Facing the Global Challenges of Emerging and Re-emerging Infectious Diseases in Taiwan

Abstract

Background: Taiwan suffered a serious Enterovirus-71 epidemic in 1998 and 78 children were dead from the outbreak. Several infectious disease surveillance systems were designed to detect virus situation in the community. However most of the surveillance system were passive surveillance and relied on physician reporting. Hence that an emergency department based syndromic surveillance system (ED-SSS) was developed and adopted in Taipei city after 2003 SARS outbreak. We aimed to use the syndromic surveillance to identified enterovirus-like illness (EVI) patient and triggered for the specimen collection and virus detection.Methods: There are 5 hospital enrolled in the ED-SSS in Taipei city. The EVI case number is daily and automatically generated by the system. We use historical control limit and CUSUM method to be abnormal detection algorithm. Only if the system indicated abnormal signal, the ED staffs collect specimens from EVI patient. All samples would be tested by RT-PCE and virus culture with influenza virus, enterovirus, adenovirus, etc. to identify the disease cause agent.Results: There were total 161,366 ED visits and 304 EVI cases were identified by the ED-SSS during Jan. 2007 to Oct. 2007. According to the historical control limit method, 29 EVI signals were triggered. We collected 169 samples from 5 hospitals to identify disease cause agents. The overall virus isolation rate is 15.4% (26/169). Six of 26 positive samples were enterovirus. The EV cases virus serotypes were CA16 (66.7%) and CA6 (33.3%). They were all under 7 year old children and the gender distribution is two males and four females respectively and distributed in different area of Taipei city.Conclusion: The syndromic surveillance system could provide public health department to initiate active surveillance with scientific evidence. Taipei city is the first metropolitan using such active surveillance to rapid response and capture virus activities in Asia. The integration of syndromic surveillance and other different surveillance systems is the most important future work. We also will to cooperate with other city to establish international cooperate surveillance to detect novel enteroviruses and other emerging infectious cause agents.