On May 20, several weeks after influenza A virus subtype H1N1 broke out in Mexico City in March this year, Taiwan recorded its first case when the Central Epidemic Command Center (CECC) confirmed the flu had been diagnosed in a 52-year-old Australian man who had just arrived from New York City. The next day, two Taiwanese women—one arriving from New York and one from San Francisco—were also found to have contracted the virus. All three cases of H1N1 were detected at the fever screening station inside Taiwan Taoyuan International Airport, where they showed temperatures exceeding 38 C. After this initial screening, each of the passengers was sent to Taoyuan General Hospital, which is operated by the Department of Health (DOH).
On July 2, the DOH’s Centers for Disease Control (CDC) announced the detection of the H1N1 virus in two specimens collected from residents of communities in Taiwan, showing that local transmission of H1N1 had begun. The first severe case of the flu in Taiwan was reported on July 17 in a 34-year-old man, and the first fatality occurred when a 39-year-old man died on July 31. Vice Premier Eric Li-luan Chu took over from Yaung Chih-liang, minister of the DOH, as CECC chief in early September as students started returning to schools, which are prone to outbreaks. As of mid-October, Taiwan had recorded around 360 cases in which H1N1 patients had been hospitalized. Of those patients, 24 died, but most recovered and are free of complications.
H1N1, commonly known as swine flu in some countries, began its global spread as health authorities were preoccupied with another flu associated with animals, bird flu. The name swine flu is somewhat misleading, however, as H1N1 is a mixture of two influenza strains found in pigs together with one found in humans and one in birds. Pork vendors around the world have complained about the flu’s common name and point out that the virus cannot be contracted by eating cooked pork. In Taiwan, the emerging disease is usually called “H1N1 flu,” or simply the “new flu.”
Despite the heavy media coverage, H1N1 has proven similar to other, more mundane types of flu, as like them, it is spread by coughing, sneezing or touching the nose or mouth with contaminated hands. An H1N1 patient suffers much like one afflicted with normal seasonal flu, which usually causes fever, a sore throat, a headache and muscle pain. Actually, despite the somewhat elevated level of public anxiety over H1N1’s seriousness, the great majority of those who have contracted the disease in Taiwan have recovered fully after developing only mild symptoms.
In June, after the World Health Organization (WHO) declared a global but mild pandemic, the CDC shifted H1N1 from its most severe category of infectious diseases, bumping it down to the fourth most-severe level. Taiwan’s Communicable Disease Control Act designates five levels of epidemics according to standards such as the potential number of fatalities, infection rate and speed of transmission. The CDC’s most serious category of communicable diseases includes smallpox, plague and severe acute respiratory syndrome (SARS), which hit Taiwan hard in 2003. Level one communicable diseases require immediate case reporting and quarantining, while level four diseases such as H1N1 require regular, comprehensive monitoring of factors such as transmission rates within communities, genetic mutation of the virus and resistance to antiviral medicines.
Wu De-lon, president of the Taiwan Hospital Association and a top advisor for the Chang Gung Healthcare System, one of the largest medical institutions in Taiwan, points out that although it is caused by a new virus, H1N1 flu is less deadly than the average seasonal flu, which kills 4,000 to 5,000 people each year in Taiwan, and thus is not a cause for excessive alarm. “Some people are easily panicked by the more sensational, exaggerated views in the media,” Wu says. “But the severe impacts that some academics and health experts warned of haven’t materialized yet.”
DOH Minister Yaung Chih-liang points out that for the government, the principal goals of handling the outbreak are to build a comprehensive picture of the impact of H1N1, including infection rates and locations, as well as give the public access to adequate, transparent information. “The most difficult thing to do is developing well-balanced control measures,” Yaung says. “We cannot afford to underestimate the risks of infection on the one hand, but we don’t have to treat it like a horrible enemy and cause panic for the general public on the other.”
For one thing, Yaung does not think that students should be prevented from attending school on a national scale. Currently, according to guidelines for schools from kindergarten to high school, the government has instituted the “three-two-five” policy, under which a class is suspended for five days, including weekends and holidays, if two or more students in that class are diagnosed with H1N1 within a span of three days. According to the Ministry of Education, in mid-October around 460 classes in about 285 schools were closed, accounting for 0.3 percent of all classes. As for colleges and universities, less than 0.1 percent of classes had been suspended.
Designated Flu Clinics
For his association’s member hospitals, Wu says the most important thing for the screening system to accomplish is to identify H1N1 patients whose illnesses tend to worsen over time instead of improve, as these cases are much more severe. Fortunately, according to the DOH there are around 3,000 designated flu-care clinics around the country, which increases the chances that medical professionals trained in infectious diseases will be able to identify the serious cases. “With these clinics available in neighborhoods, people don’t have to go to big hospitals for initial treatment for flu,” Yaung says.
