On June 7, 2017, the Taiwan Centers for Disease Control (Taiwan CDC) announced this year’s first rubella case in a 34-year-old male who resides in northern Taiwan. On March 11, the case left for the Philippines. On June 4, he returned to Taiwan via Flight BR272. He arrived in Taiwan Taoyuan International Airport at around 3pm and took a cab home. According to the case, he developed cough on May 27, and then headache and rash on May 29. He was diagnosed with measles in the Philippines on May 30 after seeking medical attention locally. Although his symptoms had subsided after he returned home on June 4, he immediately sought further medical attention at a hospital in Taiwan to confirm if he was indeed infected with measles. After the hospital collected specimens from the case for laboratory testing, infection with rubella was confirmed in the case on June 7. As the case was in the Philippines during the incubation period, it is determined that the case is an imported case.

During the infectious period (May 22 and June 5), the case was in the Philippines for the most part of the time. He had a mask on during his flight back to Taiwan and when he sought medical attention. To prevent further transmission of the disease, the local health authority has implemented a number of prevention measures and identified 60 contacts, including his family members who reside in the same household, passengers sitting in adjacent rows (including the cabin crew) on the same flight, healthcare personnel and patients that he came into contact with when he sought medical attention, to monitor and follow up until June 26, 2017. Among the contacts, none of them is pregnant and none of them has developed suspected symptoms. At the same time, passengers who were on the same flights on the same day are urged to conduct self-health management for 21 days till June 25. If suspected symptoms develop, please put on a mask immediately, seek prompt medical attention and voluntarily notify the physician of the relevant exposure history. In addition, Taiwan CDC will notify relevant countries about this case through the National IHR Focal Point.

Thus far this year, a total of 1 rubella case, which was imported from the Philippines, has been confirmed in Taiwan. Last year, a cumulative total of 4 rubella cases were confirmed in Taiwan, including 1 indigenous case and 3 imported cases from India, Hong Kong and China. According to the report published by Western Pacific Regional Office (WPRO) of the World Health Organization (WHO), as of the end of April 2017, a cumulative total of 450 rubella cases have been confirmed in the Western Pacific Region 60% of the cases were confirmed in China, 30% were confirmed in the Philippines, and sporadic cases were confirmed in other countries, including Malaysia, Laos, Vietnam, Mongolia, Japan and Cambodia.

95% of the citizens in Taiwan have had the infection or been vaccinated against the disease and most infected individuals experience mild symptoms. However, if a pregnant woman who has no rubella antibodies becomes infected with rubella during early pregnancy, there is a chance she will pass the infection to her unborn child and a chance that the child will develop congenital rubella syndrome, resulting in fetal death, miscarriage or birth defects such as deafness, glaucoma, cataract, microcephaly, intellectual disability, heart disease and even death. Hence, women of child-bearing age who are tested negative for rubella antibody during the pre-marital medical examination can receive a free dose of MMR vaccine when presenting the negative rubella antibody result at the local health station or a contracted hospital.

Travelers planning to visit affected areas are advised to visit the outpatient travel clinic at contracted hospitals in the nation to determine the need for MMR vaccination 2 to 4 weeks prior to their trip. Travelers visiting affected areas are urged to pay attention to personal hygiene, wash hands with soap and water frequently, avoid touching nose and mouth, put on a mask while visiting crowded places to ward off infection. In addition, travelers returning from affected areas are advised to pay attention to their own health and the health of the infants and children residing in the same household. If symptoms pertaining to rubella infection such as fever, fatigue, nasopharyngitis and obviously swollen lymph nodes behind the ears develop and are accompanied by generalized irregular papules, joint pain or arthritis, please put on a mask, seek immediate medical attention, and voluntarily inform the physician of relevant travel and exposure history. Healthcare facilities are also urged to heighten vigilance and report suspected cases according to relevant regulation in order to facilitate the implementation of subsequent prevention measures. 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).