2009 swine flu pandemic in Taiwan

Last updated

2009 swine flu pandemic in Taiwan began on May 20, 2009, when a non-citizen who had been living in Taiwan returned from the United States via Hong Kong. [1] By the end of September, more than 90% of influenza A detected in the community were Influenza A (H1N1). [2]

Contents

Initial response

After WHO raised the influenza pandemic phase to phase 4 on April 28, 2009, Taiwan established the Central Epidemic Command Center (CECC), and convened the first CECC meeting on the same day. [3] [4] Taiwan CDC also announced pandemic influenza A (H1N1) infection as category I notifiable disease which should be reported within 24 hours and all suspect patients should be hospitalized and isolated until the diagnosis was excluded. [5] Besides routine fever screening, which has been in place since the SARS period in 2003, multiple border quarantine measures began on April 29 to delay the importation of the virus, as a result of meeting. On-board quarantine was performed on all flights came directly from the Americas and passengers were encouraged to report voluntarily to quarantine officers if they had flu-like symptoms. [6] Through enhanced screening and quarantine, the first imported case was found when a 52-year-old foreign resident of Taiwan returned from the United States via Hong Kong on May 20. The man had been in the United States from February 20 to May 18 and was symptomatic on his flight back to Taiwan. He was sent to designated hospital directly from the airport, isolated, treated with oseltamivir and recovered fully. All passengers seated within three rows of the ill passenger were contacted, given chemoprophylaxis and quarantined. [7] Quarantine on board discontinued on May 20, after the first case was found. In the following week, 9 more imported cases were found by fever screening in the airport. On May 24, the first domestic case that became infected with influenza A (H1N1) through close contact with an imported case was diagnosed. [8] Because of enhanced contact tracing and prophylactic treatment, local transmission of the virus was stopped and no other domestic cases were found. Details of the control measures and clinical characteristics of the first 61 imported cases of pandemic influenza A (H1N1) has been published in the following article in Taiwan Epidemiology Bulletin. [9]

First cluster

Throughout the next few days, cases continued to be imported from abroad. On June 11, Taiwan Centers for Disease Control reported three cases imported from Thailand. [10] Investigation found that some cases had been on a group tour in Thailand. More cases were found in these tour groups in the next few days. [11] Thailand confirmed that the virus was found in a discothèque. [12] [13]

On 17 June 2009, it was known that a female diplomat working in Taiwan's Diplomatic Quarter had contracted the virus. The Ministry of Foreign Affairs was widely critiqued for trying to keep the outbreak hidden. [14] [15] [16]

Surveillance

Taiwan CDC has multiple surveillance systems ( disease surveillance )to monitor the epidemic.

Complicated influenza

Influenza A (H1N1) was removed from list of Category I Notifiable Disease and was included in the list of Category IV and reported as influenza complications on June 19. All cases with influenza-like illness and pulmonary complications, neurological complications, myocarditis/pericarditis, invasive bacterial infection or those who needed intensive care or died because of the illness should be reported to Taiwan CDC within one week of diagnosis. The first case of complicated influenza was reported on July 17, 2009. The first mortality case was reported on July 30, 2009. The first case in pregnant woman was confirmed on August 15. From June 19, 2009, to January 23, 2010, 884 case of complicated pandemic (H1N1) 2009 virus infections were reported and confirmed, including 39 deaths. [17] The mortality rate is around 2 per million population. Characteristics of the first 100 cases of complicated influenza can be found in the following article. [18]

Virologic surveillance

Taiwan CDC's central lab and 10 contract labs are responsible for the virologic surveillance for seasonal and pandemic influenza. Soon after the start of the pandemic, Taiwan CDC developed its own diagnostic method for pandemic influenza A (H1N1), which is rapid, sensitive and specific. [19] [20] Six weeks after the first case of influenza A (H1N1) was imported, on July 2, it was confirmed that the virus was circulating in the communities. [21] Pandemic influenza A (H1N1) had become the dominant community strain since the 30th week of 2009, and accounts for more than 90% of all influenza strains isolated. First Oseltamivir-resistant pandemic influenza A (H1N1) virus strain was discovered in October, 2009. [22] Since June 1, 2009, more than 800 isolates were tested for oseltamivir resistance and 8 were found to be resistant. All resistant strains developed after oseltamivir treatment and there are no evidence of continuous transmission of these strains. [23]

