On September 30, 2016, the Taiwan Centers for Disease Control (Taiwan CDC) scaled up the travel notice level for Maldives to Level 2: Alert for Zika virus based on the latest updates provided by the World Health Organization (WHO) on September 29 concerning the imported cases from Maldives reported in Germany and Spain and in view of the potential risk of local transmission of Zika virus. Pregnant women and women planning pregnancy are advised to postpone their trips to areas where Zika virus is active, travelers visiting areas with ongoing Zika transmission are advised to avoid mosquito bites, and people returning from Zika-affected areas are advised to follow the “1+6 Principle”. The “1+6 Principle” specifies that people who have recently traveled to Zika-affected areas should monitor their own health and take precautions against mosquito bites for at least three weeks, postpone blood donation for at least 1 month and regardless whether they develop suspected Zika symptoms, they should practice safe sex for at least 6 months to prevent Zika transmission. In addition, female travelers should postpone pregnancy for at least 6 months.　

Since 2015, at least 70 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 62 countries and territories with ongoing outbreaks or possible local transmission of Zika virus, including 7 countries in Asia: Thailand, the Philippines, Vietnam, Indonesia, Singapore, Malaysia and Maldives, and 4 counties in Florida: Broward, Miami-Dade, Pinellas and Palm Beach counties. Moreover, during 2007 and 2015, about 8 countries, including Cambodia, Laos, and Bangladesh, reported Zika outbreaks. Nonetheless, thus far in 2016, no Zika cases have been reported in those 8 countries. Hence, Taiwan CDC has issued a travel notice of Level 1: Watch for Zika virus for those countries.　

Among the aforementioned countries, 21 countries have reported cases of congenital microcephaly and 18 countries have reported Guillain-Barré syndrome cases or observed an increase in the number of GBS cases reported. The currently available clinical and epidemiological data have suggested a strong link between Zika virus infection and fetal brain defects such as microcephaly. In light of the recent rapid geographic expansion of Zika virus, the increase in Zika activity in neighboring Southeast Asian countries, and the increased activity of the mosquito vector, the risks of importing Zika cases into Taiwan and having a local outbreak are thus elevated.　

Taiwan CDC urges travelers returning to Taiwan from Zika-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. At the same time, physicians are urged to heighten vigilance for suspected cases, inquire patients of their travel history when necessary and report suspected cases to the competent health authority as soon as possible. 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).