Incidence and Risk Factors for Notifiable Typhoid and Paratyphoid in Taiwan during the Period 2011-2020

Epidemiological Changes in Acute Febrile Diseases after the COVID-19 Pandemic in Thailand

Acute undifferentiated febrile illnesses (AUFIs) are short-duration infectious diseases with nonspecific symptoms. In Thailand, common AUFIs include dengue, malaria, leptospirosis, scrub typhus, and typhoid fever. This study aimed to determine the case numbers of AUFI etiologies in Thailand before coronavirus disease 2019 (COVID-19) (phase 1 from January 2018 to February 2020) and during the COVID-19 pandemic with preventive measures (phase 2 from March 2020 to April 2022), and the loosening of the preventive measures (phase 3 from May 2022 to December 2022). We used Thailand's national database from 2018 to 2022 to determine the case numbers of AUFIs and geographic heat maps to identify endemic areas in Thailand. The case numbers of malaria, dengue, leptospirosis, typhoid, and scrub typhus significantly decreased during phase 2 (preventive measures) (P = 0.02), and cases of malaria and leptospirosis increased during phase 3 (loosened preventive measures) (P = 0.01). In 2022, malaria and leptospirosis increased by 39% and 48%, respectively, compared with the previous year. Malaria increased in western Thailand along the border between Thailand and Myanmar, where malaria preventive measures were insufficient, whereas leptospirosis increased in northern Thailand. The epidemiology of acute febrile diseases changes significantly depending on the global epidemic of infectious diseases such as COVID-19 and the implementation of preventive measures, such as face masks, hand hygiene, social distancing, and stay-at-home and lockdown measures.

Epidemiological feature of imported malaria in Taiwan during the 2014-to-2020 period

Although the World Health Organization (WHO) certified Taiwan as being malaria-free in 1965, there are reports of a few imported cases each year by travelers who visit malaria-endemic areas. This study examined the epidemiology of imported malaria cases in Taiwan from 2014 to 2020, utilizing national surveillance data from the Taiwan Centers for Disease Control. Malaria cases were confirmed through the application of standard laboratory methods. Passenger data came from the Tourism Bureau, Ministry of Transportation and Communication, Taiwan (TBMTC). All data were analyzed using SPSS version 21. The analysis included a dataset comprising 64 cases of imported malaria. Of the total cases, 77.8% were acquired from Africa, and 17.5% from Asia. Plasmodium falciparum was responsible for more than half (57.1%) of the cases, Plasmodium vivax malaria for 25.4% of cases, Plasmodium malariae malaria for 6.3%, Plasmodium ovale malaria for 4.8%, and unspecified pathogen malaria for 6.3% of the cases. Majority of the patients were male (75%) and were predominantly aged 20 to 59 years (70.3%). Most cases of imported malaria occurred during the fall season, and 51.6% of cases occurred in 8 cities during the period of 2014 to 2020. No evidence exists to indicate that indigenous malaria transmission occurs in Taiwan. Anopheles minimus was found in 4 cities (counties), namely Tainan City and Pingtung County in Southern Taiwan; Hualien County and Taitung County in Eastern Taiwan. The findings of this study highlight the necessity for robust surveillance systems, effective vector control measures, and targeted interventions for travelers and immigrants to prevent malaria outbreaks and maintain Taiwan's malaria-free status.

Epidemiology of imported travelers with dengue fever in Taiwan from 2011 to 2020

We collected data on imported dengue cases between 2011 and 2020 from Taiwan's Centers for Disease Control to determine changes in the case number and importation rate of dengue. We used open data provided by Taiwan's Centers for Disease Control to extract the number of confirmed imported cases of dengue between 2011 and 2020. From 2011 to 2020, 2883 imported cases of dengue were reported in Taiwan. The importation rate was 25.8 to 46.4 per 100,000 inbound travelers from 2011 to 2020, peaking in 2020. Disease incidence varied between sexes, age groups, seasons (P < .001), and residence from 2011 to 2020. Numerous dengue cases were imported from Indonesia (548 cases), Vietnam (516 cases), and the Philippines (500). For travelers from Taiwan, the risk ratio of becoming infected by dengue was 31,712 for traveling to the Maldives, 3153 to Cambodia, and 996 to Myanmar. In this study, more serotype 1 and 2 strains were reported by Vietnam, and more serotype 3 and 4 strains were reported by Indonesia. Our data indicate that the rate of imported cases of dengue significantly increased annually from 2011 to 2020 in Taiwan, especially during the COVID-19 pandemic (46.4 per 100,000 inbound travelers).

