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Taiwan

This large island is situated off the coastland of China and has been ruled separately since a civil war in 1949. Nevertheless, China is exerting significant pressure on the Taiwan government to ensure that the island returns under full Chinese rule. Mala
ia prophylaxis is not required. The capital of Taiwan is Taipei. This is a typical bustling Asian city with a significant pollution problem associated with cars and scooters. The climate is hot and humid for much of the year. Mains electricity is 110v using the small American style plugs.
Despite the American influences throughout Taiwan it is worth knowing that the level of understanding of English is very poor outside the major hotels. Taxi drivers (cheap and worthwhile if any distance is involved) will understand almost no English so it is essential that you have the name of your hotel written in Chinese with you at all times.
In Taipei, the shops and banks tend to open later than might be expected. Typically banks open at about 9am and many shops at 10am or later. On early arrival at Taipei airport the banks may not be open and so it is important to change money in your hotel if possible.
There is a wide variety of food available within the main urban areas ranging from the quick foods (MacDonalds etc) to the traditional Chinese restaurants) The cost of meals would be similar to most European countries.
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Taiwan US Consular Information Sheet
August 18, 2008
Reminder:
The Department of State provides information to assist travelers in better understanding foreign locations they may visit and the known risks that they should consider.
Travelers traveling to Taiwan are encouraged to inform themselves about Taiwan prior to commencement of travel.
It is the traveler’s responsibility to obtain a U.S. passport from the Department of State and the appropriate visas from the Taiwan Economic and Cultural Representative’s Office (TECRO) in Washington, D.C., or the nearest office of the Taipei Economic and Cultural Office (TECO).
When making reservations, travelers should discuss cancellation policies with their travel agent, travel insurer or airline, as scheduled trips abroad may be nonrefundable.
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation; Medicare does not cover medical expenses abroad.

DESCRIPTION:
Taiwan is a stable democracy with a strong and well-developed economy.
Tourist facilities are widely available.
Read the Department of State Background Notes on Taiwan for additional information.

ENTRY/EXIT REQUIREMENTS:
U.S. passport holders will be allowed to enter Taiwan without a visa for up to thirty days (no extensions or change of status allowed) if they have a passport valid for at least six months from the date of entry into Taiwan and a confirmed return or onward air ticket.
Travelers must have already met any additional visa requirements for the next destination, if applicable.

Visitors with passports valid for less than six months from the date of entry into Taiwan must apply for a landing visa, which has a duration of stay of no more than 30 days, or until the passport’s expiration date, whichever comes first.
Extensions are not permitted.
Travelers who apply outside of Taiwan at Taiwan Overseas Missions for a landing visa will be charged a processing fee of US $131.
Travelers who apply for a landing visa upon arrival in Taiwan will be charged NT $4,900.
This fee includes a NT $800 service charge and can be paid only in Taiwan currency.

U.S. travelers planning to visit longer than 30 days may apply for and receive a visitor visa at one of the Taiwan Overseas Missions.
The processing fee is U.S. $131; an additional $65.50 will be charged for expedited processing.
Travelers arriving in Taiwan with a valid passport and valid Taiwan visa may be admitted for up to 60 days for multiple entries even if their passports are valid for less than 6 months.

For specific information about application, entry requirements and fees, travelers should contact the Taipei Economic and Cultural Representative Office (TECRO), 4201 Wisconsin Avenue NW, Washington, DC
20016-2137, via either its main telephone number, (202) 895-1800, or its visa section telephone number, (202) 895-1814.
TECRO's visa website is http://www.taiwanembassy.org/US/lp.asp?ctNode=2315&CtUnit=62&BaseDSD=7&mp=12.
The main fax number at TECRO is (202) 363-0999, and the visa section fax number is (202) 895-0017.
TECO (Taipei Economic and Cultural Office) also has offices in Atlanta, Boston, Chicago, Guam, Honolulu, Houston, Kansas City, Los Angeles, Miami, New York, San Francisco and Seattle.

Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
For the latest security information, Americans traveling abroad should regularly monitor the Department’s Internet web site at http://travel.state.gov where the current Worldwide Caution, Travel Warnings, and Travel Alerts can be found.
Up-to-date information on security can also be obtained by calling 1-888-407-4747 toll free in the United States and Canada, or for callers outside the United States and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Standard Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.