The minister is also quite confident about the ability of the National Health Insurance (NHI) program to check the spread of H1N1. Taiwan’s universal healthcare system was launched in 1995 and, despite some financial difficulties, currently covers virtually the entire population. “Going to a doctor is not a problem for our people,” Yaung says, “and the [H1N1] medicine is also ready for use.”
In early September, the DOH began to release 250,000 doses of the antiviral drug Tamiflu, which were purchased from Swiss pharmaceutical company Hoffmann–La Roche Ltd. to treat patients in the early stages of H1N1 infection. The Tamiflu was distributed to local governments and clinics designated by health authorities in proportion to local populations. Since coverage for Tamiflu treatment was included in the NHI program in mid-August, there has been an increasing demand for the drug. In order to prevent hoarding, the CDC has directed that clinics must pay for the antiviral in cash within three months and cannot return any unused supplies. Also, the CDC has purchased another 2.68 million doses of Tamiflu from Roche for delivery to Taiwan by the end of this year.
The DOH’s decision to distribute Tamiflu to medical units at the grassroots level was welcomed by Chen Chien-jen, former DOH minister and a distinguished research fellow at Academia Sinica’s Genomic Research Center in Taipei. The epidemiologist points out that when H1N1 is detected early, especially in patients with mild symptoms and weaker contagion, it is much more effective to give them antivirals like Tamiflu than to wait and treat them by other means if their case worsens later. Chen says he hopes that there will be a sufficient amount of antivirals to treat each new flu patient within the initial “golden 48 hours” when the drugs are most effective. “That way we can wait patiently to release a vaccination,” he says.
Domestic Vaccine
In its preparations for H1N1, Taiwan has further matched WHO standards through its newfound ability to produce vaccines. In addition to five million doses of H1N1 vaccine purchased from Swiss pharmaceutical company Novartis International AG, 10 million doses were ordered from Adimmune Corp., a domestic vaccine manufacturer headquartered in Taichung County, central Taiwan. Clinical trials on humans of Adimmune’s vaccine were scheduled to wrap up in November.
H1N1 vaccinations using the Novartis or Adimmune product were scheduled to begin in Taiwan in November this year, with their administration proceeding according to an order established by the DOH that prioritizes certain occupational and age groups. Typhoon Morakot disaster survivors and healthcare and infection control personnel were given top priority, followed by infants from six months to one year old, pregnant women, preschool children, people above the age of 7 with major illnesses or injuries, elementary school students from 7 to 12 years old, junior high school students from 13 to 15 years old, high school students from 16 to 18 years old, people from 19 to 24 years old, people above the age of 25 with certain critical illnesses such as diabetes and cardiovascular, pulmonary, liver and kidney disease, people from 25 to 49 years old, people from 50 to 64 years old, and people above the age of 65.
The vaccinations, which are administered free of charge, are scheduled to run through February 2010. The Taiwan Hospital Association and Taiwan Medical Association have vowed to help promote the government’s vaccination campaign to further slow the spread of the disease. According to a survey released by the CECC in early October this year, 60 percent of the respondents said they were willing to be vaccinated, while 17 percent said they would consider it. DOH Minister Yaung notes that, like the NHI program, all of the government’s measures to contain H1N1 apply not only to Taiwan citizens, but also to all legal residents. Although the number of purchased vaccinations is not sufficient to inoculate all of Taiwan’s 23 million people, some local health authorities believe that the program will produce a collective immunity effect that will help protect those who do not receive them.
At around the same time Tamiflu distribution began in September this year, the CECC directed that 2 million facemasks be sent to convenience stores around Taiwan for sale at the mandated retail price of NT$6 (US$0.18) each, following the first such facemask release in early May. In general, while facemasks may not prove overly effective in preventing wearers from getting H1N1, for those who have already contracted the virus, the masks stop coughs and sneezes from expelling infected droplets into the air, one of the prime vectors of transmission. Yaung says that the CECC’s distribution programs are designed to facilitate circulation of the masks, as is the case for antiviral drugs, through regular market mechanisms so that retailers do not hesitate to make their stock available to consumers. According to a survey conducted by the CECC, about 80 percent of the respondents had purchased facemasks by early October this year, with the other 20 percent mostly from low-income households. Through cooperation with local civil affairs authorities, low-income households were scheduled to receive a box of 50 facemasks free of charge in November.
The CECC survey also showed that people in Taiwan have good knowledge about preventing the spread of H1N1. Among other things, more than 90 percent of those surveyed were aware of the appropriate methods of avoiding infection, including washing their hands frequently, trying not to touch their eyes or nose with their hands and understanding how to seek medical care. More than 90 percent of the people surveyed also knew how to prevent passing H1N1 to others, including staying home if they get sick, taking medications as instructed by doctors and wearing a mask when going out. Yaung says he believes that the knowledge and adaptable attitude of Taiwanese are good weapons against a possible epidemic. “Viruses are a force of nature,” the minister says. “They’re just another of the numerous barriers that humans have to use their intelligence to overcome for a sustainable existence.”
