Monday, February 6, 2017

健永 解除 競業: 許銘燦 (久年營造)/ 吳金地 (威潤科技)


健永生技:公告本公司106年第一次臨時股東會同意解除新任董事競業禁止案 鉅亨網新聞中心※來源:台灣證券交易所2017/02/03 19:400第三十四條第221.股東會決議日:106/02/032.許可從事競業行為之董事姓名及職稱:董事 許銘燦董事 吳金地3.許可從事競業行為之項目:(1) 許銘燦久年營造()公司副董事長敦年建設()公司監察人(2) 吳金地威潤科技股份有限公司獨立董事4.許可從事競業行為之期間:任職本公司董事之期間5.決議情形(請依公司法第209條說明表決結果):本案經票決通過6.所許可之競業行為如屬大陸地區事業之營業者,董事姓名及職稱(非屬大陸地區事業之營業者,以下欄位請輸不適用):不適用7.所擔任該大陸地區事業之公司名稱及職務:不適用8.所擔任該大陸地區事業地址:不適用9.所擔任該大陸地區事業營業項目:不適用10.對本公司財務業務之影響程度:11.董事如有對該大陸地區事業從事投資者,其投資金額及持股比例:不適用12.其他應敘明事項:

健永生技 發言日期106/02/03 發言時間19:03:06 發言人何志煌 發言人職稱事業處總經理 發言人電話02-2732-5205 主旨 公告本公司新任董事名單(補選符合條款 6 事實發生日106/02/03 說明1.發生變動日期:106/02/03 2.舊任者姓名及簡歷董事吳金地 / 健永生技股份有限公司 獨立董事 董事鍾育婷 / 健永生技股份有限公司 董事 3.新任者姓名及簡歷董事許銘燦 / 久年營造股份有限公司董事 董事吳金地 / 富鋒聯合會計師事務所合夥會計師 4.異動情形(請輸入「辭職」、「解任」、「任期屆滿」或「新任」):辭職 5.異動原因:106年第一次股東臨時會補選董事 6.新任董事選任時持股數董事許銘燦: 0 董事吳金地: 0 7.原任期(例xx/xx/xx ~ xx/xx/xx: 104/06/29~107/06/28 8.新任生效日期:106/02/03 9.同任期董事變動比率:28.57 10.其他應敘明事項:

恰特草(東非罌粟/阿拉伯茶/巧茶) 含有二級毒品卡西酮


恰特草偽裝茶葉 母女轉運澳洲4 20170204 04:10 林郁平/台北報導 在澳洲擔任美容師的27歲女子鄭家穎,涉嫌從非洲衣索比亞郵寄含有二級毒品卡西酮成分的「恰特草」闖關回台,由母親代收後再偽裝成茶葉轉寄到澳洲。刑事局接獲陸方情資,首度於國內查獲這種毒品。鄭女供稱,是幫紐西蘭籍的前男友運送,不知是毒品,檢方複訊後,母女均20萬元交保。警方初估,此次查獲66包、重約134公斤的恰特草在澳洲市值達1000萬台幣已通報澳洲警方追查其前男友身分及已流入的毒品流向。警方指出,恰特草有「東非罌粟」之稱,又稱「阿拉伯茶」、「巧茶」,主要分布於非洲、阿拉伯半島等地區,乾燥後形似茶葉,多國都列為毒品。大陸海關緝私局上月發現有5件自衣索比亞寄出、經北京中轉到台灣的國際郵包,內有37包新型態毒品恰特草,遂通報我方共同偵辦,並將郵包放行來台。警方根據郵包收件到台南何婦家中搜索,又查獲先前已寄到台灣的29包恰特草,發現何婦已用茶葉袋重新真空包裝,準備寄給人在澳洲墨爾本的女兒鄭家穎,經策動何婦勸說女兒前天自澳返台到案說明。鄭女表示,5年前到澳洲打工度假,在墨爾本的百貨公司工作至今,期間結交30歲的紐西蘭籍非裔男友,但2人已分手。去年10月,前男友找上她,要她幫忙從台灣轉寄包裹到澳洲,說好每公斤將給她50元澳幣當酬勞,媽媽在台已幫她收過7次包裹,並寄了4次、共200公斤的恰特草到澳洲,但她只拿到3000元澳幣、約台幣7萬多元酬勞,她強調,男友稱是用來當染色劑,不知竟是毒品,後悔不已。(中國時報)