Outpatient surveillance

Taiwan CDC's database links with that of more than 300 hospitals all over the country. The number of patients diagnosed of influenza among all patients who visited the emergency department/outpatient department of these hospitals were calculated (ER/outpatient ILI consultation rate). According to the consultation rate, the first peak of influenza A(H1N1) infection in Taiwan was in the 36th week of 2009, followed by the second peak in the 48th week. The trend was going down since the beginning of 2010 and has remained low until now.[ citation needed ]

Pneumonia and influenza (P&I) mortality surveillance

Deaths reported through the National Death Certificate System mentioning P&I as the cause of death were calculated and compared to that of the previous influenza season. By the beginning of 2010, the number is below that for this time last year. The number of deaths mentioning P&I for age groups 0–49, 50–64, and greater than 65 years was the highest for adults greater than 65 years of age. [24]

Control measures

Antiviral stockpile

In addition to oseltamivir, CECC also procured zanamivir for the pandemic. [25] [26] The first shipment of stockpiled antivirals was released on August 29. [27] All medication was paid by the National Health Insurance.[ citation needed ]

Medical care system

Taiwan compares to OECD Countries in Pandemic Mortality OECD comparison.png
Taiwan compares to OECD Countries in Pandemic Mortality

On August 17, 2009, Taiwan CDC published the "Clinical Treatment Guideline for Influenza A(H1N1)", which is a result of collaborative work with the Infectious Diseases Society of Taiwan, Taiwan Pediatric Association, Nosocomial Infection Control Society of Taiwan and Taiwan Society of Pulmonary and Critical Care Medicine. [28] Guidelines on diagnosis, treatment and control of nosocomial infection are included. According to the guideline, oseltamivir is suggested to be given to patients with influenza-like illness and a positive rapid influenza diagnostic test result, patients with complicated influenza and patients with high risk conditions as defined by the WHO. [29] National Health Insurance, a compulsory social insurance system, is covering >98% of the population and contracting with >90% of the medical care institutions in Taiwan. [30] Since August 15, 2009, oseltamivir can be prescribed free of charge in more than 3500 contracted clinics/hospitals for patients fulfilling the above criteria. Furthermore, the Taiwan Medical Association indicated that the doctors would help ease the load of patients by having clinics open on weekends. [31]

Vaccination

On June 1, the CECC began the process to procure influenza A(H1N1) vaccine. [32] As a result, 15 million doses of vaccine were bought from two manufacturers (Adimmune and Novartis), covering 60% of the population. [33] Vaccine priority list was announced in August and mass vaccination began on November 1. Vaccinations were first given to targeted high risk groups, and to school aged children who are likely to spread the disease. [34] [35] Medical personnel were the first to be immunized. Data from a cross-national study showed that 76% of physicians in Taiwan have been vaccinated, which was the highest among all the physicians interviewed. [36]

National Immunization Day

On December 12, 2009, vaccination was opened up to everyone. A large vaccination campaign was conducted to boost vaccination coverage. Vaccination stations were set up in hospitals, clinics, department stores and community gathering places. A total of 563,712 doses of vaccines (2.4% of population) were administered on that day. [37] [38] By the end of January 2010, approximately 24% of the total population have been immunized. To improve the accessibility of vaccination, phone lines set up by local health bureaus in cities and counties are open for the public to book a group appointment for pandemic influenza A (H1N1) vaccination. [39] To prevent further spread of the virus in the coming 9-day holiday of the Chinese New Year, immunization stations were set up in airports and Taipei Station to vaccinate travellers since February 1, 2010.[ citation needed ]

