On April 18, 2018, the Taiwan Centers for Disease Control (Taiwan CDC) announced 5 new measles cases confirmed in Taiwan, including 4 cases related to the recent cluster (Cases 9, 10, 11 and 12) and the source of infection for 1 case is being investigated. Cases 9, 10, 11 and 12 occurred among airline staff in an office at the airport. On April 18, Taiwan CDC sent colleagues to Taoyuan International Airport to brief the staff there on the latest update concerning the ongoing measles outbreak and the potential areas at risk for infection, as well as provide relevant prevention measures for them to follow in order to stop further transmission of the disease.

The disease onset dates for Cases 9, 10, 11 and 12 range between April 13 and 14. Infection with measles was laboratory confirmed in them on April 18Among them, Cases 9 and 10 are over 20-year-old females who reside in northern Taiwan and are cabinet crew who work at the same airline company as the index case of this cluster. Cases 11 and 12 are cabin crew who work at a different airline company. As of now, a total of 12 measles cases associated with the cluster, including the index case, have been confirmed. To prevent further transmission of the disease, the local health authority has implemented a number of prevention measures and identified 2,978 contacts to monitor and follow up until May 6, 2018. In addition, Taoyuan International Airport has recently performed disinfection of the office areas where the cabin crew work at. As measles is a highly infectious disease that is spread by contact with droplets from the nose, mouth or throat of an infected person, either directly or through aerosol transmission, people who took the same modes of public transportation and visited the same places during the aforementioned time are potential contacts and are thus urged to conduct self-health management for 18 days since the last exposure date. If suspected symptoms develop, please put on a mask immediately, seek prompt medical attention and voluntarily notify the physician of the relevant exposure history.

The fifth new case is an over 40-year-old female who reside in northern Taiwan. On April 11, she developed suspected symptoms. On April 18, infection with measles was laboratory confirmed in the case. Based on the case’s activity and exposure history during the incubation period, it is determined that the case is an indigenous case as she had not traveled overseas and her exposure history is not related to the aforementioned cluster. Her source of infection is still being investigated. So far, the local health authority has identified 20 contacts to monitor and follow up until May 6.

According to the domestic surveillance data compiled by Taiwan CDC, thus far this year, a cumulative total of 18 measles case have been confirmed, including 12 indigenous cases and 6 imported cases. Taiwan CDC once again reminds that vaccination remains the best way to prevent infection. In Taiwan, the existing routine childhood vaccination schedule recommends a dose of measles, mumps, and rubella (MMR) vaccine to children 12 months of age. 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. Parents are urged to ensure timely vaccination of children under one year old and those who have not completed the MMR vaccine series and avoid bringing unvaccinated children to the affected areas in order to prevent infection. Adult travelers planning to visit affected areas are also advised to visit the outpatient travel clinic at contracted hospitals in the nation to determine the need for MMR vaccination 2 weeks prior to their trip.

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 measles infection such as fever, nasopharyngitis, conjunctivitis, cough and rash develop after visiting affected areas, please voluntarily inform the quarantine officer at the airport upon arrival in Taiwan, 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 regulations in order to facilitate the prompt implementation of subsequent prevention measures.