勤業 郭政弘: 審計創新/ 顧問諮詢/ 互動溝通/ 敏銳觀察


勤業總裁專訪/把脈資本市場 兩藥方活血 2017-02-06 00:02:03 經濟日報 記者楊美玲、劉懿慧/台北報導 勤業眾信聯合會計師事務所總裁郭政弘表示,振興台灣資本市場,除應持續注入「新血」之外,建議應調整股利所得稅制,而政府也要協助小而美的優質上市櫃公司「被看見」。 此外,為了因應一例一休與科技變革,郭政弘指出,勤業積極推動「審計創新」計畫,並研發「審計雲」大數據資訊平台,運用科技及資料分析技術,提高審計工作效率和品質已接任勤業眾信聯合會計師事務所總裁超過一年半的郭政弘,接受本報專訪談及公司發展前景、對資本市場、新創事業、稅制改革、企業新南向等看法。以下是專訪紀要。

問:您上任總裁已一年半,勤業眾信有什麼不一樣的改變?您對未來發展願景為何?答:我上任後致力於推動「科技、專精、同理心」三方向。科技部分,因為一例一休的實施,我們積極推動「審計創新」計畫,運用科技及資料分析技術,提高審計工作效率和品質,讓同仁能提升效率、減少工時。科技發展快速,我在審計部門營運長任內,就推動建立「財務數據資料庫」,這些資料庫可讓同仁藉由比較分析公開發行公司的財務數據以及各項指數,快速掌握產業發展趨勢及客戶的定位;近期也在事務所內部啟動一場數位科技革命,正研發「審計雲」大數據資訊平台,過去必須人工分析、勾稽的程序,未來客戶資訊將彙整至雲端平台後,都可在雲端平台中自動化進行,還可快速分析、比對、運算、輸出,全面提昇審計品質與效率。專精的部分,關注在產業專精,配合政府五加二創新產業發展過程中,我們跟公協會、生技中心有很多合作,讓產業發展更好。同理心部分,不僅要即時回應客戶提出來的問題,更要比客戶早一步想到服務的內容,提出客製化「有感」的解決方案。目前勤業眾信共有審計、稅務、財務顧問、風險顧問、管理顧問五大事業部門,均是市場第一。顧問諮詢這一塊,是未來發展重要的方向。會計師如果只給客戶財報的查核簽證,是遠遠不夠的,對於客戶產業發展、經營管理,如果能給諮詢服務,對客戶更有附加價值。

藥方1:須持續引入新星 問:您對台灣資本市場表現及未來發展看法如何?答:資本市場和國際景氣、經濟環境有關,這幾年有一點遲緩,新IPO家數沒有很大的突破,台灣產業過去二、三十年集中在高科技產業,目前需要產業多元化與轉型,才能對資本市場注入更多新的活力。簡而言之,台灣資本市場欠缺「新血」,政府正力推包含物聯網、大數據、綠能產業在內的「五加二」產業,這些新興產業都要是資本市場的未來新星,是讓資本市場「注入新血」、創造多元豐富產業個股樣貌,才能為資本市場帶來資金活水、重建投資人信心。但企業是否願意進入資本市場,關鍵因素包括周轉率、本益比、殖利率,台股周轉率近年來一直在減緩,與交易量減少有直接相關,其實台灣好的股票不少,殖利率平均有4.6%的報酬率,政府卻未把殖利率反映出來,導致市場資金過多卻不願意投入股市,因此應思考如何將資金導引至資本市場。雖然金管會或相關部門也提出包括定期定額買台股或ETF等措施,仍未看到台股有較大的動能。

