A medical center in northern Taiwan notified a suspect case of dengue fever of a 33 years old man on September 19, 2012. The virus is different from the virus strains in southern Taiwan, but similar to a Cambodian strain in 2011, though the case had history of travelling to southern Taiwan. Epidemiological investigation revealed that the case had stayed at Taoyuan County during incubation and viremic period. Furthermore, two family members were found to have suspected symptoms during middle and late August, and were then confirmed as dengue fever. Further investigation found the relatives at neighbor had been touring to Cambodia in late July. Within three days after returning, one of the children had fever and diarrhea, and was confirmed by laboratory as the first case of imported dengue fever and thus caused the outbreak. A total of nine cases were confirmed as indigenous dengue fever infection. The outbreak was attributed to many factors including delayed diagnosis, delayed reporting, living in remote area, vacant lots, vegetable garden, and abandoned pig house with piled junks around the residence, and with level 9 container index, meaning high density of dengue vector. Since receiving the notification, the public health authorities immediately mobilized the manpower and other resources for disease control, and have taken integrated strategies including surveillance of mosquito breeding sites, environment sanitation, vector source reduction and chemical control for mosquitoes. Within a week, the authorities removed large quantity of positive vector containers and potential ones, rapidly reduced the vector density, and no further infection was noted.

The first cluster of typhoid fever this year (2011) was identified in Hsinchu area involving four cases with a common history of dietary exposure. The epidemiological investigations on correlation among persons, time and places, as well as test for samples collected from the catering staff were conducted. Salmonella typhi was detected by laboratory from the samples on May 8 that confirmed the catering staff was an asymptomatic carrier. Based on the results of epidemiological investigation and laboratory data, the source of infection in this cluster outbreak was suggested to be associated with food-related settings. Taiwan CDC has coordinated with local health authorities to take urgent and relevant prevention and quarantine measures, to suspend the catering business till completing the treatment and testing negative for patients, as well as to enhance the surveillance for gastrointestinal infections in Hsinchu area till late June if no new case occurred.

Taiwan CDC statistics show that imported dengue fever (DF) cases have on average increased by 46.07% annually in the recent 3 years. To shorten the time to detect probable DF cases in arriving passengers, Taiwan CDC implemented the Rapid Dengue Blood Screening (RDBS) Pilot Trial for Taiwan Taoyuan International Airport in 2008, in an attempt to accelerate the DF quarantine process. The aim of this study is to investigate passenger acceptance of and satisfaction with RDBS as a reference for decision-making. Both self-administered surveys and phone interviews were conducted with inbound passengers receiving RDBS. Passengers were asked to complete a questionnaire containing five-level Likert items to measure their level of RDBS acceptance, and 3 open-ended questions are included for them to comment on RDBS. Data were analyzed with SPSS 10. The total number of valid samples is 300. Results indicate that among the respondents, only 17.67% have heard of RDBS; 82.67% approve RDBS at international airports; 62.38% recommend that the waiting time for the test should be limited to 10-20 minutes; 61.67% express their will to cooperate with the quarantine policy; 62.45% are satisfied with the professional practice and overall service of health personnel; and 42.22% are satisfied with the privacy of examination environment although the examination environment and equipment need immediate improvement. Summarizing the above results, passengers are satisfied with international airport RDBS and its quality. However, RDBS should be better publicized, and supportive policies should be established to encourage RDBS-positive cases to comply with medical or quarantine arrangements. Examination environment privacy should be improved to enhance the service quality of quarantine agencies and the image of international airports.

ABSTRACT We used the dengue virus NS1 antigen (Ag) rapid test for on-site detection of imported dengue cases at airports. Among 22 positive cases of dengue identified from 850 patients with a fever suspected to have dengue, 17 were NS1 Ag test positive. These findings demonstrate the usefulness of the NS1 Ag rapid test in screening imported dengue cases at airports.

On Jan. 23 and 25, 2008, 2 suspected cases of enteroviruses infection with severe complications were reported to the Second Branch of the Department of Health Center for Disease Control. During disease surveillance, the 2 cases were found to live in the same area and had a common suspected infection source, a kindergarten which led to further investigation. This investigation was to understand the cluster event in the kindergarten in order to avoid an outbreak of secondary cases of enteroviruses infection with severe complications in students or their family members. A total of 29 symptomatic cases (including the first reported cases) were found in the surveillance. A total of 19 viral throat swabs and 11 stool samples were gathered. The results showed that all of the 19 viral throat swabs were negative and among the 11 stool samples, 7 cases were confirmed to be infected by enterovirus 71. These results show that a cluster infection of enterovirus 71 did occur in the kindergarten during the time of surveillance. The first 2 cases were concluded to have a direct relationship, but each had the infection separately at home. This surveillance showed that the cluster event infection source was the basement; transmission was through student contact which spread to their family members and then back to the school. As for disease prevention, symptomatic cases were quarantined at home with follow up services done by phone by the Health Bureau. Monitoring continued for 2 weeks after they came back to school. The level of disease prevention was raised to the ”community” level to control the disease in order to prevent secondary severe complications from appearing.

Foreign workers infected with Rubella in Toufen Township of Miaoli County and Guanyin Township of Taoyuan County were reported on the 4(superscript th) and 6(superscript th) of June, 2007. After further investigation of the cases, other suspected cases were discovered among the workers living in the dormitories. In order to determine the scale of the epidemic and trace the origin, the medical records of the foreign workers were examined according to their symptoms of Rubella. The cases involved in the two outbreaks were all foreign workers with a total of 46 people diagnosed with Rubella. In consideration of their labor history and the living environment, the Centers of Disease Control administered a wide scale MMR vaccine. A total of 1,662 shots were administered to all foreign workers involved in the two outbreaks. After the preventive measures were administered, no further suspected Rubella cases were reported in Miaoli and Taoyuan counties on July 2 and 14, showing control of the epidemic. In addition, this outbreak of Rubella infections has lead to the prevention of diseases from overseas and increasing the validity of the diagnosis report time to become the main points in preventative measures.