Global Impact of COVID-19 Pandemic on Gastrointestinal Infections: A Scoping Review

During the COVID-19 pandemic, nonpharmaceutical public health interventions (NPIs) were implemented worldwide to control the spread of severe acute respiratory syndrome coronavirus 2. However, the incidence of other pathogens, including gastrointestinal (GI) pathogens, was also affected. Here, we reviewed studies assessing the impact of NPIs during the COVID-19 pandemic on the incidence of GI infections, particularly foodborne infections. A systems literature search was conducted in May 2023, using Living Evidence on COVID-19 (COAP) and Scopus. Articles were identified and selected through a screening process with inclusion and exclusion criteria based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Data were extracted from each full-text article included in the review. Parameters included were GI viruses, GI bacteria, NPIs against the COVID-19 pandemic, and the associated impact of NPIs on GI pathogens. A total of 42 articles were included in the review, representing 18 countries. Overall, a larger reduction was observed for viral GI infections compared with bacterial GI infections during the COVID-19 pandemic, particularly for norovirus. For bacterial GI infections, Campylobacter and nontyphoidal Salmonella were the most frequently detected pathogens in the majority of the studies, with the largest reduction observed for Shigella and Shiga toxin-producing Escherichia coli infections. The sharp decrease in GI viral infections in most of the included countries is suggested to be related to the disruption of person-to-person transmission due to several implemented interventions (e.g., social distancing and hand hygiene). GI bacterial pathogens, more commonly transmitted via the foodborne route, were least impacted, and their reduction is associated with closure of food-providing settings and travel restrictions. However, the observed changes appear to be multifactorial; alterations in health-care-seeking behaviors and in routinary diagnostic testing have undeniably played a significant role, affecting national surveillance systems. Therefore, although NPIs likely had a substantial impact on the burden of GI infectious diseases, the extent of the true change cannot be fully assessed.

Spatial heterogeneity of socio-economic determinants of typhoid/paratyphoid fever in one province in central China from 2015 to 2019

BACKGROUND

Typhoid fever and paratyphoid fever are one of the most criticial public health issues worldwide, especially in developing countries. The incidence of this disease may be closely related to socio-economic factors, but there is a lack of research on the spatial level of relevant determinants of typhoid fever and paratyphoid fever.

METHODS

In this study, we took Hunan Province in central China as an example and collected the data on typhoid and paratyphoid incidence and socio-economic factors in 2015-2019. Firstly spatial mapping was made on the disease prevalence, and again using geographical probe model to explore the critical influencing factors of typhoid and paratyphoid, finally employing MGWR model to analysis the spatial heterogeneity of these factors.

RESULTS

The results showed that the incidence of typhoid and paratyphoid fever was seasonal and periodic and frequently occurred in summer. In the case of total typhoid and paratyphoid fever, Yongzhou was the most popular, followed by Xiangxi Tujia and Miao Autonomous Prefecture, Huaihua and Chenzhou generally focused on the south and west. And Yueyang, Changde and Loudi had a slight increase trend year by year from 2015 to 2019. Moreover, the significant effects on the incidence of typhoid and paratyphoid fever from strong to weak were as follows: gender ratio(q = 0.4589), students in ordinary institutions of higher learning(q = 0.2040), per capita disposable income of all residents(q = 0.1777), number of foreign tourists received(q = 0.1697), per capita GDP(q = 0.1589), and the P values for these factors were less than 0.001. According to the MGWR model, gender ratio, per capita disposable income of all residents and Number of foreign tourists received had a positive effect on the incidence of typhoid and paratyphoid fever. In contrast, students in ordinary institutions of higher learning had a negative impact, and per capita GDP shows a bipolar change.

CONCLUSIONS

The incidence of typhoid and paratyphoid fever in Hunan Province from 2015 to 2019 was a marked seasonality, concentrated in the south and west of Hunan Province. Attention should be paid to the prevention and control of critical periods and concentrated areas. Different socio-economic factors may show other directions and degrees of action in other prefecture-level cities. To summarize, health education, entry-exit epidemic prevention and control can be strengthened. This study may be beneficial to carry out targeted, hierarchical and focused prevention and control of typhoid fever and paratyphoid fever, and provide scientific reference for related theoretical research.