Surveillance for adverse events following immunization

To ensure and safety and effectiveness of H1N1 vaccine, Taiwan CDC has passive and active surveillance system for vaccine adverse events. For passive surveillance, any adverse event happens after H1N1 immunization can be reported to local health bureau and Taiwan CDC. For active surveillance, vaccination record database is linked with the National Health Insurance database to ensure that the incidence of neurological diseases (such as Guillain–Barré syndrome), cardiovascular disease, adverse pregnancy outcome, stroke and anaphylaxis does not exceed the background incidence. By January 26, 2010, 1176 suspected vaccine-related adverse events have been reported, including 330 suspected serious adverse events and 35 deaths. Based on the number of vaccine doses administered, the incidence of adverse events and serious adverse events did not exceed the expected value. [40] Vaccine Injury Compensation Program (VICP) committee is composed of a group of expert consultants with expertise in clinical medicine, pathology, sociology and law. It works independently from the government and is responsible for reviewing petitions requesting compensation for individuals thought to be injured by a vaccine. [41] As of January 29, 2010, the VICP has received a total of 218 claims requesting compensation for individuals thought to be injured by the pandemic influenza A (H1N1) vaccine. VICP has completed reviewing 39 petitions. Five cases were ruled compensable (association is confirmed in one while association cannot be excluded in the other four) while the other thirty-four cases were ruled non-compensable. [42]

School closures

In the beginning of the pandemic, the strategy was to contain the disease. During containment, one case was found in a school-aged child, resulting in the suspension of classes for the entire school. [43] After school re-commenced in the fall, instead of closing the entire school, it was decided that only classrooms with two or more students with influenza in a 3-day period would have classes suspended for 5 days, which is the so-called 325 rule for class suspension. [44] [45] School-based vaccination program started on November 16, 2009, and half of the students in elementary or junior high school were vaccinated against flu by the end of November. Therefore, the rule for class suspension shifted from 325 to "814". Class suspension is no longer indicated, if >80% of the students in a class have been vaccinated for more than 2 weeks. The number of suspended classes reached its peak by the end of November, when more than 2000 classrooms were suspended daily all over Taiwan. However, because of successful school-based immunization program, less than 5 classrooms were suspended daily by the end of 2009.[ citation needed ]

Mass communication

Taiwan CDC has multifacet strategies to communicate with the public, media and the medical personnels. Daily and weekly updates on the statistics of influenza A(H1N1) is available on the website. [46] Important news about policy and current situation of the pandemic will be announced as press releases in routine news conference and on the website. [47] Many celebrities, including Chien-Ming Wang, participated in H1N1 prevention campaign by shooting videos to urge the public to work as a team to stop H1N1. [48] The 24/7 hotline of Taiwan CDC-1922, is an important channel of communication with the public. 1922 hotline deals with any inquiries related to communicable diseases such as reporting, diagnosis, consultation and referral. As the pandemic evolves, the number of incoming calls increased to more than 3000 per week. Many vaccine-related adverse events were reported via this hotline. It also provides first-hand information about how the policy is being executed. Since August 2009, CECC releases "E-Letter to doctors" to disseminate the latest information regarding diagnosis, treatment and policy making about influenza A(H1N1). [49] By the end of 2009, 61 letters had been issued. More than 6000 doctors in Taiwan have subscribed.

Related Research Articles

<i>Influenza A virus</i> Species of virus

Influenza A virus (IAV) is a pathogen with strains that infect birds and some mammals, as well as causing seasonal flu in humans. Mammals in which different strains of IAV circulate with sustained transmission are bats, pigs, horses and dogs; other mammals can occasionally become infected.