藥方2:調整股利所得稅 問:資本市場應如何改革?答:投資股票除了賺資本利得,另一個是股利所得,振興資本市場,應該從股利所得稅制調整。我國現行內外資股利所得課稅方式不同,外資採20%稅率分離課稅,比我國居住者個人併入綜合所得課稅,最高稅率達45%優惠許多2015年開始股東可扣抵稅額減半,使得股利所得的稅負負擔上,產生內外資不同,造成稅負不公平的現象。為健全我國資本市場投資環境,鼓勵外資來台投資,並平衡內外資股利所得稅負差異,調整股利所得課稅方式為分離課稅扣繳制度為方式之一。未來不論是維持20%或採取稅率分級,或往下調降,都可以思考;若國人實質所得稅率低於20%應該要用此稅率去計算股利所得進入後的實質繳付稅額,也就是可併入綜所稅課稅。但若高於20%是否和外資一樣採分離課稅20%,或要將外資部分調降成10%15%,以拉抬股市動能,所以不只內資要調整,外資也可以調整。其次,政府要幫助小而美的優質上市櫃公司「被看見」。上市櫃公司1,600多家,加權指數約9,400點,但台積電一家公司可能就占了1,6001,700點,如果少了台積電,台股還剩多少?加權平均指數過於集中,反而忽略一些優質股票。現在每日成交量不到100張的股票,高達500家,將近三分之一,但這500家企業有些很優質,EPS、殖利率高於5%者很多,政府若要活絡資本市場,應該有更多政策去幫助這些優質公司,才能受到投資人關注與瞭解。對於這些小而美的優質股,政府可透過政策去吸引投資人注意。交易所就像一間百貨公司,股票就像是專櫃,應如何去經營各個櫃位,讓每家專櫃都有曝光機會,不能只關注熱區,政府應該思考端出什麼政策,才能吸引消費者去買去逛,投資人才不會只關注某些大公司。

響應新南向 派專員駐點 問:政府積極推動新南向,是否可成為台商的新藍海?答:蔡政府推新南向,需注重在擴大與夥伴國產業供應鏈整合、與當地台商的產業互補,連結在地資源,協助台商在地群聚布局,並瞄準東南亞市場的內需消費需求,享受東協經濟體之間免關稅的好處。舉例來說,中鋼近年積極布局東南亞,投資越南台塑河靜廠在越南當地生產鋼鐵,完成供應上游料源。當地台資中下游用鋼產業,會形成衛星供應鏈,大陸台商也可能在磁吸效應下往東協遷移形成聚落。台商鋼鐵供應鏈站穩東協基地,不僅輸出到東南亞內需市場免關稅,外銷歐美日韓等國也享有零關稅待遇,競爭力自然大幅提升,可以有效化解目前台灣鋼廠出口面臨高關稅的困境,這就是台商「打群架」最佳範例。會計師作為專業服務行業,同樣也跟著台商一起「新南向」。正值新政府推出新南向政策,勤業眾信與Deloitte東南亞會員所也預計在2017年擴大合作規模,預計2017年底前,在越南、泰國、印尼、馬來西亞、菲律賓五國,各派駐一至二位專業服務同仁,透過長期累積的專業知識,以語言優勢全方位服務當地台灣企業。外,吸引更多優質東南亞台商回台灣資本市場掛牌上市,也是我們會計師事務所「新南向」的工作之一。我過去經常與交易所、櫃買中心及券商到東南亞招商,與東南亞各地的台商交流頻繁。東南亞台商的「根」仍在台灣,對回到台灣來掛牌,仍是相當支持,勤業眾信過去運用國際會員所的連結與資源,也引介不少台商或東南亞企業來台上市。

