On October 9, 2018, Taiwan Centers for Disease Control (Taiwan CDC) announced an  imported cluster of malaria among Taiwanese nationals. The cases are 2 students from a university in northern Taiwan. During September 10 and 23, they traveled to Uganda, Africa for social work with 10 other students and teachers from the same school. The 2 of them respectively developed symptoms such as fever, chills, nausea, vomiting and muscle ache on October 4 and 6, and sought medical attention. Infection with malaria was laboratory confirmed in the cases after they were reported to the competent health authority. As of now, the 2 cases’ symptoms have improved and they are still hospitalized for treatment. The local health authority will continue to follow up on the cases until their specimens are tested negative.

According to the epidemiological investigation, the 2 cases both visited the outpatient travel clinic for consultation and took malaria prophylaxis prior to the trip. One of them only took the medicine for 2 days, while the other took the medicine irregularly. Among the other 10 people who traveled with the cases, 1 developed symptoms and was diagnosed with malaria in Uganda. This individual completed the treatment for malaria, and had fully recovered from the disease prior to returning to Taiwan. 1 other individual experienced headache after returning to Taiwan. The local health authority has provided the person with relevant health consultation. The other 8 people have not experienced any suspected symptoms.

According to the surveillance data compiled by Taiwan CDC, as of October 8, a total of 5 malaria cases have been confirmed in Taiwan thus far this year. All 5 cases are imported cases; 2 acquired infection in Uganda, the other 3 acquired infection in India, Kenya, and Solomon Islands respectively. Among these cases, 3 were found to be infected with Plasmodium falciparum, 1 was infected with Plasmodium vivax, and 1 with mixed species. The total number of cases thus far this year is relatively lower than those reported during the same period from 2014 to 2017, which were respectively 15, 7, 11 and 7. Over the past 5 years, the majority of the reported cases became infected in Africa. In addition, the most commonly identified parasite species in the specimens is Plasmodium falciparum, followed by Plasmodium vivax.

Malaria is caused by bites from anopheles mosquitoes, which are infected with the malaria protozoan. Protozoa of Plasmodium Vivax and Plasmodium ovale can remain dormant in liver for months or even years. Most infected individuals develop symptoms 7 to 30 days after infection. Early symptoms are similar to those of influenza. The main symptom is high fever. Other symptoms include headache, muscle soreness, joint pain, nausea, vomiting and fatigue. If the patient is not treated appropriately, symptoms of intermittent or periodic cold shivering (chills and shivering), high fever and sweating may occur. In more severe cases, malaria infection may lead to splenomegaly, jaundice, shock, liver and kidney failure, pulmonary edema, acute brain diseases and coma.

Taiwan CDC once again urges people traveling to areas affected by malaria to visit the outpatient travel clinic at contracted hospitals in the nation at least one month prior to their departure to assess the risk of infection, take the malaria prophylaxis according to the doctor’s orders. Throughout the trip, travelers are advised 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 to lower the risk of infection, and staying at accommodations installed with window screens, screen doors or air conditioners. Taiwan CDC emphasizes if suspected symptoms develop after returning to Taiwan, please proactively contact the quarantine officer at the fever screening station at the airport, seek immediate medical attention, and inform the doctor of any recent travel history and any malaria medicine taken to facilitate prompt diagnosis and treatment. For more information, please visit Taiwan CDC’s website at https://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Consultation Hotline, 1922 (or 0800-001922).