On July 2, the DOH’s Centers for Disease Control (CDC) announced the detection of the H1N1 virus in two specimens collected from residents of communities in Taiwan, showing that local transmission of H1N1 had begun. The first severe case of the flu in Taiwan was reported on July 17 in a 34-year-old man, and the first fatality occurred when a 39-year-old man died on July 31. Vice Premier Eric Li-luan Chu took over from Yaung Chih-liang, minister of the DOH, as CECC chief in early September as students started returning to schools, which are prone to outbreaks. As of mid-October, Taiwan had recorded around 360 cases in which H1N1 patients had been hospitalized. Of those patients, 24 died, but most recovered and are free of complications.
H1N1, commonly known as swine flu in some countries, began its global spread as health authorities were preoccupied with another flu associated with animals, bird flu. The name swine flu is somewhat misleading, however, as H1N1 is a mixture of two influenza strains found in pigs together with one found in humans and one in birds. Pork vendors around the world have complained about the flu’s common name and point out that the virus cannot be contracted by eating cooked pork. In Taiwan, the emerging disease is usually called “H1N1 flu,” or simply the “new flu.”
Despite the heavy media coverage, H1N1 has proven similar to other, more mundane types of flu, as like them, it is spread by coughing, sneezing or touching the nose or mouth with contaminated hands. An H1N1 patient suffers much like one afflicted with normal seasonal flu, which usually causes fever, a sore throat, a headache and muscle pain. Actually, despite the somewhat elevated level of public anxiety over H1N1’s seriousness, the great majority of those who have contracted the disease in Taiwan have recovered fully after developing only mild symptoms.
In June, after the World Health Organization (WHO) declared a global but mild pandemic, the CDC shifted H1N1 from its most severe category of infectious diseases, bumping it down to the fourth most-severe level. Taiwan’s Communicable Disease Control Act designates five levels of epidemics according to standards such as the potential number of fatalities, infection rate and speed of transmission. The CDC’s most serious category of communicable diseases includes smallpox, plague and severe acute respiratory syndrome (SARS), which hit Taiwan hard in 2003. Level one communicable diseases require immediate case reporting and quarantining, while level four diseases such as H1N1 require regular, comprehensive monitoring of factors such as transmission rates within communities, genetic mutation of the virus and resistance to antiviral medicines.
Wu De-lon, president of the Taiwan Hospital Association and a top advisor for the Chang Gung Healthcare System, one of the largest medical institutions in Taiwan, points out that although it is caused by a new virus, H1N1 flu is less deadly than the average seasonal flu, which kills 4,000 to 5,000 people each year in Taiwan, and thus is not a cause for excessive alarm. “Some people are easily panicked by the more sensational, exaggerated views in the media,” Wu says. “But the severe impacts that some academics and health experts warned of haven’t materialized yet.”
DOH Minister Yaung Chih-liang points out that for the government, the principal goals of handling the outbreak are to build a comprehensive picture of the impact of H1N1, including infection rates and locations, as well as give the public access to adequate, transparent information. “The most difficult thing to do is developing well-balanced control measures,” Yaung says. “We cannot afford to underestimate the risks of infection on the one hand, but we don’t have to treat it like a horrible enemy and cause panic for the general public on the other.”
For one thing, Yaung does not think that students should be prevented from attending school on a national scale. Currently, according to guidelines for schools from kindergarten to high school, the government has instituted the “three-two-five” policy, under which a class is suspended for five days, including weekends and holidays, if two or more students in that class are diagnosed with H1N1 within a span of three days. According to the Ministry of Education, in mid-October around 460 classes in about 285 schools were closed, accounting for 0.3 percent of all classes. As for colleges and universities, less than 0.1 percent of classes had been suspended.
Designated Flu Clinics
For his association’s member hospitals, Wu says the most important thing for the screening system to accomplish is to identify H1N1 patients whose illnesses tend to worsen over time instead of improve, as these cases are much more severe. Fortunately, according to the DOH there are around 3,000 designated flu-care clinics around the country, which increases the chances that medical professionals trained in infectious diseases will be able to identify the serious cases. “With these clinics available in neighborhoods, people don’t have to go to big hospitals for initial treatment for flu,” Yaung says.
The minister is also quite confident about the ability of the National Health Insurance (NHI) program to check the spread of H1N1. Taiwan’s universal healthcare system was launched in 1995 and, despite some financial difficulties, currently covers virtually the entire population. “Going to a doctor is not a problem for our people,” Yaung says, “and the [H1N1] medicine is also ready for use.”