Public Demonstrations:
Taiwan is a modern democracy with vibrant public participation.
Political demonstrations are common, especially around election time.
Since Taiwan democratized in the early 1990s, there have been very few cases of violence associated with political demonstrations.
But even demonstrations intended to be peaceful can turn confrontational.
American citizens are therefore urged to avoid the areas of demonstrations, and to exercise caution if within the vicinity of any political demonstrations.

CRIME:
Although the overall violent crime rate in Taiwan is relatively low, travelers should avoid high crime areas, such as areas where massage parlors, illegal "barbershops," and illegal "nightclubs" run by criminals prevail.
In contrast to their counterparts, legal barbershops prominently display the usual grooming services.
Illegal nightclubs have no advertisement and are publicized by word of mouth only.
Public transportation, including the buses and the subway, is generally safe in Taiwan, but women should exercise caution when traveling alone in taxis late at night.
In several parts of Taiwan, incidents of purse snatching by thieves on motorcycles have been reported.

In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at www.cybercrime.gov.

The emergency telephone number for Taiwan services (ambulance, fire, police) is 119.
Taiwan Police offers a 24-hour telephone line for foreigners in English:
0800-024-111.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the National Immigration Agency and to American Institute in Taiwan (AIT)-Taipei or AIT-Kaohsiung.
The National Immigration Agency has foreign affairs sections that are usually staffed by English-speaking officers.
National Immigration Agency contact numbers for the major cities in Taiwan are as follows: Taipei (02) 2389-9983, Kaohsiung (07) 282-1400, Tainan (06) 293-7641, Taichung (04) 2254-9981, Taitung (089) 342-251, Pingtung (08) 721-6665.

If you are the victim of a crime while in Taiwan, in addition to reporting to the local police, contact AIT-Taipei (02) 2162-2000 or AIT-Kaohsiung (07) 238-7744 for assistance.
AIT’s consular staff can, for example, help you find appropriate medical care, contact family members or friends, and explain how funds can be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help explain the local criminal justice process and assist with finding an attorney if needed. See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Health facilities in Taiwan are adequate for routine and emergency medical treatment.
Physicians are well trained and many have studied in the U.S. and speak English.
State-of-the-art medical equipment is available at many clinics and hospitals.
Hospitals’ nursing services provide medication dispensing and wound care, but generally not the daily patient maintenance functions found in U.S. hospitals.
Ambulances are available in Taiwan but are not like those in the U.S.
There are no trained Emergency Medical System Technicians accompanying an ambulance, unless within 2 kilometers of National Taiwan University Hospital or Veterans General Hospital.
For information on specific clinics and hospitals, please refer to the AIT web page at http://www.ait.org.tw/en/uscitizens/HealthCareInTW.asp
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747); fax 1-888-CDC-FAXX (1-888-232-3299), or via the CDC’s Internet site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.

English speakers experiencing a personal crisis in Taiwan can contact the Community Services Center in Taipei (www.community.com.tw) at (02) 2836-8134 or (02) 2838-4947 to arrange counseling or to contact a support group.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Taiwan.
However, persons staying over 90 days or applying for residency or work permits must be tested for HIV/AIDS.
MEDICAL INSURANCE:
Doctors and hospitals in Taiwan expect immediate cash payment for health services, although some private clinics may accept credit cards.
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS:
While outside the United States, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Taiwan is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Roads in Taiwan's major cities are generally congested, and the many scooters and motorcycles that weave in and out of traffic make driving conditions worse. Special caution should be taken when driving on mountain roads, which are typically narrow, winding, and poorly banked, and which may be impassable after heavy rains.

Pedestrians should exercise caution when crossing streets because many drivers do not respect the pedestrian's right of way.

Please refer to our Road Safety page for more information.
The national authority responsible for road safety in Taiwan is the Traffic Safety Committee, MOTC. Information regarding road safety may be found on their web site at http://www.motc.gov.tw/en/hypage.cgi?HYPAGE=Eng_Index.htm.

For general information on tourism in Taiwan information may be found at www.tbroc.gov.tw (Taiwan Tourism Bureau - Ministry of Transportation and Communication).

