foreign nationals had been prohibited from entering Taiwan. Passengers eligible for entry were required to undergo home quarantine for 14 days. Upon arrival, passengers were required to declare their symptoms and travel history, and to receive fever screening and health assessment. Throat swab specimens were collected from those who presented symptoms at the airport or in the hospital, and then these passengers stayed in a centralized quarantine facility to wait for testing results. In addition, aiming at reducing risks originated from crowds and frequent movement, only aircrafts from five airports in China were allowed to enter Taiwan. Also, all connecting flights were suspended, and cruises and cross-strait passenger liners were banned from calling at ports of Taiwan. For front-line officers at ports of entry, health monitoring and protection guidelines were developed to protect their safety. In order to ensure safety and security of air and sea transport, the competent authorities in charge of transportation have established an epidemic prevention and management mechanism for air and sea transport respectively. Over 184,000 home quarantine notices had been issued by border quarantine authorities. More than 80% of the inbound travelers completed the declaration via Entry Quarantine System, greatly improving timeliness and accuracy of information required for further epidemic prevention and control in community. With on-board quarantine and health surveillance system for entry, not only the first confirmed case in Taiwan, but also more than one-third of imported cases were detected through border quarantine, sparing more capacity for domestic response and preparedness for medical resources and medical systems and therefore alleviating pressure on epidemic prevention and control in the community. Despite continuous and serious epidemic and significant challenges ahead, Taiwan keeps on implementing various quarantine measures in accordance with the principle of ＂strict risk control at border ＂ to comprehensively protect border security.
The outbreak of pneumonia caused by novel coronavirus in Wuhan, China began at the end of 2019. World Health Organization named the virus as coronavirus disease 2019 (COVID-19). Afterwards, the pandemic of COVID-19 hit countries worldwide and outbreaks of healthcare-associated infection occurred. The pandemic of COVID-19 is a rigorous challenge to public health and healthcare system in Taiwan. To strengthen the preparedness and response capacity of healthcare system, Taiwan developed 10 contingency strategies for healthcare facilities, long-term care facilities, and laboratories, to reach three major goals: ＂mitigation of the transmission＂, ＂maintenance of the healthcare system operation＂, and ＂reduction of severe and death cases＂. The 10 contingency strategies included: (1) strengthening infection control and biosafety; (2) conducting un-notified on-site inspections and drills on medical responses; (3) tracing and identifying persons at-risk via National Health Insurance database; (4) implementing patient triage and decentralizing in-patients; (5) preparing response hospitals and designated wards; (6) constructing national testing networks; (7) monitoring capacity of healthcare system; (8) expanding capacity of quarantine places; (9) managing visitors to hospitals; and (10) monitoring health status of healthcare workers.
In 2018, enteric cytopathic human orphan virus 11 (Echo 11) was prevalent in the community, and the neonatal cases of Echo 11 infections with severe complications and Echo 11 clusters in neonatal care units of hospitals or postpartum nursing care centers were also confirmed successively. In addition to the completion of existing control measures for enterovirus such as hygiene promotion for enterovirus infection prevention and pre-symptoms of severe syndromes, professionals training, and visiting and counseling for enterovirus-responsible hospitals, Taiwan Centers for Disease Control (TCDC) and local governments adopted series of special measures, including strengthening the risk communication in prevention and awareness of severity of neonatal enterovirus infection with pregnant women, baby-caregiver and medical staff, improving the quality of medical care and maintaining the referral system, and supervising hospitals and postpartum nursing care centers to implement infection control and epidemic prevention measures. In order to reduce the health hazards and social impacts caused by enterovirus, TCDC will continue to monitor the trend of the epidemic and adjust the prevention and control strategies timely in the future.
Echovirus type 11, a less common cause in outbreak previously, was the main virus responsible for the epidemic of enterovirus infection in Taiwan in June 2018. More than half of the cases of enteroviruses infection with severe complications were neonates, resulting in six fatalities. In addition, several outbreaks of neonatal enterovirus infections had been reported in hospitals. In order to prevent the neonatal enterovirus infections and outbreaks, healthcare workers (HCWs) in hospitals and postpartum care institutions should be aware of the epidemic to diagnose case early, detect outbreak timely, and adhere to relevant infection control measures appropriately when providing medical services. HCWs should also educate pregnant woman to inform her physician when she shows symptoms of suspected enterovirus infections such as fever, upper respiratory tract infection, diarrhea, or pleural pain, during 14 days before delivery and after delivery.
During 2015 and 2016, 251 cases of acute hepatitis C were reported from six counties in Taipei Region, 169 were confirmed, 125 (74%) were male and 61 (36%) were HIV-infected. The median age of confirmed cases was 44 years-old (range: 20- 90 years-old). Nearly 73% of these cases were residing in Taipei City and New Taipei City. However, the age-adjusted standardized incidence per 100,000 populations in 2015 and 2016 revealed that Yilan County (3.18) and Keelung City (2.66) were the highest. Forty-five percent of infected cases co-infected with HIV were residing in the large metropolitan areas such as Taipei City and New Taipei City. Among them, one-third had unsafe sexual behavior in men having sex with men (MSM). Compared with Keelung and Yilan, the cases in Metropolitan area had a relatively high proportion of unsafe sexual behavior within 3 months, but a relatively low proportion of using intravenous drugs, needle/diluent sharing, or contacting blood through either wound or mucosa by accident. The analysis shows that unsafe MSM sexual behavior among HIV-infected people in large metropolitan areas poses high risk of hepatitis C infections, presumably due to anal mucous membrane damage caused by sexual behavior, which increases the risk of infection. Therefore, the public health department should arrange the appropriate prevention and control strategies as early as possible according to the demographic characteristics of different regions and the risk factors of the cases, in order to enhance the effectiveness of prevention and control.
Dengue is the most important vector-borne infectious disease in southern Taiwan. The first indigenous dengue case in 2017 was reported in Nanzih District, Kaohsiung in July. The public health agencies initiated an epidemiological investigation and found two more dengue cases. Taiwan Centers for Diseases Control and the local government cooperated with each other to control the dengue cluster, assessing the effectiveness of vector control measures using the Gravitrap and Ovitrap provided by the National Mosquito-Borne Diseases Control Research Center. This dengue cluster was terminated quickly and involved only three cases. We recommended using multiple ways of advocacy for dengue control to the public and health care workers to facilitate early detection of dengue cases. Outdoors ovitrap performed well and could be used with other tools to monitor the vector density and assess the effectiveness of control measures.
Beginning May 2018, Taiwan Centers for Disease Control was notified of an increase in reports related to severe enterovirus (EV) infection in newborns. Through July 31, severe echovirus 11 infections were confirmed in eight neonatal patients (5 males, age 0-12 days). Clinical presentations included hepatitis with coagulopathy (n = 8), sepsis syndrome (n = 8), myocarditis (n = 2), and multiorgan dysfunction (n = 7); 7 (87.5%) died. Neonatal echovirus 11 infections may be acquired transplacentally, during delivery, or from postnatal transmission, and are associated with severe complications. Clinicians should consider and report severe EV infection in neonates having myocarditis, hepatitis, encephalitis, thrombocytopenia, sepsis syndrome, or multiorgan dysfunction, but with sterile bacterial cultures. In EV epidemic seasons, we recommend appropriate hand and respiratory hygiene of pregnant women; obstetric notification of fever and other illness from 14 days before delivery; keeping sick people away from a newborn; and infection controls in healthcare/postpartum care facilities.
