In the evening of April 22, 2014, the Taiwan Centers for Disease Control (Taiwan CDC) confirmed the third imported case of H7N9 avian influenza in a 44-year-old female from Nanjing, Jiangsu, China. When the patient traveled to Taiwan on April 17, she was already experiencing some symptoms such as dry cough, fever and muscle soreness prior to leaving China. After she arrived in Taiwan, she visited a local clinic in New Taipei City to seek medical attention. On April 18, her illness progressed. On April 19, she was hospitalized in a local hospital due to left-sided pneumonia. On April 20, she was transferred to a medical center by an ambulance with the tourist group leader for further treatment. Oseltamivir was then prescribed to the patient. After the medical center reported the case to Taiwan CDC, infection with avian influenza A (H7N9) was confirmed through the sputum specimen on April 22. Currently, the patient is in a severe condition and being treated at the Intensive Care Unit (ICU) with negative pressure. According to the epidemiological investigation, the patient had bought slaughtered chicken at a wet market in Liuohe, Nanjing before developing her illness. At present, no symptoms have been identified in all members of her family. The 34-member tour group, including the guide and driver, are continuing their schedule of travel till April 24. Thus far, none of the contacts have developed related symptoms.

Taiwan CDC pointed out that the patient has already visited a number of scenic spots in Taipei City, New Taipei City and Nantou County.Taiwan CDC has obtained the detailed itinerary of the patient’s trip and accommodation information. At the time of writing, Taiwan CDC is working on obtaining the list of people who have come into contact with the patient, including passengers on the same flight and healthcare workers at the clinic and the hospital where the case has sought medical attention, for investigation and follow-up activities. Close contacts that were issued “Self-Health Management Advice for H7N9 Influenza”will be followed up by the public health authority closely until the period of voluntary contact tracing is lifted. Close contacts were also provided with oseltamivir prophylaxes and asked to put on a mask when they develop influenza-like illness such as fever and cough. In addition, the public health authority will voluntarily assist the individual in seeking medical attention. Taiwan CDC is in the process of reporting this case to the World Health Organization (WHO) through the National IHR Focal Point.

The patient is the third imported case of H7N9 avian influenza in Taiwan, following the first and second cases that were respectively confirmed on April 24 and December 31, 2013. Since “H7N9 influenza” was listed as a Category V Notifiable Infectious Disease in Taiwan on April 3, 2013, thus far, a cumulative total of 576 suspected H7N9 cases have been reported to Taiwan CDC and infection with avian influenza A (H7N9) has been confirmed in 3 imported cases (from Mainland China).

As the second H7N9 influenza wave has been on decline since February 2, most recent cases are sporadic and the number of provinces and cities where cases are distributed has also decreased. According to WHO, since the beginning of last Autumn (October 1, 2013), a cumulative total of 290 H7N9 influenza infections have been confirmed around the world. All of the cases are either Chinese nationals or imported from China. Taiwan CDC has issued a travel notice of Level 2: Alert for avian influenza to Hunan Province, Anhui Province, Jiangsu Province, Guangdong Province and Fujian Province, and a travel notice of Level 1: Watch for avian influenza to the other provinces and cities in China, excluding Hong Kong and Macau.

As the risk and threat of H7N9 influenza transmission remain, Taiwan CDC once again urges travelers visiting China to practice good personal hygiene such as washing hands frequently and putting on a mask, take preventive measures such as avoiding direct contact with poultry and birds or their droppings, avoiding visiting traditional markets with live poultry, consuming only thoroughly cooked poultry and eggs. If symptoms such as fever and cough develop after returning to Taiwan, please put on a surgical mask and seek immediate medical attention. Moreover, please inform the physician of the recent travel history to facilitate diagnosis and treatment. For more information, please call the toll-free Communicable Disease Reporting and Care Hotline, 1922, or 0800-001922 if calling from a cell phone, or visit the Taiwan CDC’s website at http://www.cdc.gov.tw.