On October 14, 2016, the Central Epidemic Command Center for Zika Virus (CECC for Zika Virus) announced 2 additional imported Zika cases identified in Taiwan. They respectively are an over 60 Taiwanese male (11th case) and an over 20 Thai male (12th case). The local health authority has implemented relevant prevention measures. Both cases have been asked to prevent mosquito bites and isolate themselves till their viremic periods are over and follow the “1+6 Principle” to prevent further transmission.

The 11th case resides in New Taipei City who went on the same tour group to Malaysia with the 10th imported case. During October 4 and 6, he developed rashes on his upper body, but he did not seek medical attention. Infection with Zika virus was laboratory confirmed in the case on October 14. During the viremic period, besides his workplace, he visited Taitung from October 9 to 12. As of now, the case has returned home. The case has been provided with relevant health education and asked to prevent mosquito bites and isolate himself till October 15. Currently, none of his contacts, including family members who reside in the same household with him and his colleagues, have developed suspected symptoms. Taiwan CDC will continue to monitor and follow up on the health of the 71 members of the same tour group. Among them, Taiwan CDC collected specimens for laboratory testing from 3 individuals with symptoms and 9 individuals without symptoms. 2 of the 3 individuals with symptoms tested negative for Zika virus and the 1 individual tested positive for the virus is the 11th imported case. All 9 individuals without symptoms tested negative for the virus.

The 12th case resides in Kalasin Province, Thailand. On October 9, he developed symptoms, including fever, muscle ache, headache, stomachache, and joint pain. On October 12, he came to Taiwan for work with his family. He was detected with a fever at the airport by the fever screening system upon his arrival and specimen was collected from him. Infection with Zika virus was laboratory confirmed in the case on October 14. Since his arrival in Taiwan, he has stayed at his workplace in Changhua County. As of now, his symptoms have subsided. The case has been provided with relevant health education and asked to prevent mosquito bites and isolate himself till October 20. None of his contacts have developed suspected symptoms.

Thus far this year, a total of 12 imported Zika cases have been identified in Taiwan and they respectively became infected in Thailand (3), Vietnam (2), Malaysia (2), Indonesia (1), Singapore (1), St. Lucia (1), St. Vincent and the Grenadines (1), and Florida, the U.S. (1). Since September 2016, a cumulative total of 7 cases of Zika virus infection in Malaysia, including 2 pregnant women, have been reported in Sarawak, Sabah, and Johor Bahru that neighbors Singapore. As of October 3, 2016, Thailand has reported a cumulative total of 392 Zika cases, including 39 pregnant women, in 16 provinces in the country. In addition, the first two cases of microcephaly have been reported in Southeast Asia.

Since 2015, 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 63 countries and territories with ongoing outbreaks or possible local transmission of Zika virus, including 7 countries in Asia: Malaysia, Thailand, the Philippines, Vietnam, Indonesia, Singapore, and Maldives, and 4 counties in Florida: Broward, Miami-Dade, Pinellas and Palm Beach counties. Moreover, about 4 countries, including Laos, have previously reported Zika outbreaks. Nonetheless, thus far in 2016, no Zika cases have been reported in those 4 countries. Hence, Taiwan CDC has issued a travel notice of Level 1: Watch for Zika virus for those countries.

CECC for Zika Virus once again urges pregnant women and women planning pregnancy to postpose travels to Zika-affected areas. Travelers visiting Zika-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. Travelers returning to Taiwan from affected areas are advised to proactively contact the quarantine officer at the fever screening station at the airport when suspected symptoms develop and follow the “1+6 Principle” to prevent Zika transmission. 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. If symptoms develop, 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).