For specific information concerning Taiwan's driver's permits, vehicle inspection road tax and mandatory insurance, contact the nearest TECO office.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed Taiwan's Civil Aeronautics Administration (CAA) as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Taiwan's air carrier operations.
For more information, visit the FAA’s Internet web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES: Screening Process:
Because of the need for early detection and prevention of communicable diseases, all arriving passengers are scanned with an infrared thermal apparatus to test for elevated temperatures.
Passengers with elevated temperatures are required to fill out the Communicable Disease Survey Form and will then be evaluated for additional testing and/or follow up with local health authorities.

Customs Regulations:
Taiwan customs authorities may enforce strict regulations concerning temporary import or export of items such as: firearms, antiquities, medications, currency, ivory, etc.
It is advisable to contact the Taipei Economic and Cultural Office (TECRO) in Washington or one of the TECO offices in the United States for specific information regarding customs requirements.
Please see our information on customs regulations.

Disaster Preparedness:
Taiwan is subject to strong earthquakes that can occur anywhere on the island.
Taiwan is also hit by typhoons, usually from July to October.
Travelers planning a trip to Taiwan can obtain general information about natural disaster preparedness on the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.
Additional information about currently active typhoons can be obtained on the University of Hawaii tropical storm page at http://www.solar.ifa.hawaii.edu/Tropical/tropical.html.
The Central Weather Bureau of Taiwan also maintains a web site that provides information about typhoons and earthquakes.
Its Internet address is http://www.cwb.gov.tw.

Dual Nationality and Compulsory Military Service:
Taiwan law provides for compulsory military service.
Men between the ages of 18 and 36 who were born in Taiwan or who have ever held a Taiwan passport should be aware that they may be subject to compulsory military service in Taiwan, even if they are also U.S. citizens, and even if they have entered Taiwan on U.S. passports.
Potentially affected individuals are urged to consult with the nearest office of the Taipei Economic and Cultural Office (TECO) in the United States before visiting Taiwan to determine whether they are subject to the military service requirement.

English Language Programming:
The International Community Radio Taipei (ICRT) www.icrt.com.tw provides all of Taiwan with English-language programming 24 hours a day.
In the event of an emergency or an approaching typhoon, travelers in the Taipei and Kaohsiung areas should tune their radios to FM 100.7 for English-language updates.
Travelers can find ICRT in Taichung at FM 100.1.
Travelers can listen to ICRT's live broadcasting on the Internet at http://www.icrt.com.tw/en/D01.php.
TV news in English is available on channel 53 at 6:00 a.m. and at 11:45 pm on Formosa Television, or at its web site http://englishnews.ftv.com.tw.
The three main English-language daily newspapers published in Taiwan are Taipei Times, Taiwan News and China Post.
In addition to the print versions, readers can read their content online at http://www.taipeitimes.com, http://www.etaiwannews.com and http://www.chinapost.com.tw.

Judicial Assistance:
Judicial assistance is provided by authorities on Taiwan in response to letters rogatory from foreign courts in accordance with Taiwan's "Law Governing Extension of Assistance to Foreign Courts."
For further information regarding judicial assistance in Taiwan please go to the following website: http://www.ait.org.tw/en/uscitizens/judicial.asp.

AUTHORITY - 22 U.S.C. 3306(b) provides acts performed by officers of the American Institute in Taiwan under 22 U.S.C. 3306 are valid, as if performed by any other person authorized under the laws of the United States to perform such acts (consular officers).
The American Institute in Taiwan (AIT) is a nonprofit corporation under the laws of the District of Colombia.
22 U.S.C. 3305, 3306(a)(3).
The judicial assistance acts of AIT personnel parallel the acts performed by U.S. consular officers under 28 U.S.C. 1781 (a)(2).
See Sec. 1-201(h) of Executive Order No. 12143, 44 Fed. Reg. 37191 (June 23, 1979).
Pursuant to Section 10(a) of the Taiwan Relations Act (TRA), 22 U.S.C. 3309(a), the Taiwan Economic Cultural Representative's Office ("TECRO") is the instrumentality established by the people of Taiwan having the necessary authority under the laws of Taiwan to take actions on behalf of Taiwan in accordance with the Act.