<span class="mw-page-title-main">Oseltamivir</span> Antiviral medication used against influenza A and influenza B

Oseltamivir, sold under the brand name Tamiflu, is an antiviral medication used to treat and prevent influenza A and influenza B, viruses that cause the flu. Many medical organizations recommend it in people who have complications or are at high risk of complications within 48 hours of first symptoms of infection. They recommend it to prevent infection in those at high risk, but not the general population. The Centers for Disease Control and Prevention (CDC) recommends that clinicians use their discretion to treat those at lower risk who present within 48 hours of first symptoms of infection. It is taken by mouth, either as a pill or liquid.

<span class="mw-page-title-main">Influenza vaccine</span> Vaccine against influenza

Influenza vaccines, colloquially known as flu shots, are vaccines that protect against infection by influenza viruses. New versions of the vaccines are developed twice a year, as the influenza virus rapidly changes. While their effectiveness varies from year to year, most provide modest to high protection against influenza. Vaccination against influenza began in the 1930s, with large-scale availability in the United States beginning in 1945.

<span class="mw-page-title-main">Swine influenza</span> Infection caused by influenza viruses endemic to pigs

Swine influenza is an infection caused by any of several types of swine influenza viruses. Swine influenza virus (SIV) or swine-origin influenza virus (S-OIV) refers to any strain of the influenza family of viruses that is endemic in pigs. As of 2009, identified SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H2N1, H3N1, H3N2, and H2N3.

<span class="mw-page-title-main">Flu season</span> Recurring periods of influenza

Flu season is an annually recurring time period characterized by the prevalence of an outbreak of influenza (flu). The season occurs during the cold half of the year in each hemisphere. It takes approximately two days to show symptoms. Influenza activity can sometimes be predicted and even tracked geographically. While the beginning of major flu activity in each season varies by location, in any specific location these minor epidemics usually take about three weeks to reach its pinnacle, and another three weeks to significantly diminish.

<span class="mw-page-title-main">Influenza A virus subtype H1N1</span> Subtype of Influenza A virus

In virology, influenza A virus subtype H1N1 (A/H1N1) is a subtype of influenza A virus. Major outbreaks of H1N1 strains in humans include the 1918 Spanish flu pandemic, the 1977 Russian flu pandemic and the 2009 swine flu pandemic. It is an orthomyxovirus that contains the glycoproteins hemagglutinin (H) and neuraminidase (N), antigens whose subtypes are used to classify the strains of the virus as H1N1, H1N2 etc. Hemagglutinin causes red blood cells to clump together and binds the virus to the infected cell. Neuraminidase is a type of glycoside hydrolase enzyme which helps to move the virus particles through the infected cell and assist in budding from the host cells.

<span class="mw-page-title-main">Influenza pandemic</span> Pandemic involving influenza

An influenza pandemic is an epidemic of an influenza virus that spreads across a large region and infects a large proportion of the population. There have been six major influenza epidemics in the last 140 years, with the 1918 flu pandemic being the most severe; this is estimated to have been responsible for the deaths of 50–100 million people. The 2009 swine flu pandemic resulted in under 300,000 deaths and is considered relatively mild. These pandemics occur irregularly.

<span class="mw-page-title-main">Influenza A virus subtype H3N2</span> Virus subtype

Influenza A virus subtype H3N2 (A/H3N2) is a subtype of viruses that causes influenza (flu). H3N2 viruses can infect birds and mammals. In birds, humans, and pigs, the virus has mutated into many strains. In years in which H3N2 is the predominant strain, there are more hospitalizations.

<span class="mw-page-title-main">Pandemrix</span> Flu vaccine

Pandemrix is an influenza vaccine for influenza pandemics, such as the 2009 flu pandemic. The vaccine was developed by GlaxoSmithKline (GSK) and patented in September 2006.

<span class="mw-page-title-main">Influenza</span> Infectious disease

Influenza, commonly known as "the flu" or just "flu", is an infectious disease caused by influenza viruses. Symptoms range from mild to severe and often include fever, runny nose, sore throat, muscle pain, headache, coughing, and fatigue. These symptoms begin one to four days after exposure to the virus and last for about two to eight days. Diarrhea and vomiting can occur, particularly in children. Influenza may progress to pneumonia from the virus or a subsequent bacterial infection. Other complications include acute respiratory distress syndrome, meningitis, encephalitis, and worsening of pre-existing health problems such as asthma and cardiovascular disease.