調高營所稅 要完整配套 問:財政部正積極推動稅制改革,您有何建議?答:台灣營所稅17%,若現在要調高,就會牽扯到美國新總統川普上任後要調降企業稅。國際上的趨勢都是調降營所稅,我們卻要調高,應去思考我國調高的目標是什麼。過去因營利事業所得稅率低,政府可運用之租稅獎勵籌碼有限。若這次稅制改革,打算調高營所稅,必須要有配套措施來鼓勵企業投資。政府可以就未來擬推行之產業政策給予適當的租稅減免,例如新增獎勵事業免徵營所稅、公司盈餘轉投資一定產業之股利所得緩課所得稅、或股東投資政府獎勵事業得適用投資抵減等,應可增加政府推行政策籌碼,稅率調增與租稅減免並行。在綜所稅部分,主要是薪資所得,且稅收比率很高,是否為健康正常的現象,值得檢討。所得級距適用不同稅率,高所得者負擔較高的稅負,但有無必要到45%那麼高?且像是二代健保的2%,為了財源稽徵方便,和稅負掛勾十分怪異,保險是使用者付費的概念,所得稅是義務,不應為了課徵方便而綁在一起。另外,我建議政府應重新思考稅制結構,營業稅應有調高的空間。過去提到調高營業稅率,就會擔心物價受影響,但事實上台灣已維持很長一段時間的低通膨,低通膨結果就是會造成長期壓抑物價,但物價隨著相對原物料或人力成本增加,卻未讓它有適度的通貨膨脹,而從成本面抑制,就會發生食安及低薪問題,因此適度的通貨膨脹,若可以讓整個結構有所改善與調整。台灣營業稅5%已維持很久一段時間,且相較其他周邊國家,稅率低很多,應該調高到多少,都可以評估。

郭政弘靠借宿青春 養成溝通力 【記者 劉懿慧、楊美玲】對於現在的年輕人期許,勤業眾信聯合會計師事務所總裁郭政弘認為,除了分析數據能力外,也需培養彈性適應能力、社交溝通技能及自我管理能力。從小在高雄旗山農村長大的郭政弘,父母在做小生意,十分重視教育。為了讓他更有競爭力,希望郭政弘能夠就讀師資較好、升學率較高的國中,因此在小學五年級時就被父母送進市區,也開啟借宿家庭的青少年生活。每周一到周五,郭政弘都住在位在於市區的父母朋友家,周六搭兩個小時的公車,回到旗山家裡,周日晚上再搭兩個小時的公車,回到借宿家庭。很多人都是高中畢業才離開家中,但郭政弘自11歲便離家,總共換過五個不同的借宿家庭,直到雄中畢業,才結束他的「借宿青春」。郭政弘回憶,借宿時因父母不在身邊,許多事都須靠自己,再加上與寄宿家庭成員相處在同一個屋簷下,因此學會彈性適應能力、與他人互動溝通及具備敏銳觀察力,而為避免造成他人困擾,生活管理也必須做好,要有同理心回想這八年,郭政弘認為對他的性格養成是「關鍵時期」,後來在會計師事務所工作時,必須與各行各業的客戶接觸,過去這八年的社交技能也幫助他許多,使他能夠站在客戶角度思考問題,贏得客戶的信任。郭政弘認為,現代社會的變化很快,今年是蘋果發表第一代iPhone的十周年,十年前Nokia還在、只要手上拿一支Sony Ericsson就已經很先進了,當時很難想像,手機市場因iPhone而產生這麼大的革命性變化。現在就連會計行業也因科技發展而出現革命性的改變,但是郭政弘說,有一項人類技能是不可能被機器取代的,就是社交溝通能力。無論科技如何發達,人是有感情、有溫度的,尤其會計行業不只是每天與冷冰冰的數字、財報為伍,而必須透過溝通讓客戶信任,溝通能力非常重要。社會不斷變遷,郭政弘期勉年輕人一定要培養適應環境的能力、面對變化必須要有彈性、有一顆不斷學習的心,另外,自我管理能力同樣是他認為當今年輕人所缺乏的特質,這卻是對公司負責、甚至對自己負責最重要的能力之一。