CRIMINAL PENALTIES:
While outside the United States, a U.S. citizen is subject to local laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than those in the United States for similar offenses.
Persons violating Taiwan’s laws, even unknowingly, may be expelled, arrested or imprisoned. In Taiwan, either side has the right to appeal a court decision, sometimes necessitating a second or even a third trial.
Americans contemplating visiting or residing in Taiwan should note that judges have discretionary authority to prevent defendants from leaving Taiwan until all appeals have been exhausted.
Americans have been barred from leaving Taiwan for extended periods, even in cases that involved only nominal civil damages or fines. .
Penalties for possession of, use of, or trafficking in illegal drugs in Taiwan are severe and convicted offenders can expect long jail sentences and heavy fines.
Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign state is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

CHILDREN'S ISSUES:
For information see our Office of Children's Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION/LOCATION OF THE AMERICAN INSTITUTE:
The American Institute in Taiwan is authorized by law to perform American citizen services.
Americans living or traveling in Taiwan are encouraged to register with AIT through the State Department’s travel registration web site, and to obtain updated information on travel and security within Taiwan.
Americans resident in Taiwan are encouraged also to become a member of AIT's group email notifications by sending an email to AIT_Citizens-subscribe@yahoogroups.com.
Americans without Internet access may register directly with AIT Taipei or AIT Kaohsiung.
By registering, American citizens make it easier for the American Institute to contact them in case of emergency.

The American Institute in Taiwan is a full passport services agency.
Processing time for routine passports is about two weeks.

The American Institute in Taiwan is located at No.7 Lane 134, Hsin Yi Road Section 3, Taipei, Taiwan, telephone: (886) 2-2162-2000; fax: (886) 2-2162-2239, web site: http://www.ait.org.tw.
The American Institute in Taiwan branch office is located at No. 2 Chung Cheng 3rd Road, 5th Floor, Kaohsiung, Taiwan, telephone: (886) 7-238-7744; fax: (886) 7-238-5237.
AIT's citizen services section can also be contacted by e-mail at aitamcit@mail.ait.org.tw.
In case of emergencies after working hours, the duty officer at the American Institute in Taiwan at Taipei may be contacted at (886) 2-2162-2000.
* * *
This replaces the Specific Information dated April 15, 2008, to add emergency telephone numbers, to change the email address for subscribing to the Yahoo group for email notifications, and to update the section on Entry/Exit Requirements, Medical Facilities and Health Information, Criminal Penalties and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Tue, 21 Jan 2020 12:26:16 +0100 (MET)

Taipei, Jan 21, 2020 (AFP) - Taiwan on Tuesday reported its first confirmed case of the new SARS-like coronavirus as the government warned the public against travelling to Chinese city where it emerged.    The patient is a Taiwanese woman in her fifties, living in Wuhan, who returned to the island on Monday with symptoms including fever, coughing and a sore throat.   Asian countries have ramped up measures to block the spread of the new virus as the death toll in China rose to six and the number of cases jumped to almost 300 since it first emerged in the central Chinese city of Wuhan.

The Taiwan patient reported her symptoms to quarantine officials on arrival at Taoyuan airport and was immediately taken to a hospital for treatment, said the island's Centers for Disease Control (CDC).    The woman told officials that she had not visited any local markets or had contact with birds or wild animals while in Wuhan.    Authorities are monitoring some 46 passengers and crew from the same flight, the agency said.

The CDC raised its alert on Wuhan to the highest level, urging the public against travelling to the city unless necessary.    "We ask the public not to panic as the individual was taken to hospital directly from the airport and did not step into the community," it said in a statement, adding that it reported the case to the World Health Organization and China authorities.   The coronavirus has spread to Thailand, Japan, South Korea and Taiwan.
Date: Tue 19 Nov 2019
Source: Outbreak News Today [edited]

The Taiwan Department of Disease Control announced the 1st case of severe fever with Thrombocytopenia Syndrome (SFTS) in the country. According to the news release (computer translated), the patient is a 70-year-old male in the north who has not recently gone abroad but is often active in mountainous areas.

