title: Public Health Responses to Reemergence of Animal Rabies, Taiwan, July 16-December 28, 2013.
abstract: Taiwan had been free of indigenous human and animal rabies case since canine rabies was eliminated in 1961. In July 2013, rabies was confirmed among three wild ferret-badgers, prompting public health response to prevent human rabies cases. This descriptive study reports the immediate response to the reemergence of rabies in Taiwan. Response included enhanced surveillance for human rabies cases by testing stored cerebrospinal fluids (CSF) from patients with encephalitides of unknown cause by RT-PCR, prioritizing vaccine use for postexposure prophylaxis (PEP) during periods of vaccine shortage and subsequent expansion of PEP, surveillance of animal bites using information obtained from vaccine application, roll out of preexposure prophylaxis (PrEP) with vaccine stock restoration, surveillance for adverse events following immunization (AEFI), and ensuring surge capacity to respond to general public inquiries by phone and training for healthcare professionals. Enhanced surveillance for human rabies found no cases after testing 205 stored CSF specimens collected during January 2010-July 2013. During July 16 to December 28, 2013, we received 8,241 rabies PEP application; 6,634 (80.5%) were consistent with recommendations. Among the 6,501 persons who received at least one dose of rabies vaccine postexposure, 4,953 (76.2%) persons who were bitten by dogs; only 59 (0.9%) persons were bitten by ferret-badgers. During the study period, 6,247 persons received preexposure prophylaxis. There were 23 reports of AEFI; but no anaphylaxis, Guillain-Barré syndrome, or acute disseminated encephalomyelitis were found. During the study period, there were 40,312 calls to the Taiwan Centers for Disease Control hotline, of which, 8,692 (22%) were related to rabies. Recent identification of rabies among ferret-badgers in a previously rabies-free country prompted rapid response. To date, no human rabies has been identified. Continued multifaceted surveillance and interministerial collaboration are crucial to achieve the goal of rabies-free status in Taiwan.
authors.affiliation: Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Angela Song-En
authors.initials: AS
authors.lastname: Huang
authors.affiliation: Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Wan-Chin
authors.initials: WC
authors.lastname: Chen
authors.affiliation: Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Wan-Ting
authors.initials: WT
authors.lastname: Huang
authors.affiliation: Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Shih-Tse
authors.initials: ST
authors.lastname: Huang
authors.affiliation: Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Lo
authors.affiliation: Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Sung-Hsi
authors.initials: SH
authors.lastname: Wei
authors.affiliation: Epidemic Intelligence Center, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Hung-Wei
authors.initials: HW
authors.lastname: Kuo
authors.affiliation: Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Pei-Chun
authors.initials: PC
authors.lastname: Chan
authors.affiliation: Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Min-Nan
authors.initials: MN
authors.lastname: Hung
authors.affiliation: Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Yu-Lun
authors.initials: YL
authors.lastname: Liu
authors.affiliation: Center for Research and Diagnostics, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Jung-Jung
authors.initials: JJ
authors.lastname: Mu
authors.affiliation: Center for Research and Diagnostics, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Jyh-Yuan
authors.initials: JY
authors.lastname: Yang
authors.affiliation: Epidemic Intelligence Center, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Ding-Ping
authors.initials: DP
authors.lastname: Liu
authors.affiliation: Office of Deputy Director, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Jih-Haw
authors.initials: JH
authors.lastname: Chou
authors.affiliation: Office of Deputy Director, Centers for Disease Control, Taipei, Taiwan.
authors.forename: Jen-Hsiang
authors.initials: JH
authors.lastname: Chuang
authors.affiliation: National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan.
authors.forename: Feng-Yee
authors.initials: FY
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001733:Bites and Stings / Q000821:virology; D021821:Communicable Diseases, Emerging / Q000453:epidemiology*; D004285:Dogs; D005260:Female; D005289:Ferrets / Q000821:virology; D005843:Geography; D006266:Health Education; D006282:Health Personnel / Q000193:education; D006801:Humans; D007114:Immunization / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D056990:Post-Exposure Prophylaxis; D011634:Public Health; D011818:Rabies / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D011819:Rabies Vaccines / Q000276:immunology; D013624:Taiwan / Q000453:epidemiology
chemical_list: D011819:Rabies Vaccines