VZCZCXYZ2484
RR RUEHWEB

DE RUEHIN #0284/01 0630825
ZNR UUUUU ZZH
R 030825Z MAR 08
FM AIT TAIPEI
TO RUEHC/SECSTATE WASHDC 8234
INFO RUEHOO/CHINA POSTS COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 7878
RUEHUL/AMEMBASSY SEOUL 9363
RUEHKO/AMEMBASSY TOKYO 9619
RUEAUSA/DEPT OF HHS WASHDC

UNCLAS AIT TAIPEI 000284 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
HHS PASS CDC MARK ABDOO 
 
E.O. 12958: N/A 
TAGS: AMED AMGT CASC ECON SENV SOCI TBIO TW
SUBJECT: CAN TAIWAN ERADICATE ITS TB PROBLEM? 
 
 ¶1.  (SBU)  SUMMARY.  Tuberculosis has been recorded in 
Taiwan since the early 20th century and successive 
administrations have tried to control this scourge.  TB 
infects about 15,000 persons per year in Taiwan and 1,300 
people die from it every year.  Treatment is a major 
challenge, given the rigorous treatment regime with high 
doses of antibiotics.  Three years ago, Taiwan health 
authorities made a strategic decision to disband its 
provincial level TB treatment center and let local clinics 
handle TB treatment.  This resulted in TB experts being 
disbanded and the TB combating effort diluted.  Taiwan has 
the technical expertise to handle TB but is hobbled by a 
less-than-efficient organization.  Taiwan's Centers for 
Disease Control, (CDC), an adjunct of the Department of 
Health, is actively seeking ways to eradicate the disease and 
hopes to reduce TB rates in Taiwan by half by 2015, but its 
anti-TB effort is driven by administrators with little 
experience in TB treatment. END SUMMARY 
 
 
BACKGROUND 
---------- 
 
¶2.  (SBU) Tuberculosis records have been kept in Taiwan since 
the early 20th century (during the Japanese occupation), 
although the disease was probably around for much longer. 
Because TB bacteria can survive in the air for up to three 
months, infected people pose a particular threat to others by 
coughing and spitting.  TB is the 12th leading cause of death 
in Taiwan, and although it has not attracted the attention 
that SARS has, its persistence and difficulty in treating are 
drawing concern from health authorities.  Postwar data from 
CDC indicates that the mortality of TB was 294 per 100,000 
(compare with current mortality rates of 4.3 per 100,000). 
The elderly above 65 account for 60 percent of the patients 
and mortality increases with age.  However, lower mortality 
rates do not imply that the infection rate has dropped 
drastically, only that drugs have managed to control the 
disease and make it less lethal.  In Taiwan, aborigines are 
four times more susceptible to becoming infected with TB 
because they don't have easy access to medical care and the 
authorities have made efforts to correct that by providing 
subsidies and medical teams to the mountain areas to provide 
X-rays. 
 
CONNECTING THE DOTS 
------------------- 
 
¶3.  (SBU) Directly observed treatment Short Course (DOTS) is 
a TB management system developed by the World Health 
Organization (WHO) and widely used for regular TB and drug 
resistant TB ( MDR-TB).  The DOTS program, administered by 
the CDC is locally monitored by more than 400 outreach 
workers from local health units who daily monitor patients to 
ensure that the drugs are taken as prescribed.  This is 
inadequate for the large number of TB sufferers who are over 
65 years old.  DOTS was first implemented in Taiwan starting 
2006 and targeting of MDR-TB started in 2007.  Taiwan has 427 
MDR-TB cases and a total TB population of 150,000.  MDR-TB 
has developed resistance to antibiotics largely because 
patients that are treated are not taking the drugs on a 
regular basis allowing the bacteria to develop drug-resistant 
strains.  According to news reports, 10-13 percent of 
patients are afflicted with MDR-TB posing special challenges 
to disease prevention experts at CDC. This is a perennial 
problem with TB treatment, where drug induced discomfort 
discourages people from staying on the drug treatment regime. 
 To medical experts, it is crucial that treatment regimes are 
followed and monitored under a strict program.  That used to 
be the case, according to Dr. Lin Taoping, head of the 
National Tuberculosis Association (NTA), an NGO which gets 
funding from CDC.  Lin headed the Provincial TB treatment 
center which combined medical expertise with systematic 
monitoring and research.  When his center was disbanded, 
apparently to save money (but also for political reasons as 
provincial organizations were done away), his medical experts 
went to work at local clinics and did not have the extensive 
support system that took so long to build up. 
 
MONITORING AND DATA UPDATES-A CAUSE FOR CONCERN 
--------------------------------------------- -- 
 
¶4.  (SBU)  ESTH officer visited Dr. Cynthia Yang (Chin-hui), 
who is in charge of the TB/AIDS program at CDC.  Yang said 
once a patient is diagnosed with TB, they are put on a 
monitoring list and local health officials trace the 
patient's drug intake and progress throughout the treatment 
period using the DOTS program.  A list of actively treated 
patients is submitted to the immigration bureau to ensure 
that their whereabouts are monitored.  According to Yang, 
Taiwan's TB infection rate is dropping at the rate of 5 
percent a year.  In mid-July 2007, a couple who were 
undergoing TB treatment (one of whom was a MDR-TB case) 
absconded to mainland China in defiance of a travel ban.  PRC 
authorities eventually traced them to Jiangsu province and 
arranged for them to fly back. In spite of the patients' 
names being registered on the CDC watchlist, loose 
enforcement let them slip unnoticed from Kaoshiung to the 
mainland.  According to information from NTA, CDC discovered 
later that the person monitoring this couple had checked off 
the days the couple were supposed to have taken the medicine 
in Taiwan although they were in the mainland (!).  The couple 
were fined NT$150,000 ($4,800).  In another case late last 
year, a passenger was denied boarding even though he was not 
contagious and had been cleared by the medical personnel at 
NTA.  In that incident, CDC head Steve Kuo personally went to 
the airport and after verifying the records noticed they had 
not been updated (the passenger was allowed to board in the 
end).  Lin lamented that with the CDC staffed with 
administrators with little background in TB treatment, yet 
are tasked with drastically reducing the incidence of TB. 
 
COMMENT: 
-------- 
 
¶5.  (SBU)   Given the success in Taiwan of eradicating 
malaria, smallpox and other diseases, hope remains that TB 
will eventually be wiped out.  But the incubation period of 
the disease, its long term survivability in the environment, 
its drug resistance and difficulty of monitoring potential 
carriers all pose tremendous challenges for its management. 
Lack of expertise, personality-driven management and lack of 
a systemic approach to combat TB among disease control 
authorities, all contribute to the difficulty in eradicating 
TB.  It is no wonder that new TB patients are popping up at 
the rate of 15,000 a year.  With 150,000 afflicted persons 
island-wide, reducing the incidence of new cases is a more 
realistic goal, rather than lofty goals aiming at reducing in 
half those infected with TB. END COMMENT 
YOUNG