On March 14, 2011, the Taiwan Centers for Disease Control (Taiwan CDC) announced this year’s third confirmed indigenous case of measles in Taiwan.The case is a one-year-old male baby who has not received the MMR (measles, mumps and rubella) vaccine.After an in-depth epidemiological investigation, the three measles cases confirmed this year all reside in Wenshan District, Taipei City. Case 1 (a 28-year-old foreign student) and Case 2 (a 20-year-old Taiwanese female) live within a 10-minute walk to each other, while Case 3 live in the same community with Case 2.Although the three cases do not know one another, the sequencing of the measles virus isolates from the three cases showed the same genotype.It is initially determined that they were exposed to the same source of virus and Case 3 probably became infected by Case 2, an indigenous case.Due to the spatial proximity of the three cases’ residences and the fact that measles is highly contagious, the residents living in the same district are urged to seek immediate medical attention when suspected symptoms developed.At the same time, physicians are advised to include measles in the differential diagnosis of patients with suspected symptoms and report suspected cases in accordance with the law in order to promptly implement appropriate isolation protocols and appropriate treatment.The local health bureau has reinforced health education messages to raise measles awareness in the community of Case 3.

Since measles is a highly contagious respiratory disease and a case remains infectious four days before and after the onset of rash, health authorities have implemented all the necessary prevention control measures upon receiving reports of the three measles cases.All the contacts of Case 1, approximately 400 people, were asked to monitor their health and educated about measles.On-site epidemiological investigations were conducted at the public transportation taken and places visited by Case 1 and Case 2.As Case 2 took public transportation to Pingxi Township, New Taipei City (formerly known as Taipei County) when she was still infectious, Taiwan CDC immediately announced about the case and advised close contacts of the case to monitor their health for 18 days.

Epidemiological investigations have been conducted at the residence and the treating hospital of Case 3.Further, as a post-exposure prophylaxis, on March 9, two contacts of Case 3 who are aged below one year and have been evaluated by physicians were given immunoglobulin to prevent measles infection.18 contacts of Case 3 are infants reaching the age for receiving MMR vaccination and one of the infants who was not vaccinated against MMR previously was immediately given the vaccine.Health authorities will continue to monitor the health of the 155 contacts of Case 3 who live in the same building with the case.Currently, no new suspected case has been detected.

Measles is a highly infectious respiratory disease that is spread by contact with droplets from the nose, mouth or throat of an infected person, either directly or through aerosol transmission.Measles is more common during late winter and spring.Early symptoms include fever (over 38℃), coryza, cough, and conjunctivitis.Rash usually starts from behind the ears and spread to the face and down across the body.Taiwan CDC reminds the public to seek immediate medical attention when sick and avoid going to work or school or taking public transportation to reduce further transmission.Infants, people who suffer from malnutrition and hunger and people living in areas of lower medical standards are likely to develop more severe symptoms when they are infected with measles and the fatality rate is about 5-10%.People with low immunity are more likely to develop complications when they become infected with measles.Pregnant women who are infected with measles are also more likely to develop complications, fetal death or preterm labor.

The best way to prevent measles is vaccination.In Taiwan, the existing routine childhood vaccination schedule recommends a dose of MMR vaccine to children 12 months of age and another dose to first graders in elementary schools.Unvaccinated infants and children, those who do not receive vaccine in a timely manner and those who have never been infected with measles are high-risk groups.

Taiwan CDC once again reminds parents the importance of timely vaccination for children.As the MMR vaccine coverage rate has remained high over the recent years in Taiwan, the number of measles cases occurred has drastically decreased.Taiwan CDC urges physicians to remain vigilant against measles and report a patient to the health authority if he/she develops suspected symptoms of measles such as rash, fever over 38℃ and one of the following symptoms: cough, runny nose or conjunctivitis (sensitivity to light, watering of the eyes or redness in the eyes).In addition, physicians are advised to isolate patients when necessary to prevent further spread of the virus.

For more information on measles prevention, please visit the Taiwan CDC’s website: http://www.cdc.gov.tw/ or call the toll-free Communicable Disease Reporting and Consultation Hotline, 1922.