Review And Current Status of Hyperimmune Plasma for Snake Antivenoms in Taiwan

Chien-Hsin Liu^*, Rang-Hui Yeh, Chao-Hung Chen, Wen-Chin Hsieh

2024 Vol.40 No.7

Correspondence Author： Chien-Hsin Liu^*

Abstract：

        In Taiwan, there are six clinically significant vipers, including Deinagkistrodon acutus, Trimeresurus stejnegeri, Protobothrops mucrosquamatus, Daboia russelii siamensis, Bungarus multicinctus and Naja atra. To save people from envenoming, Taiwan Centers for Disease Control produces and supplies four antivenoms for six vipers from hyperimmune horse. To find a suitable horse facility, the farm was moved several times and finally settled down at the national immunization horse farm in 2019, with Pharmaceutical Inspection Co-operation Scheme (PIC/S) and Good Manufacturing Practice, (GMP) designation. Consequently, the following processes can comply with regulations, including antigen preparation, immunization, blood collection, plasma collection, and reinfusion. 
        Recently we overcame the obstacle of low success rate and low titers for hyperimmune plasma of Trimeresurus stejnegeri, and the production capacity increased by approximately 36 times. Meanwhile, we also reduced and refined the use of venom in horses, which led to decreasing the quantity of horses used and the side effects of immunization on horses. 
        In the future, we will further improve the production capacity for other hyperimmune plasma and establish plasmapheresis on plasma production to ensure the health and safety of people with snakebites envenoming in Taiwan.
 

Keywords：Antivenoms, national immunization horse farm, snake venom, hyperimmune plasma for snake antivenoms
 

Management of A Probable Case of Creutzfeldt-Jakob Disease in Southern Taiwan, 2020

Po-Chen Kuo^*, Ching-Ying Chen, Jen-Yih Lee, Tzu-Chun Chen, Tsuey-Fong Lee

2024 Vol.40 No.7

Correspondence Author： Po-Chen Kuo^*

Abstract：

        Creutzfeldt-Jakob disease (CJD) is caused by the accumulation of abnormal prion proteins in the brain, resulting in a spongiform encephalopathy. Prions are highly resistant to destruction, can persist in soil for extended periods, and remain infectious. To prevent the spread of prions in the environment and food chain, human remains of CJD cases must be cremated.
        In 2018, a patient in southern Taiwan was diagnosed as a probable case of CJD following a panel review and passed away in June 2020. According to the CJD infection control manual, the remains should have been cremated. However, the patient's family members refused cremation due to their religious beliefs and because the patient had not been definitively diagnosed with CJD.
        Despite negotiations by the Public Health Bureau, no consensus was reached with the family members. Subsequently, the Public Health Bureau, Taiwan Centers for Disease Control, and an influential local councilor familiar to the family members collaborated to secure the family's agreement to cremate the remains.
        This article outlines the incident's handling process, discusses relevant policies, and offers recommendations for managing similar cases and policy revisions.

Keywords：Creutzfeldt-Jakob disease, remains cremation, case review, benefits of public health, communication with people