On February 18, 2014, the Taiwan Centers for Disease Control (Taiwan CDC) announced the third and fourth imported cases of measles confirmed this year. The two cases are nine-month-old twin girls who traveled to the Philippines with their parents to visit their relatives. After returning to Taiwan on January 19, they subsequently developed fever and rash. After seeking medical attention and being reported to the health authority, measles infection was confirmed in the two cases. On February 15, they were discharged upon recovery and removed from isolation. To prevent further spread of the disease, the health authority has compiled a list of 961 contacts to monitor their health and administer follow up activities such as post-exposure prophylaxis until March 3. As of now, none of the contacts has developed suspected symptoms.  

During 2 to 4pm on February, the cases visited Costco’s North Kaoshiung Dashun Store. Hence, Taiwan CDC urges people who visited the same store on the same day to remain vigilant for measles infection and monitor their own health for 18 days till February 26. If symptoms pertaining to measles such as fever and rash develop, please seek immediate medical attention and voluntarily notify the physician of the relevant exposure history.

The ongoing measles outbreaks in the Philippines have continued to persist. Manila, Calabarzon, Luzon and Mindanao Island are the more severely affected areas. Recently, a number of other countries have reported measles cases, including Singapore, Australia, New Zealand, Canada and Japan. Most cases became infected because they were unvaccinated against measles. The number of measles cases reported in Vietnam has been on the rise. Thus far this year, as of February 5, a cumulative total of 620 measles cases, including 7 deaths in children, have been reported in Vietnam, which is the highest among the same period during the past three years. Over 160 children have been hospitalized due to measles infection. Among them, 20 experienced severe pneumonia and respiratory failure. Most of them were unvaccinated. In addition, measles cases have been reported in a number of provinces in Vietnam, including Hanoi City, Yen Bai Province, Lao Cai Province, Son La Province, and Ho Chi Minh City.

Measles is a highly infectious respiratory disease that is spread by contact with droplets from the nose, mouth or throat of an infected person, either directly or through aerosol transmission. Nevertheless, measles is vaccine-preventable. Travelers visiting the Philippines and Vietnam are urged to pay attention to personal hygiene and avoid brining children under one year old and those who have not completed the MMR vaccine series to the affected areas. On the other hand, some teenagers who have not been infected with measles or those who received the MMR vaccine when young, but their measles antibody level has decreased over time are still at risk for infection. Therefore, they are advised to receive the MMR vaccine two to four weeks prior to their departure to prevent infection.

To facilitate prompt diagnosis and case reporting, Taiwan CDC has notified the healthcare professionals and medical associations to remind physicians to stay vigilant. If a patient develops symptoms pertaining to measles infection such as fever, rhinitis, conjunctivitis and rash, the physician should consider the patient’s recent travel history and vaccination history when diagnosing and report any suspected cases to the health authority as soon as possible. People who return from endemic areas and seek medical attention should inform the physician of their recent travel history to help diagnosis and timely treatment. For any questions or further information, please visit the Taiwan CDC’s website at http://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Care Hotline, 1922, or 0800-001922 if calling from a cell phone.