On [2 Nov 2019], due to repeated fever and vomiting symptoms, he went to the clinic for medical treatment. Later, due to rash and consciousness change, he was sent to hospital on [3 Nov 2019] and admitted. He was suspected of having dengue fever.

The test was judged to be SFTS virus-positive on the evening of [13 Nov 2019], and the expert meeting held yesterday [18 Nov 2019] confirmed the virus sequence and the date. Korean epidemic strains are similar to this Taiwan case.

A total of 68 contacts will be monitored until the end of the month [November 2019].

This is the 1st SFTS case reported in Taiwan. Cases have been previously reported in China, Japan, and South Korea.

Severe fever with thrombocytopenia syndrome (SFTS) is a newly emerging infectious disease. Symptoms and laboratory abnormalities are fever, thrombocytopenia, leukocytopenia, and elevated serum enzyme levels. Multiorgan failure occurs in severe cases, and 6%-30% of patients die. The syndrome is caused by the SFTS virus (SFTSV) (genus _Phlebovirus_, family Bunyaviridae).  Ixodid tick species are implicated as vectors of SFTSV.
====================
[Cases of SFTS are being detected in new areas in Asia since it was first reported in China in 2009. At that time, researchers identified the virus responsible in blood samples from a cluster of people who shared a combination of symptoms that included high fever, gastrointestinal problems, low white blood cell count, and low platelet count (thrombocytopenia). The virus killed 30 percent of those infected in China that year. It was even more lethal when the 1st cases appeared in Japan and South Korea in 2013. More than one-third of those infected in Japan and nearly half of those infected in South Korea died that year. Now a case of that virus infection has occurred in Taiwan.

SFTS is a serious disease and of significant public health concern. Although SFTS virus infections may be serious, there is evidence for subclinical or mild infections as well, so the previous numbers may be an underestimate of the total number of infections. There is also some evidence for person-to-person direct transmission of the virus, but that appears to be a rare event. The virus is doubtless endemic in several countries in Asia, and cases have occurred previously in Japan. Apparently, there are 2 previously reported affected individuals who acquired their infections directly from an SFTS virus-infected cat. No mention was made of tick transmission in that instance. The possible route of transmission from the cat to the veterinarian and veterinary nurse via exposure to blood or other bodily fluids is not mentioned (see Severe fever w/ thrombocytopenia synd. - East Asia (02): Japan (MZ)  http://promedmail.org/post/20181211.6204927).

The Asian longhorn tick, _Haemaphysalis longicornis_, is a vector of SFTS virus. Interestingly, this tick has recently been found for the 1st time in several states in eastern USA, but fortunately, without evidence that they carry SFTS virus.

SFTS virus is a tick-transmitted phlebovirus in the Bunyavirus family. Images of an _H. longicornis_ tick, the SFTS vector, can be seen at

[HealthMap/ProMED-mail map of Taiwan:
Date: Tue 24 Sep 2019
Source: Outbreak News Today [edited]

The Taiwan Department of Disease Control (CDC) reported today (24 Sep 2019) the 1st imported case of extensively drug-resistant (XDR) typhoid fever in the country. The patient, a 30-year-old male, travelled to a number of countries during the incubation time including Pakistan, which has been battling an outbreak of XDR typhoid for several years. According to the results of genetic sequencing and drug-resistance gene comparison, the place where [the disease] was contracted was in Pakistan.

According to the CDC, the patient began to present with symptoms while still overseas and didn't seek medical care until returning to Taiwan. The patient is now in stable condition but is currently being kept in an isolation ward at the hospital for further observation, the CDC said.

Typhoid fever is a potentially life-threatening illness caused by the bacterium _Salmonella_ Typhi. _Salmonella_ Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed _S._ Typhi in their feces.

You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding _S._ Typhi or if sewage contaminated with _S._ Typhi bacteria gets into the water you use for drinking or washing food. Therefore, typhoid fever is more common in areas of the world where handwashing is less frequent and water is likely to be contaminated with sewage.