Friday, February 3, 2017

CDE行政法人化 終於過關! 衛福部 (何啟功) 審查縮短1~2月就很厲害 ~


新藥加速上市期程 將設國家藥物審查中心2017/02/03生技產業 | 呂雪彗/台北報導 生醫新藥審查可望仿效日本快轉!行政院會昨天拍板《國家藥物審查中心設置條例草案》,設立國家藥物審查中心,新藥審查由三階段簡化為二階段,該中心具有提升醫藥品審查速度、縮短新藥上市時程,及輔導諮詢新藥研發等兩大功能,有利打造台灣成亞太生醫研發重鎮,台灣生醫產業可望邁向新的里程碑。 衛生署早於87年捐助成立「財團法人醫藥品查驗中心」,委託該中心執行藥物申請查驗登記及臨床試驗技術資料審查等任務,但歐盟等外商動輒反映新藥審查程序太長,呼籲台灣縮短新藥上市流程,與國際接軌;另查驗中心財務仰賴國家預算,經費不穩定,若改為法人化,財務可自給自足。行政院會昨通過《國家藥物審查中心設置條例草案》,同時搭配《藥事法》修正案。衛福部次長何啟功表示,衛福部參考日本制度,規劃設立行政法人的國家藥物審查中心,專責辦理藥品跟醫材的技術性資料審查。何啟功表示,未來經衛福部公告之新藥,由現三階段縮為二階段,第一階段先送藥物審查中心審查技術性資料;第二階段由食藥署審查公共衛生需要或倫理,給予藥品、醫材上市許可證之核發。至於審查程序可以縮短多少時間?何啟功說,藥品種類很多,若能縮短時間12個月,就算很厲害。另該中心還有一大功能,就是協助國內業者研發時予臨床或非臨床試驗新藥輔導,避免業者走冤枉路,以協助安全有效藥物儘早上市。官員表示,目前新成分新藥平均一半在360天審查完成,學名藥僅41%在180天(半年)完成,個案差別很大,有的年限更長,國內外藥商皆抱怨審查效率太慢,未來查驗中心法人化後,期五年內讓新成分新藥90%比率360天內完成;學名藥90%在180內完成。

 

(The Lancet) 過量食用荔枝(litchi, Lychee)小心hypoglycin A, MCPG (methylenecyclopropylglycine): 低血糖抽搐


印度百童怪病亡 疑因空腹吃荔枝 20170203日【國際中心╱綜合報導】印度東北部一個小鎮每年夏天都有數百名兒童突然發高燒、抽搐,上百人因此死亡。專家研究多年,發現死因可能跟當地盛產的荔枝有關。近日刊於《刺胳針-全球衛生》期刊的研究指,印度穆札佛普爾鎮2014年時,近400名兒童突然染怪病,其中122人死亡。起初專家以為是貧窮地區營養不足或吃太多含農藥的農作物導致。但印度與美國專家聯手調查發現,染病的兒童發病前通常吃了許多荔枝,回家後可能就不想晚飯,導致血糖降低。正常狀況,血糖降低後,身體開始代謝脂肪酸,製造所需的葡萄糖,但這些病童的尿液樣本顯示,約2/3病童體內含存在於荔枝種子的毒素、次甘氨酸,使其體內無法合成葡萄糖。血糖過低時很快就出現急性腦腫而抽搐、失去知覺等症狀。印度政府前天據此研究,呼籲家長限制孩童吃荔枝的量且確保一定要吃晚餐。但研究也稱,盛產荔枝地區的兒童約每百人才1人發病,顯示可能不僅和吃荔枝有關,可能還包括遺傳基因變異等問題,須進一步研究。林口長庚臨床毒物科主任顏宗海昨表示,荔枝糖分高,吃多會致血糖升高,印度例子較特別,不能以單一因素解釋,有可能是小朋友本身營養不良,或遺傳基因變異,加上空腹大量吃荔枝,導致低血糖。台灣臨床沒有大量吃荔枝導致低血糖的病例。他提醒,若家人出現大量冒汗、意識不清,甚至抽搐或昏迷,可能是血糖過低的警訊,趕緊讓他們吃一顆糖並盡快送醫。

