On January 19, 2016, the Taiwan Centers for Disease Control (Taiwan CDC) announced the first imported case of Zika virus infection identified in Taiwan. The case is a Thai male who was stopped by the quarantine officer at the fever screening station upon his arrival in Taiwan Taoyuan International Airport. Infection with Zika virus was confirmed in the case through testing his blood samples by the Taiwan CDC laboratory. This is the first case of Zika virus infection detected among the 50,000 samples collected by the Taiwan CDC laboratory since 2003. As Zika virus is rampant in Central and South America, to ensure the health and wellbeing of the people in Taiwan, Taiwan CDC is to list Zika virus infection as a Category II Notifiable Infectious Disease according to relevant regulations. As a result, a physician needs to report a suspected case within 24 hours once identified. In addition, Taiwan CDC is raising the travel notice level for Central and South America and six countries in Southeast Asia.

The case is a 24-year-old Thai male who resides in northern Thailand. Upon his arrival in Taiwan on January 10, he was detected with a fever by the fever screening station and was stopped by the quarantine officer. According to the case, prior to his trip to Taiwan, he was in Thailand for the past three months and it was his first visit to Taiwan, When he was in Thailand on January 9, he already experienced symptoms such as fever and headache. After specimens were collected from him, he was tested negative for dengue virus by the dengue NS1 rapid test and his specimens were submitted to the Taiwan CDC laboratory for further testing. He was then confirmed to have Zika virus infection. The other two travelers traveling with him are his coworkers who both reside in northern Thailand as well. Although one of them experienced sore threat and headache, the symptoms subsided after seeking medical attention. The other one of them experienced a mild sore throat and mucus. Both of them were tested negative for Zika virus and dengue virus. As of now, the case is currently stable and recovering. The other 5 people who stayed with the case and 10 coworkers who worked with the case in Taiwan have not experienced any suspected symptoms. The local health authorities had implemented cleaning of vector breeding sites and investigated the mosquito population density around the cases’ office.

During the second half of 2015, Zika virus spread rapidly in Central and South America. As of now, at least 17 countries in Central and South America and the Caribbean have reported local outbreaks. Beside the aforementioned areas, Cape Verde in Africa has also reported indigenous cases. Sporadic, imported cases from Central and South America and Southeast Asia have been reported in Europe, the U.S. and Canada. Countries in Asia that have identified Zika virus infection include Cambodia, Malaysia, the Philippines, Thailand and Indonesia. During 2013 and 2015, imported cases from Malaysia, Thailand, Maldives and Indonesia were reported. On the other hand, in Brazil, some cases of Zika virus infection developed microcephaly. In French Polynesia, some cases of Zika virus infection developed Guillain-Barré syndrome (GBS). A Hawaii baby born with microcephaly had prior Zika virus infection from the mother who was an imported case of Zika virus infection. The connection between these neurologic conditions and Zika virus infection requires further studies.

As the number of microcephaly cases reported in Central and South America and the Caribbean has dramatically increased, Zika virus poses threat to pregnant women. Hence, Taiwan CDC decided to raise the travel notice level for Central and South America and the Caribbean to Level 2: Alert for Zika virus. In addition, Cambodia, Indonesia, Malaysia, the Philippines, Thailand, and Maldives are also at risk of transmission. As the first case in Taiwan was imported from the region, Taiwan CDC decided to raise the travel notice for the six countries in Southeast Asia, including Cambodia, Indonesia, Malaysia, the Philippines, Thailand, and Maldives to Level 1: Watch for Zika virus. Moreover, Taiwan CDC advises pregnant women to postpone their trips to areas affected by Zika virus. If visits to affected areas are necessary, please notify the physician beforehand and take precautions accordingly. Further, Taiwan CDC urges travelers visiting affected areas to take precautions against mosquito bites such as wearing light-colored clothing, long sleeves and long pants, and applying officially approved mosquito repellent to exposed parts of the body. 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).