XDR typhoid is a life-threatening and highly infectious disease, resistant to 5 classes of antimicrobials.
=======================
[It is likely that more and more cases of XDR typhoid will be exported into Europe, Australia, other parts of Asia, and the USA. Prevention of acquisition in travelers depends on appropriate avoidance of potentially contaminated food and water, and immunization. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Date: Tue 10 Sept 2019
Source: Focus Taiwan [edited]

Taiwan's enterovirus cases continued to increase last week, bringing the total number to nearly 20 000 between [1 and 7 Sep 2019], the Centers for Disease Control (CDC) said Tuesday [10 Sep 2019].

A total of 19 254 patients sought outpatient or emergency treatment at hospitals for enterovirus infection around the country, up 4% from the figure recorded the previous week [25-31 Aug 2019] and the highest over the same period in nearly 5 years, according to CDC data.

CDC physician Lin Yung-ching said there were 2 severe cases recorded last week, one of which involved an 8-month-old girl and the other a 4-year-old boy, both in central Taiwan. The 2 children were reported in stable condition after treatment.

Some of the 2 patients' family members or classmates with whom they had had contact have also been confirmed as enterovirus cases, and the CDC judged that the infection might have been spread through contact, Lin said.

A total of 303 cases of enterovirus-71 (EV-71), the most severe enterovirus strain, have been reported so far this year [2019], the highest in the same period from 2016 to 2018.

Meanwhile, a total of 36 cases with severe complications have been recorded nationwide, including 27 EV-71 cases, according to CDC statistics.

EV-71 is a neurological disease that attacks the nervous system, and infants under the age of 5 are at highest risk of developing severe complications from this type of infection.

In extreme cases, EV-71 can cause polio-like permanent paralysis, according to the CDC. As Taiwan is still in the peak season for enterovirus infection, CDC Deputy Director-General Philip Lo urged the public to take precautions against the spread of the illness, especially among children.

Children infected with enterovirus should be kept away from school so as to prevent the spread of the disease, as enterovirus is highly contagious, Lo advised.  [Byline: Chen Wei-ting and Evelyn Kao]
=====================
[The enteroviruses are spread from person to person by coughs, sneezes, or touching objects or surfaces that have the virus on them. Therefore, practicing good personal hygiene -- washing hands regularly and thoroughly with soap and water -- is the best way to prevent from getting and spreading the infectious disease.

However, most people infected with non-polio enteroviruses do not get sick, or present with mild illness, like the common cold. Infants, children, and teenagers are more likely than adults to get infected and become sick because they do not yet have immunity (protection) from previous exposures to the viruses. Adults can get infected too, but they are less likely to have symptoms, or their symptoms may be milder. Symptoms of mild illness may include fever; runny nose, sneezing, and cough; skin rash; mouth blisters; and body and muscle aches.

Some non-polio enterovirus infections can lead to:
- Viral conjunctivitis;
- Hand-foot-mouth disease;
- Viral meningitis (infection of the covering of the spinal cord and/or brain);
- Viral encephalitis (infection of the brain);
- Myocarditis (infection of the heart);
- Pericarditis (infection of the sac around the heart);
- Acute flaccid paralysis (a sudden onset of weakness in one or more arms or legs);
- Inflammatory muscle disease (slow, progressive muscle weakness).

Infants and people with weakened immune systems have a greater chance of having these complications. People who develop myocarditis may have heart failure and require long-term care. Some people who develop encephalitis or paralysis may not fully recover.

Enterovirus cases were reported from Taipei, Taiwan in 2017 (Human enterovirus - Taiwan: alert http://promedmail.org/post/20170418.4978387), and health alerts like the one mentioned in report above were issued to the general public to observe proper hygiene to reduce disease transmission. Also the case number for EV-71 associated severe disease has also increased, which is a cause for public health concern. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map:
Date: 27 Aug 2019
Source: Taiwan News [edited]

A migrant worker in Taiwan has been diagnosed with [a] hantavirus infection, the 1st case in the country this year [2019].

The afflicted individual, a male in his 20s, is a fisherman living in northern Taiwan. He has not travelled abroad recently, and his life is mostly spent at sea, said the Centers for Disease Control and Prevention (CDC).

The male started exhibiting symptoms of the disease on 3 Aug [2019], including vomiting, diarrhoea, and fatigue. He later developed liver and renal conditions before receiving a confirmed diagnosis of hantavirus infection.