Lychee identified as cause for mystery deadly childhood illness in India Updated yesterday at 2:13pm For more than two decades, apparently healthy children in the Indian region of Bihar suffered sudden seizures and lost consciousness. A third of them died, leaving doctors baffled. But a team of American and Indian scientists say they have found the cause of the mystery illness, which killed more than 100 children a year: eating too many lychees on an empty stomach. The research, published in medical journal The Lancet, has found lychees — particularly unripe fruits — contain an amino acid that affects blood glucose levels. "Parents in affected villages report that during May and June, young children frequently spend their day eating lychees in the surrounding orchards; many return home in the evening uninterested in eating a meal," the researchers wrote, saying most children then arrived at hospital unconscious or having seizures in the middle of the night or early morning.  In South-East Asia, outbreaks of similar illnesses have been reported from lychee-growing areas of Bangladesh and Vietnam. 

How has this link not been made before?  The researchers said the lychee's potential toxic effects were noted in ancient literature from China, where the fruit originates, however the commercial lychee industry in India is relatively young and has expanded quickly. "This knowledge has been slow to reach certain parts of Asia where the so-called mysterious lychee disease has been attributed to various causes (fruit colouring, heat stroke) in Bihar, India, to an unidentified pesticide in north-west Bangladesh and, after an exhaustive negative virological search, to a yet-to-be-discovered neurotropic virus in northeast Vietnam," Professor Peter Spencer and Dr Valerie Palmer wrote in a Lancet paper discussing the research. The amino acid found to be the culprit is found in the fruit of many members of the Soapberry family, which also includes the lychee, along with rambutan, longan and ackee. To guard against the illness, the researchers recommended minimising lychee consumption and making sure children had an evening meal. The children's age and state of nourishment were also factors. If a child did become ill, the researchers said they should be treated quickly to correct their glucose levels to prevent lasting damage such as mental impairment, muscle weakness and movement disorders.  "Fortunately, the high cost of these imported fruits and the likelihood that would be eaten in small quantities by well-nourished consumers, suggests there is little reason for concern in the USA," Professor Spencer and Dr Palmer noted.  However, lychee production is increasing in Australia. The researchers also said there were now studies looking at how to put the lychee's glucose-lowering properties to good use in treating metabolic syndrome.

Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control study  (The Lancet) , Published: 30 January 2017

Background Outbreaks of unexplained illness frequently remain under-investigated. In India, outbreaks of an acute neurological illness with high mortality among children occur annually in Muzaffarpur, the country's largest litchi cultivation region. In 2014, we aimed to investigate the cause and risk factors for this illness.

Methods In this hospital-based surveillance and nested age-matched case-control study, we did laboratory investigations to assess potential infectious and non-infectious causes of this acute neurological illness. Cases were children aged 15 years or younger who were admitted to two hospitals in Muzaffarpur with new-onset seizures or altered sensorium. Age-matched controls were residents of Muzaffarpur who were admitted to the same two hospitals for a non-neurologic illness within seven days of the date of admission of the case. Clinical specimens (blood, cerebrospinal fluid, and urine) and environmental specimens (litchis) were tested for evidence of infectious pathogens, pesticides, toxic metals, and other non-infectious causes, including presence of hypoglycin A or methylenecyclopropylglycine (MCPG), naturally-occurring fruit-based toxins that cause hypoglycaemia and metabolic derangement. Matched and unmatched (controlling for age) bivariate analyses were done and risk factors for illness were expressed as matched odds ratios and odds ratios (unmatched analyses).

Findings Between May 26, and July 17, 2014, 390 patients meeting the case definition were admitted to the two referral hospitals in Muzaffarpur, of whom 122 (31%) died. On admission, 204 (62%) of 327 had blood glucose concentration of 70 mg/dL or less. 104 cases were compared with 104 age-matched hospital controls. Litchi consumption (matched odds ratio [mOR] 9·6 [95% CI 3·6 – 24]) and absence of an evening meal (2·2 [1·2–4·3]) in the 24 h preceding illness onset were associated with illness. The absence of an evening meal significantly modified the effect of eating litchis on illness (odds ratio [OR] 7·8 [95% CI 3·3–18·8], without evening meal; OR 3·6 [1·1–11·1] with an evening meal). Tests for infectious agents and pesticides were negative. Metabolites of hypoglycin A, MCPG, or both were detected in 48 [66%] of 73 urine specimens from case-patients and none from 15 controls72 (90%) of 80 case-patient specimens had abnormal plasma acylcarnitine profiles, consistent with severe disruption of fatty acid metabolism. In 36 litchi arils tested from Muzaffarpur, hypoglycin A concentrations ranged from 12·4 μg/g to 152·0 μg/g and MCPG ranged from 44·9 μg/g to 220·0 μg/g.

