On August 4, 2016, the Central Epidemic Command Center (CECC) for Zika Virus announced the fourth imported case of Zika virus infection identified in Taiwan.　 The case is a 43-year-old Taiwanese female. During February 21 and July 22, 2016, she traveled to St. Lucia with her husband for work. On July 24, she returned to Taiwan. On July 26, she sought medical attention at a clinic after developing nausea, vomiting, fever, runny nose, joint pain and muscle ache. On July 29, she sought further medical attention after developing rash on her face and limbs. After the healthcare provider reported her to the health authority as a suspected case, infection with Zika was confirmed in the case on August 3.

The case is not pregnant. In addition, the gene sequence of the virus detected in the case is similar to the virus strain identified in Martinique, Panama and Colombia. Based on the viremic phase of her infection, the case should prevent mosquito bites and isolate herself till August 6 and follow the the “2226 Principle” to prevent further spread. As of now, the case is highly cooperative and her symptoms have subsided. None of the 4 family members who reside in the same household have developed symptoms. The local health authority has implemented various prevention measures, including cleaning of vector breeding sites, investigating the mosquito population density around the case’s residence, and providing the case’s family members with relevant health education. A travel notice of Level 2: Alert for Zika virus has been issued for St. Lucia.

Since January 2016, 4 imported Zika cases have been identified in Taiwan. Thus far, no indigenous cases have been reported in Taiwan. Taiwan CDC has been implementing 6 major prevention and control measures that focus on offshore and border control to ward off Zika transmission, including mosquito control for aircrafts, health education for arriving and departing passengers, fever screening of all inbound travelers, traveler’s health declaration, blood tests at ports, and hospital referrals.　

Current scientific evidence has proved that Zika virus infection is usually mild in adults and suggested the occurrence of congenital microcephaly and even deaths in babies of mothers who were infected with Zika virus while pregnant. In addition, pregnant women during their first trimester (3 months) are at higher risk of contracting the virus. Therefore, pregnant women and women planning pregnancy are advised to postpone all unnecessary travels to Zika-affected areas. CECC for Zika Virus urges travelers returning to Taiwan from Zika-affected areas to follow the “2226 Principle” to prevent Zika transmission. The “2226 Principle” specifies that female travelers are urged to seek immediate medical attention if they develop suspected Zika symptoms within 2 weeks of their return from an affected-area and postpone pregnancy 2 months after their return regardless whether they develop suspected Zika symptoms, and male travelers, if they do not develop suspected Zika symptoms, are urged to avoid sex or use condoms correctly for 2 months after their return from an affected-area and if they develop suspected Zika symptoms, they are urged to avoid sex or use condoms correctly for 6 months after their return.

Thus far, at least 64 countries, areas and/or territories worldwide, primarily in Latin America and the Caribbean region, have reported local outbreaks of Zika virus infection. Taiwan CDC has issued a travel notice of Level 2: Alert for Zika virus for 54 countries and territories, including 4 countries in Asia: Thailand, the Philippines, Vietnam and Indonesia.　　

Travelers visiting affected areas are once again urged to take precautions against mosquito bites such as wearing light-colored clothing, long sleeves and long pants, applying officially approved mosquito repellent to exposed parts of the body, staying at accommodations installed with window screens, screen doors or air conditioners. Further, Taiwan CDC urges travelers returning from affected areas to proactively contact the quarantine officer at the fever screening station at the airport when suspected symptoms develop. If symptoms develop within two weeks of their return, please seek immediate medical attention and inform the physician of their travel history. 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).