On August 19, 2016, the Taiwan Centers for Disease Control (Taiwan CDC) scaled up the travel notice level for the Bahamas to Level 2: Alert for Zika virus based on the latest updates on recent local transmission of Zika virus provided by the World Health Organization (WHO) on August 18. 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 “2226 Principle”.

Thus far, at least 67 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 57 countries and territories with ongoing outbreaks or possible local transmission of Zika virus, including 4 countries in Asia: Thailand, the Philippines, Vietnam and Indonesia, as well as Broward and Miami-Dade counties, Florida. Moreover, during 2007 and 2015, about 10 countries, including Cambodia, Indonesia, Malaysia, Laos, and Bangladesh, reported Zika outbreaks. Nonetheless, thus far in 2016, no Zika cases have been reported in those 10 countries. Hence, Taiwan CDC has issued a travel notice of Level 1: Watch for Zika virus for those countries.

Among the aforementioned countries, 17 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. Although some countries have reported a gradual decline in the number of Zika virus infection cases, Zika outbreaks continue to persist worldwide. Hence, the outbreaks are expected to spread to other countries with the vector mosquitoes. The public is urged to remain vigilant for the virus.　

Although the disease is usually mild in adults, there have been reports of congenital microcephaly and even deaths in babies of mothers who were infected with Zika virus while pregnant. Taiwan CDC advises pregnant women and women planning pregnancy to postpone all unnecessary travels to Zika-affected areas. In addition, travelers are advised to follow the “2226 Principle” after leaving the affected areas to prevent Zika transmission, which specifies that female travelers are urged to 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.

Travelers visiting affected areas are 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).