Interpretation Our investigation suggests an outbreak of acute encephalopathy in Muzaffarpur associated with both hypoglycin A and MCPG toxicity. To prevent illness and reduce mortality in the region, we recommended minimising litchi consumption, ensuring receipt of an evening meal and implementing rapid glucose correction for suspected illness. A comprehensive investigative approach in Muzaffarpur led to timely public health recommendations, underscoring the importance of using systematic methods in other unexplained illness outbreaks.

Funding US Centers for Disease Control and Prevention.

Evidence before this study We searched PubMed between Jan 30, and April 30, 2013, before our 2013 field investigation, for any studies related to the acute unexplained neurological illness in Muzaffarpur using the search terms "Muzaffarpur," AND ("encephalitis" OR "encephalopathy" OR "seizure.") This identified two articles that suggested potential causes for the outbreak illness varying from Japanese Encephalitis virus, another unknown virus, to heat stroke. Following the results of our 2013 investigation, which suggested hypoglycaemia might be an important factor in illness, and raised the possibility of a toxic origin, we repeated a PubMed search in December, 2013, using terms ("ackee hypoglycin" OR "ackee encephalopathy" OR "glycine analog AND litchi" OR "litchi encephalopathy" or "litchi methylenecyclopropylglycine" (MCPG), OR "Jamaican vomiting sickness") for studies describing an association between litchis, ackee fruit, hypoglycin, MCPG and acute neurologic illness published between Jan 1, 1954, and Dec 1, 2013. We found 61 studies; 11 described cases or outbreaks of ackee fruit poisoning which implicated hypoglycin toxicity; an additional 11 studies described the pathophysiology of hypoglycin A in animal models, and five described methods to characterise hypoglycin A in ackee fruits. An ecological study from 2012 from Vietnam indicated an association between litchi plantation surface area and acute encephalitis incidence. A study from 1962 described the isolation of MCPG in litchi seeds, and two studies from 1989 and 1991 described the hypoglycaemic effect of MCPG in animal studies. No studies implicated a direct epidemiological association between litchi consumption in affected individuals and encephalopathy. No studies showed hypoglycin or MCPG or their metabolites in affected individuals.

Added value of this study This study, to the best of our knowledge, is the largest investigation of the Muzaffarpur outbreak and the first comprehensive confirmation that this recurring outbreak illness is associated with litchi consumption and toxicity from both hypoglycin A and MCPG. We confirm the presence of MCPG and hypoglycin in litchis, and, for the first time, our data show the metabolites of these toxins in human biological specimens, the biological impact of these toxins on human metabolism, and the modifying effect of the lack of an evening meal on the impact of these toxins.

Implications of all the available evidence  Based on the results of our investigation, public health and clinical recommendations targeted at preventing illness and reducing morbidity and mortality from the Muzaffarpur outbreak illness were provided to state and national health authorities. This included recommendations to minimise litchi consumption among young children in the affected area, to ensure that children receive an evening meal throughout the outbreak period, and to rapidly assess and correct hypoglycaemia in any child suspected of having the outbreak illness. Evaluation of other potential factors, including missed evening meal, poor nutritional status, and as yet unidentified genetic differences, may provide further insights into additional risk factors for this outbreak illness. Application of a similar comprehensive and systematic approach to the evaluation of both infectious and non-infectious aetiologies of unexplained illness outbreaks in other parts of the world has the potential to contribute toward identifying interventions that can reduce morbidity and mortality.

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