<span class="mw-page-title-main">2009 swine flu pandemic</span> 2009–2010 pandemic of swine influenza caused by H1N1 influenza virus

The 2009 swine flu pandemic, caused by the H1N1/swine flu/influenza virus and declared by the World Health Organization (WHO) from June 2009 to August 2010, was the third recent flu pandemic involving the H1N1 virus. The first identified human case was in La Gloria, Mexico, a rural town in Veracruz. The virus appeared to be a new strain of H1N1 that resulted from a previous triple reassortment of bird, swine, and human flu viruses which further combined with a Eurasian pig flu virus, leading to the term "swine flu".

The 2009 flu pandemic in the United States was caused by a novel strain of the Influenza A/H1N1 virus, commonly referred to as "swine flu", that was first detected on 15 April 2009. While the 2009 H1N1 virus strain was commonly referred to as "swine flu", there is no evidence that it is endemic to pigs or of transmission from pigs to people; instead, the virus spreads from person to person. On April 25, the World Health Organization declared a public health emergency, followed concurringly by the Obama administration on April 26.

<span class="mw-page-title-main">2009 swine flu pandemic timeline</span>

This article covers the chronology of the 2009 novel influenza A (H1N1) pandemic. Flag icons denote the first announcements of confirmed cases by the respective nation-states, their first deaths, and relevant sessions and announcements of the World Health Organization (WHO), the European Union , and the U.S. Centers for Disease Control (CDC).

<span class="mw-page-title-main">Pandemic H1N1/09 virus</span> Virus responsible for the 2009 swine flu pandemic

The pandemic H1N1/09 virus is a swine origin influenza A virus subtype H1N1 strain that was responsible for the 2009 swine flu pandemic. This strain is often called swine flu by the public media due to the prevailing belief that it originated in pigs. The virus is believed to have originated around September 2008 in central Mexico.

The 2009 flu pandemic, involving an outbreak of a new strain of influenza commonly known as swine flu, reached France in early May 2009.

<span class="mw-page-title-main">2009 swine flu pandemic vaccine</span> Protection against the H1N1/09 virus

The 2009 swine flu pandemic vaccines were influenza vaccines developed to protect against the pandemic H1N1/09 virus. These vaccines either contained inactivated (killed) influenza virus, or weakened live virus that could not cause influenza. The killed virus was injected, while the live virus was given as a nasal spray. Both these types of vaccine were produced by growing the virus in chicken eggs. Around three billion doses were produced, with delivery in November 2009.

The 2009 swine flu pandemic was a global outbreak of a new strain of influenza A virus subtype H1N1, first identified in April 2009, termed Pandemic H1N1/09 virus by the World Health Organization (WHO) and colloquially called swine flu. The outbreak was first observed in Mexico, and quickly spread globally. On the 11th of June 2009, the WHO declared the outbreak to be a pandemic. The overwhelming majority of patients experience mild symptoms, but some persons are at higher risk of suffering more serious effects; such as those with asthma, diabetes, obesity, heart disease, or those who are pregnant or have a weakened immune system. In the rare severe cases, around 3–5 days after symptoms manifest, the sufferer's condition declines quickly, often to the point respiratory failure. Although Ukraine was not (very) affected at first there was on outbreak of the virus in Western Ukraine in early November 2009 that led to the closing of public buildings and cancellation of meetings for three weeks.