In early September, the DOH began to release 250,000 doses of the antiviral drug Tamiflu, which were purchased from Swiss pharmaceutical company Hoffmann–La Roche Ltd. to treat patients in the early stages of H1N1 infection. The Tamiflu was distributed to local governments and clinics designated by health authorities in proportion to local populations. Since coverage for Tamiflu treatment was included in the NHI program in mid-August, there has been an increasing demand for the drug. In order to prevent hoarding, the CDC has directed that clinics must pay for the antiviral in cash within three months and cannot return any unused supplies. Also, the CDC has purchased another 2.68 million doses of Tamiflu from Roche for delivery to Taiwan by the end of this year.
The DOH’s decision to distribute Tamiflu to medical units at the grassroots level was welcomed by Chen Chien-jen, former DOH minister and a distinguished research fellow at Academia Sinica’s Genomic Research Center in Taipei. The epidemiologist points out that when H1N1 is detected early, especially in patients with mild symptoms and weaker contagion, it is much more effective to give them antivirals like Tamiflu than to wait and treat them by other means if their case worsens later. Chen says he hopes that there will be a sufficient amount of antivirals to treat each new flu patient within the initial “golden 48 hours” when the drugs are most effective. “That way we can wait patiently to release a vaccination,” he says.
Domestic Vaccine
In its preparations for H1N1, Taiwan has further matched WHO standards through its newfound ability to produce vaccines. In addition to five million doses of H1N1 vaccine purchased from Swiss pharmaceutical company Novartis International AG, 10 million doses were ordered from Adimmune Corp., a domestic vaccine manufacturer headquartered in Taichung County, central Taiwan. Clinical trials on humans of Adimmune’s vaccine were scheduled to wrap up in November.
H1N1 vaccinations using the Novartis or Adimmune product were scheduled to begin in Taiwan in November this year, with their administration proceeding according to an order established by the DOH that prioritizes certain occupational and age groups. Typhoon Morakot disaster survivors and healthcare and infection control personnel were given top priority, followed by infants from six months to one year old, pregnant women, preschool children, people above the age of 7 with major illnesses or injuries, elementary school students from 7 to 12 years old, junior high school students from 13 to 15 years old, high school students from 16 to 18 years old, people from 19 to 24 years old, people above the age of 25 with certain critical illnesses such as diabetes and cardiovascular, pulmonary, liver and kidney disease, people from 25 to 49 years old, people from 50 to 64 years old, and people above the age of 65.
The vaccinations, which are administered free of charge, are scheduled to run through February 2010. The Taiwan Hospital Association and Taiwan Medical Association have vowed to help promote the government’s vaccination campaign to further slow the spread of the disease. According to a survey released by the CECC in early October this year, 60 percent of the respondents said they were willing to be vaccinated, while 17 percent said they would consider it. DOH Minister Yaung notes that, like the NHI program, all of the government’s measures to contain H1N1 apply not only to Taiwan citizens, but also to all legal residents. Although the number of purchased vaccinations is not sufficient to inoculate all of Taiwan’s 23 million people, some local health authorities believe that the program will produce a collective immunity effect that will help protect those who do not receive them.
At around the same time Tamiflu distribution began in September this year, the CECC directed that 2 million facemasks be sent to convenience stores around Taiwan for sale at the mandated retail price of NT$6 (US$0.18) each, following the first such facemask release in early May. In general, while facemasks may not prove overly effective in preventing wearers from getting H1N1, for those who have already contracted the virus, the masks stop coughs and sneezes from expelling infected droplets into the air, one of the prime vectors of transmission. Yaung says that the CECC’s distribution programs are designed to facilitate circulation of the masks, as is the case for antiviral drugs, through regular market mechanisms so that retailers do not hesitate to make their stock available to consumers. According to a survey conducted by the CECC, about 80 percent of the respondents had purchased facemasks by early October this year, with the other 20 percent mostly from low-income households. Through cooperation with local civil affairs authorities, low-income households were scheduled to receive a box of 50 facemasks free of charge in November.
The CECC survey also showed that people in Taiwan have good knowledge about preventing the spread of H1N1. Among other things, more than 90 percent of those surveyed were aware of the appropriate methods of avoiding infection, including washing their hands frequently, trying not to touch their eyes or nose with their hands and understanding how to seek medical care. More than 90 percent of the people surveyed also knew how to prevent passing H1N1 to others, including staying home if they get sick, taking medications as instructed by doctors and wearing a mask when going out. Yaung says he believes that the knowledge and adaptable attitude of Taiwanese are good weapons against a possible epidemic. “Viruses are a force of nature,” the minister says. “They’re just another of the numerous barriers that humans have to use their intelligence to overcome for a sustainable existence.”
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