On October 4, 2016, the Taiwan Centers for Disease Control (Taiwan CDC) announced this year’s second imported case of Lyme disease in a 60-year-old Taiwanese female.　She permanently resides in Massachusetts, US with her family. On September 11, when she developed paralysis on the right side of her face and rashes on her limbs, she sought medical attention there. On September 14, she returned to Taiwan. On September 19, when her symptoms persisted, she sought further medical attention at a hospital and informed her physician that she was diagnosed with Lyme disease in the US. Infection with Lyme disease was laboratory confirmed in the case after the hospital reported her to the health authority. As of now, the case has been discharged from the hospital.

During her incubation period (August 11 and September 8), the case came into contact with a wild deer in a bush area in Massachusetts and was bitten by ticks. Based on the case’s activity history during the incubation period and the Lyme disease prevalent area, it was determined that the case became infected in the US.

Thus far this year, a total of 2 cases of Lyme disease have been confirmed in Taiwan and both are imported cases. The two cases respectively are a Swedish and a Taiwanese, and they became infected in Sweden and US. Since 2007, a total of 12 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 (7), followed by Americans (4), and Swedish (1). In addition, most of them became infected in the US (8), followed by Denmark (1), the UK (1), and Germany (1). Lyme disease is primarily found in North America, especially the north eastern part, North Asia, Central Asia, Canada, South America, Japan, Korea and China.

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). 70-80% 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).