<span class="mw-page-title-main">Influenza A virus subtype H7N9</span> Subtype of the influenza A virus

Influenza A virus subtype H7N9 (A/H7N9) is a bird flu strain of the species Influenza virus A. Avian influenza A H7 viruses normally circulate amongst avian populations with some variants known to occasionally infect humans. An H7N9 virus was first reported to have infected humans in March 2013, in China. Cases continued to be reported throughout April and then dropped to only a few cases during the summer months. At the closing of the year, 144 cases had been reported of which 46 had died. It is known that influenza tends to strike during the winter months, and the second wave, which began in October, was fanned by a surge in poultry production timed for Lunar New Year feasts that began at the end of January. January 2014 brought a spike in reports of illness with 96 confirmed reports of disease and 19 deaths. As of April 11, 2014, the outbreak's overall total was 419, including 7 in Hong Kong, and the unofficial number of deaths was 127.

<span class="mw-page-title-main">Stephen C. Redd</span>

Stephen C. Redd is a U.S. physician and rear admiral with the U.S. Public Health Service and an Assistant Surgeon General. With over 30 years of public health and executive leadership experience, Redd served as the Director of the Office of Public Health Preparedness and Response at the Centers for Disease Control and Prevention. Previously, he was the Director of the CDC's Influenza Coordination Unit, where he served as the incident commander for the 2009-2010 H1N1 pandemic influenza response.

The Central Epidemic Command Center is an agency of the National Health Command Center (NHCC). It has been activated by the government of Taiwan for several disease outbreaks, such as the 2009 swine flu pandemic and the COVID-19 pandemic. The head of the agency is Chen Shih-chung, the minister of health and welfare. The CECC is associated with the Taiwan Centers for Disease Control.

