Chang, S.F.

Chen, W.R.

Kao, C.L.

King, C.C.

Wu, T.S.

Yen, M.Y.

International Journal of Infectious Diseases

Elsevier - Publisher Connector 

Detection of Novel Enterovirus with Emergency Department Based Syndromic Surveillance System in Taipei City 

13th International Congress on Infectious Diseases Abstracts, Poster Presentations e195
23.018
Detection of Novel Enterovirus with Emergency Depart-
ment Based Syndromic Surveillance System in Taipei City
T.S. Wu1,∗, S.F. Chang2, W.R. Chen1, M.Y. Yen3, C.L. Kao2,
C.C. King1
1 Institute of Epidemiology, National Taiwan University,
Taipei, Taiwan
2 Department of Clinical Laboratory Sciences and Medical
Biotechnology, National Taiwan University, Taipei, Taiwan
3 Department of Health, Taipei City Government, Taipei,
Taiwan
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 commu-
nity. However most of the surveillance system were passive
surveillance and relied on physician reporting. Hence that
an emergency department based syndromic surveillance sys-
tem (ED-SSS) was developed and adopted in Taipei city after
2003 SARS outbreak. We aimed to use the syndromic surveil-
lance 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 pro-
vide public health department to initiate active surveillance
with scientiﬁc evidence. Taipei city is the ﬁrst metropolitan
using such active surveillance to rapid response and cap-
ture 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.
doi:10.1016/j.ijid.2008.05.484
23.019
Facing the Global Challenges of Emerging and Re-emerging
Infectious Diseases in Taiwan
C.C. King1,∗, T.S.J. Wu1, H.P. Lin1, C.J. Lee1, C.L. Kao2,
C.Y. Lin1, S.T. Ma1, Y.C.L. Chu1, C.S. Huang3, H.Y. Lee4,
D.C. Chan1, S.F. Chuang2, M.Y. Yen5, C.M. Liu6
1 Institute of Epidemiology, College of Public Health (CPH),
National Taiwan University (NTU), Taipei, Taiwan
2 Inst. of Med. Tech., CM., NTU, Taipei, Taiwan
3 Inst. of Med. Informatics, CM, Taipei Med. University,
Taipei, Taiwan
4 Department of Public Health, CPH, NTU, Taipei, Taiwan
5 Taipei City Department of Health and Taipei Municipal
United Hospital, Taipei, Taiwan
6 Global Change Research Center, NTU and, Dept of Atmo-
spheric Sciences, College of Science, NTU, Taipei, Taiwan
Emerging and re-emerging infectious diseases can involve
large at risk populations and lead to a rapid increase in case
numbers or case fatalities. With movement from one part of
the earth to another so convenient and frequent in today’s
world, cross-country and cross-continent spread of emerg-
ing infectious diseases (EID) has become more frequent. If
control efforts are not made more effective and the EID are
not more recognized, then epidemics of any infectious dis-
ease unbeknownst to the public at large can readily spread
locally, nationally and internationally.
Taiwan has experienced several outbreaks of emerg-
ing and re-emerging infectious diseases, including stem
encephalitis caused by enterovirus 71 (EV71) in 1998,
dengue/dengue hemorrhagic fever (DHF) in Kaohsiung and
Pingtung in 2001—2003, inter-hospital nosocomial spread
of severe acute respiratory syndrome (SARS) in 2003, and
island-wide avian inﬂuenza H5N2 during the winter season
of 2003—2004. In order to face these challenges, a hos-
pital emergency department-based syndromic surveillance
system (ED-SSS) was established in Taiwan using a team of
multi-disciplinary experts monitoring 11 syndromes, includ-
ing fever, respiratory, inﬂuenza-like illness, asthma, upper
and lower gastro-intestinal, enterovirus-related infection
syndrome, skin, neurological, and syndrome for severe ill-
ness or deaths, on a daily basis (Wu TS and King CC et al.,
2008). Using ED-SSS, the scale of red-eye epidemic was min-
imized after public education through immediate notifying
parents by cellular phone.
To maintain preparedness for the possibility of pandemic
inﬂuenza, our research activities have been expanded to
include virologic and serologic surveillance of live-bird mar-
ket personnel and poultry workers for avian inﬂuenza and
on-going investigation of daily meteorological factors asso-
ciated with outbreaks of low and high pathogenic avian
inﬂuenza viruses (Liu CM and King CC, 2007).
In conclusion, integrated surveillance plus evidence-
based epidemiologic data can help formulate better public
health policies and increase preparedness tomeet the future
challenges presented by emerging/re-emerging infectious
diseases.
doi:10.1016/j.ijid.2008.05.485


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Detection of Novel Enterovirus with Emergency Department Based Syndromic Surveillance System in Taipei City

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