On October 5, 2015, officials from the China Health and Family Planning Commission confirmed one new H7N9 influenza infection was reported in Shaoxing City, Jiangsu Province on October 2. The case is a 62-year-old female who resides in Shengzhou City Shaoxing City, Jiangsu Province. Prior to her disease onset, she had exposure to poultry. She is currently hospitalized in critical condition. This is the first H7N9 influenza infection reported in Zhejiang Province since this fall (October 1, 2015). The Taiwan Centers for Disease Control (Taiwan CDC) has thus raised the travel notice level for Zhejiang Province to Level 2: Alert for avian influenza.

Since March 31, 2013, a cumulative total of 678 H7N9 influenza infections, including 275 deaths, announced by WHO on September 4, 2015 have been confirmed in China (658), Hong Kong (13), Taiwan (4), Canada (2), and Malaysia (1). Currently, Taiwan CDC has issued a travel notice of Level 2: Alert for avian influenza to Zhejiang Province and a travel notice of Level 1: Watch for avian influenza to the other provinces and cities in China, excluding Hong Kong and Macau.

Although this year’s Hajj pilgrimage to Mecca, Saudi Arabia came to a close in the end of September, hospital-related MERS-CoV clusters in Riyadh and Madina, Saudi Arabia and sporadic MERS-CoV cases in other parts of Saudi Arabia have recently occurred. On the other hand, a suspected MERS death was reported in the Philippines on October 3 and relevant authorities have stressed that strict screening procedures are in place at the country’s airports for those returning from Hajj. Taiwan CDC urges physicians to be sure to inquire suspected patients, especially those who just returned from Hajj or high-risk areas such as the Arabian Peninsula, their travel, occupation, contact and cluster (TOCC) history and reinforce the reporting of suspected cases to ensure prompt treatment and subsequent implementation of the relevant prevention and control measures.

According to WHO, during September 2012 and October, 2015, a total of 1,593 laboratory-confirmed cases of infection with MERS-CoV, including 568 related deaths, were announced. Thus far, MERS-CoV has been reported in 26 countries. The majority of the cases were reported in the Middle East, including Saudi Arabia, UAE and Qatar. Among these countries, Saudi Arabia has reported the most cases (80% of the total cases). In addition, most cases have travel history to these affected areas prior to their disease onset. Currently, Taiwan CDC has issued a travel notice of Level 2: Alert for MERS-CoV to Saudi Arabia, and a travel notice of Level 1: Watch for MERS-CoV to UAE, Jordan, Qatar, Iran, Oman and Kuwait.

Taiwan CDC advises travelers visiting China to practice good personal hygiene such as washing hands with soap and water frequently and putting on a mask when coughing and take preventive measures such as avoiding direct contact with poultry and birds or their droppings/dead bodies, and consuming only thoroughly cooked poultry and eggs to ward off H7N9 influenza infection. While travelers planning to visit countries in the Middle East are advised to not only pay attention to personal hygiene, respiratory protection and hand cleanliness, but also avoid visiting any farms and all direct contact with camels, including drinking un-pasteurized camel milk, to reduce the risk of infection with MERS-CoV. When symptoms such as fever and influenza-like illness such as cough develop after returning to Taiwan, please voluntarily notify the airline crew and the quarantine officer at the airport and seaport, put on a surgical mask and seek immediate medical attention. Moreover, please inform the physician of the recent travel and exposure history to facilitate diagnosis and treatment. 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).