Epidemiology and risk factors for notifiable Clostridium botulinum infections in Taiwan from 2003 to 2020

Botulinum toxin is produced by Clostridium botulinum, a gram-positive anaerobic bacterium. This study aimed to examine the epidemiological characteristics, including sex, age, season in which infection occurred, place of residence, and epidemiological trends, of confirmed botulism cases in Taiwan from 2003 to 2020. This study examined the annual summary data on reported botulism in Taiwan' s Center for Disease Control from 2003 to 2020 available to the public on the internet. We found that there were 50 confirmed domestic cases of botulism. The incidence of botulism ranged from 0 to 0.48 per 1000,000 from 2003 to 2020 and peaked in 2008 and 2010. During the 18-year investigation period in which 6-year intervals were used, the study results showed a decreasing trend (2003-2008, 2009-14, and 2015-2020, had 22, 19, 9 cases each). In terms of patients' gender, age, and place of residence, most of the patients were females (56%), were aged ≥ 50 years (48%), and resided in Taipei and northern Taiwan (44%). The number of botulism cases in Taiwan from 2012 to 2020 compared with other years (from 2003 to 2011) found that there were significant differences among patients within an age group of <20 years (P = .003, odds ratio = 18.500, and 95% confidence interval = 3.287-104.111), and there were significant differences among patients whose place of residence was Taipei metropolitan area (P = .025, odds ratio = 5.667, and 95% confidence interval = 1.248-25.734). During 2003 to 2009, there was no case of botulism among those aged <20 years. Over the last 10 years, botulism in children showed an increasing trend. A total of 9 children were found to have botulism during 2010 to 2020; most of these children were male (66.7%) and were infected during spring and summer (66.7%). This study is the first to report the number of confirmed domestic cases with botulism from surveillance data from Taiwan's Center for Disease Control during 2003 to 2020. This study also found that the place of residence and age were associated with an increased risk of botulism in Taiwan. This information may be useful for policymakers and clinical experts to direct prevention- and control-based activities regarding botulism that result in the most severe illness and the greatest burden on Taiwanese.

Clinical manifestations and microbiological features between indigenous and imported enteric fever in Taiwan, 2010-2020

Previous studies had showed that indigenous clones of Salmonella Typhi and S. Paratyphi were originally imported from other countries in Taiwan. We presented the clinical manifestations and laboratory findings of indigenous and imported enteric fever cases in Taiwan in the current decade. We retrospectively reviewed typhoid and paratyphoid fever cases in two medical centers of Chang Gung Memorial Hospitals in 2010-2020. A total of 37 enteric fever cases including 24 typhoid fever and 13 paratyphoid fever were recorded. There were 20 indigenous cases, 16 imported cases, and one indetermined case. Splenomegaly and hepatitis were more frequent in typhoid fever than in paratyphoid fever (P < 0.05). Imported cases had more ciprofloxacin non-susceptibility rate (8/16, 50.0%) than indigenous cases (2/20, 10%). Indigenous ciprofloxacin non-susceptible S. Typhi isolates were found in 2018. One indigenous S. Paratyphi B isolate was multi-drug resistant (MDR) to chloramphenicol, ampicillin, and trimethoprim/sulfamethoxazole.

The Epidemiology of Entamoeba histolytica Infection and Its Associated Risk Factors among Domestic and Imported Patients in Taiwan during the 2011-2020 Period

Background and Objectives: Amebiasis remains an important public health problem worldwide, and immigration and increased international travel have affected incident disease cases. This study assesses the prevalence of Entamoeba histolytica in Taiwan between 2011 and 2020 by analyzing data from surveillance programs conducted by the Centers for Disease Control of Taiwan (TCDC) on laboratory-confirmed cases. Materials and Methods: The E. histolytica infection-related data reported to the National Infectious Diseases Statistics System at the TCDC from 1 January 2011 to 31 December 2020 were collected, including age, gender, place of residence, and the geographic season of exposure for each case. Results: In total, 3066 cases with E. histolytica infections were included in our analysis. Among them, 1735 (57%) cases were imported, and 1331 (43%) were locally acquired. The average annual incidence rate of E. histolytica infections in Taiwan between 2011 and 2020 was 10.6 and 16.1 per 1,000,000 patients. There were statistical differences in gender, age group, and place of residence (p < 0.001) by the source distribution of cases. Also, these differences were found every year (p < 0.05). There were statistical differences in gender and age group (p < 0.001) by place of residence (p < 0.001). The only difference between the distribution of cases and age group was in gender (p < 0.001). Eight patients with amebiasis died, and the fatality rate was 0.3% (8/3066), of whom 75% (6/8) were male, and 75% (6/8) were over 45 years old. This study demonstrates that multiple linear regression analysis shows positive associations between NO2 concentration and amebiasis cases (B value = 2.569, p = 0.019), O3 concentration and amebiasis cases (B value = 0.294, p = 0.008), and temperature and amebiasis cases (B value = 1.096, p = 0.046). Conclusions: This study is the first report of confirmed E. histolytica cases from TCDC surveillance data between 2011 and 2020. This study showed the importance of long periods, air pollutants, and geographically comprehensive analysis for estimating the effect of amebiasis transmission in Taiwan’s populations.

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.