References

  1. ↑ "First imported case of influenza A (H1N1) confirmed in Taiwan". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  2. ↑ Taiwan Influenza Express (Week 39 in 2009). [ permanent dead link ]
  3. ↑ Minister of Health convenes first meeting held by Central Epidemic Command Center [ permanent dead link ]
  4. ↑ "WHO raises influenza pandemic alert level, Taiwan establishes Central Epidemic Command Center in response". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  5. ↑ "Suspected influenza A (H1N1) case must be reported within 24 hours". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  6. ↑ "Taiwan CDC to implement onboard quarantine inspection of certain flights". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  7. ↑ "First imported case of influenza A (H1N1) confirmed in Taiwan; current pandemic alert level in Taiwan raised to phase 2 (yellow light)". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  8. ↑ "Three new cases of influenza A (H1N1), including one domestic case, confirmed in Taiwan; current pandemic alert level in Taiwan raised to phase 3 (yellow light)". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  9. ↑ "The Response to Novel Influenza A (H1N1) Epidemic in Taiwan and Analysis of the Initial 61 Confirmed Cases". Archived from the original on 2012-07-30. Retrieved 2010-02-01.
  10. ↑ "Four more imported cases of influenza A (H1N1) confirmed". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  11. ↑ "Seven new imported cases of pandemic influenza A (H1N1) confirmed". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  12. ↑ "21 Discotheque Staff In Pattaya Infected With H1N1". Archived from the original on 2009-06-15. Retrieved 2010-01-29.
  13. ↑ "Thailand sees jump in H1N1 cases, many in Pattaya". Archived from the original on 2009-06-14. Retrieved 2010-01-29.
  14. ↑ "議員痛批：使館特區爆新流感 外交部隱匿". The Liberty Times (自由時報). 19 June 2009. Archived from the original on 16 June 2019. Retrieved 1 November 2017.
  15. ↑ 許, 甫 (18 June 2009). "國合會有人得H1N1 隱匿危及使館？". TVBS Media Inc. Archived from the original on 10 June 2019. Retrieved 1 November 2017.
  16. ↑ "指責外交部隱匿新流感 綠議員：使館特區陷集體感染危機". NOWnews.com (今日傳媒). 18 June 2009. Archived from the original on 2017-11-07. Retrieved 2017-11-01.
  17. ↑ "Influenza Express". Archived from the original on 2009-11-11. Retrieved 2010-02-01.
  18. ↑ "The First 100 Hospitalized Severe Complicated Influenza Cases Caused by 2009 Pandemic Influenza A (H1N1) in Taiwan". Archived from the original on 2012-07-24. Retrieved 2010-02-02.
  19. ↑ "Diagnostic test for influenza A(H1N1) already available in Taiwan". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  20. ↑ Rapid SYBR Green I and Modified Probe Real-Time Reverse Transcription-PCR Assays Identify Influenza H1N1 Viruses and Distinguish between Pandemic and Seasonal Strains
  21. ↑ "Taiwan CDC identifies presence of novel influenza A (H1N1) virus in community". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  22. ↑ "First Oseltamivir-resistant pandemic influenza A (H1N1) virus strain discovered in Taiwan; no signs of further transmission detected". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  23. ↑ "Investigation of the First Two Cases of Oseltamivir- Resistant Pandemic (H1N1) 2009 Virus in Taiwan". Archived from the original on 2012-08-01. Retrieved 2010-02-01.
  24. ↑ "Influenza Express". Archived from the original on 2009-11-11. Retrieved 2010-02-01.
  25. ↑ "More than two million doses of oseltamivir and Relenza are in place". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  26. ↑ "Central Epidemic Command Center announces government purchase of 0.9 million courses of Relenza". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  27. ↑ "Central Epidemic Command Center announces release of first 250,000 doses of Tamiflu from national stockpile". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  28. ↑ Clinical Treatment Guideline for Influenza A(H1N1) [ permanent dead link ]
  29. ↑ CLINICAL MANAGEMENT OF PANDEMIC(H1N1) 2009 VIRUS INFECTION, Interim Guidance from Expert Consultation
  30. ↑ "Bureau of National Health Insurance, Taiwan". Archived from the original on 2010-04-28. Retrieved 2010-02-02.
  31. ↑ "Letter from the Taiwan Medical Association". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  32. ↑ "Central Epidemic Command Center announces plans to procure influenza A (H1N1) vaccine". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  33. ↑ "Additional swine flu vaccine acquired from abroad". Taiwan Today. 2009-09-02. Archived from the original on 2021-08-28. Retrieved 2021-08-28– via China (Taiwan) Ministry of Foreign Affairs.
  34. ↑ "Taiwan to launch H1N1 vaccine campaign according to vaccine priority list and schedule". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  35. ↑ "H1N1 vaccination priority schedule". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  36. ↑ "Cross-National Study：H1N1 vaccination rate among physicians highest in Taiwan". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  37. ↑ "Commander Yang: general and municipal hospitals to remain open during weekend for campaign to vaccinate entire population against H1N1 that begins on December 12, 2009". Archived from the original on February 29, 2012. Retrieved October 29, 2017.
  38. ↑ "Epidemic Command Center thanks people in Taiwan for writing a new chapter in history of disease prevention". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  39. ↑ "Group H1N1 vaccination appointment lines open Monday". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  40. ↑ Summary of 2009 Monovalent H1N1 Vaccine Safety Surveillance [ permanent dead link ]
  41. ↑ "Important decisions made and 5 petitions reviewed at first conference convened by new VICP expert consultants". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  42. ↑ "Vaccine Injury Compensation Program (VICP) completes review of eleven petitions". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  43. ↑ "Guangfu Elementary School suspends class". Archived from the original on 2009-05-29. Retrieved 2010-01-29.
  44. ↑ Precautions, Reporting, and Procedure in Response to H1N1 September 7, 2009 [ permanent dead link ]
  45. ↑ "325 class suspension policy". Archived from the original on 2009-09-08. Retrieved 2010-01-29.
  46. ↑ Surveillance for influenza A(H1N1) [ permanent dead link ]
  47. ↑ "Press releases from Taiwan CDC". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
  48. ↑ "Chien-Ming Wang participates in H1N1 prevention campaign by shooting video for Taiwan CDC". Archived from the original on 2012-02-29. Retrieved 2019-08-29.
  49. ↑ "Letter to doctors from CECC". Archived from the original on 2012-02-29. Retrieved 2017-10-29.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.