On August 25, 2016, the Taiwan Centers for Disease Control (Taiwan CDC) confirmed this year’s first imported case of Lyme disease in a 53-year-old Swedish male. In early August, the case developed fatigue and knee pain. On August 17, the case sought medical attention at a clinic. On the following day, when his symptoms persisted and he developed rash on his groin, he sought further medical attention at a hospital. Infection with Lyme disease was then laboratory confirmed in the case. As of now, the case has resumed his normal schedule and is not experiencing any discomforts.

According to the epidemiological investigation, the case frequently travels back and forth between Taiwan and Sweden. During the incubation period (July 18 and August 14, 2016), the case was in Sweden and got tick bites at home in Sweden. Although ticks had been found on his family members in Sweden, none of them was bitten by ticks. 　 Further, the case visited a local ranch in the end of July, but he did not come into contact with cows. Based on his activities during the incubation period and the fact that Lyme disease is endemic in Sweden, it is determined that the case became infected in Sweden.

Thus far since 2007, a total of 11 cases of Lyme disease have been confirmed in Taiwan and all of them are imported cases. No deaths associated with Lyme disease have been reported.　During 2007 and 2015, the majority of the cases are Taiwanese (6), followed by Americans (4). In addition, most of them became infected in the U.S. (7), followed by Denmark (1), the U.K. (1), and Germany (1). This year’s first imported case reported in Taiwan is Swedish who became infected in Sweden. Lyme disease is primarily found in North America and Europe. Moreover, the number of cases reported in Europe has continued to escalate every year since 1990. In 2010, a total of 35,000 cases were reported, which is 14 times more than that reported in 1990. Countries with a higher incidence include Slovenia, Lithuania, Estonia, and the Czech Republic. In Sweden, Lyme disease is frequently reported along the coast of the Baltic Sea and the Gulf of Bothnian.

Lyme disease is a zoonotic disease transmitted to humans through the bite of infected ticks. The disease is not infectious from person to person. In the wild, ticks primarily host on rats. The incubation period of Lyme disease varies from 3 to 32 days (average : 7-10 days). 0-80% of infected individuals develop erythema migrans (EM) rash. Early signs after tick bite include cold-like symptoms such as headache, fever, swollen lymph nodes, sore throat, and neck stiffness. Without treatment, complications involving the heart and nervous system can occur.

Taiwan CDC urges the public to take prevention measures when visiting affected areas or outdoor to ward off infection. Some of the prevention measures include wearing protective clothing such as long-sleeve shirts, pants, gloves and boots, tucking pants into socks, applying insect repellents to exposed skin to prevent tick bites, and changing clothes and taking a shower immediately after a visit to the bush area to reduce the risk of infection. If a tick is found attached to the skin, please promptly remove the tick using fine-tipped tweezers with caution to prevent causing the mouth-parts to break off and remaining in the skin, and clean the bite site using soap and water to lower the risk of infection. If suspicious symptoms develop, please seek medical attention immediately and inform the doctor of your travel and exposure history to serve as a reference for clinical diagnosis. For more information, please visit the Taiwan CDC website at http://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Consultation Hotline, 1922 (or 0800-001922).