Hantavirus is contracted through contact with rodent urine and faeces or rodent bites. Signs and symptoms include fever, muscle pain, headache, abdomen pain, and flushing. Some patients may fall ill with symptoms like renal failure, haemorrhaging, and shock.

CDC noted that the individual has been discharged from hospital, and the health authorities have conducted sterilization and rodent control around locations he visited.

Taiwan sees around 0-2 cases of hantavirus infections a year, mostly among the indigenous population. Males account for 83 percent of the total confirmed cases. Residents are advised to sterilize areas contaminated by rodent excrement with diluted bleach.  [Byline: Huang Tzu-ti]
===============
[The circumstances under which the individuals acquired his hantavirus infection are not given, nor does the report above indicate which hantavirus is involved in this and in previous cases.

In Asia, the 5 recognized hantaviruses, with their main rodent reservoir species, are: Hantaan virus (_Apodemus agrarius_), Amur virus (_A. peninsulae_), Thailand virus (_Bandicota indica_), Seoul virus (widely distributed worldwide in the brown rat, _Rattus norvegicus_), and Muju virus (_Myodes regulus_). Hantaan virus and Seoul virus cause cases of haemorrhagic fever with renal syndrome (HFRS) frequently in China.

The hantavirus most likely involved in the case above in Taiwan is Seoul virus harboured by _Rattus_ spp., as was the case in 2010 (see ProMED-mail archive no. http://promedmail.org/post/20100415.1221). People become infected when exposed to virus in excreta (urine, saliva, and faeces) of infected rats. It is not necessary to have contact with liquid urine; dust particles contaminated with dried urine may be inhaled.

An image of the brown rat, _R. norvegicus_, a reservoir of Seoul, virus can be accessed at

[HealthMap/ProMED map available at:
More ...

World Travel News Headlines

Date: Mon, 17 Feb 2020 11:56:28 +0100 (MET)

Tokyo, Feb 17, 2020 (AFP) - Organisers said Monday they are cancelling the amateur portion of the Tokyo marathon, affecting around 38,000 runners, on fears about the spread of the new coronavirus in Japan.   "We reached the conclusion that unfortunately it is difficult to organise the event... after several cases (of the virus) were confirmed in Tokyo," the Tokyo Marathon Foundation said in a statement.
Date: Mon, 17 Feb 2020 10:59:27 +0100 (MET)

Cairo, Feb 17, 2020 (AFP) - Egypt's Sharm el-Sheikh has welcomed the first British charter flights since 2015, when the Islamic State group's bombing of a Russian airliner dealt a devastating blow to the Red Sea resort.   Britain halted flights to Sharm el-Sheikh following the attack, which killed all 224 people on board the plane that took off from the resort, long popular with British tourists.

After multiple airport inspections and visits by aviation security experts, Britain announced in October that it was lifting the flight restrictions.   "Sharm el-Sheikh airport received the first two direct charter flights... from London's Gatwick airport carrying 184 passengers and Manchester airport carrying 190 passengers," Egypt's civil aviation ministry said in a statement late Sunday.    The flights were operated by Britain's biggest travel agency, TUI.

The company has scheduled three flights a week between London's Gatwick Airport and Sharm el-Sheikh until late March, the statement said.   British budget airline easyJet said in January it would restart flights to the resort town in June.   On Sunday, flag carrier EgyptAir said it would start operating a weekly flight between London and Sharm el-Sheikh later this month.   British tourists have long been vital to the tourism industry in Sharm el-Sheikh, which was left reeling after the airliner bombing.

Egypt has since sought to lure tourists back, boosting airport security and allowing international inspections of security procedures there.   Russia, another major source of tourists to Egypt, initially suspended all direct flights to the North African country following the attack.   It resumed direct flights to Cairo in 2018 but has yet to restart them to popular Red Sea resorts.   Egypt's tourism industry has shown signs of recovery in recent years with arrivals reaching 11.3 million in 2018, compared with 5.3 million in 2016.
Date: Mon, 17 Feb 2020 10:43:58 +0100 (MET)

Hong Kong, Feb 17, 2020 (AFP) - A gang of knife-wielding men jumped a delivery driver in Hong Kong and stole hundreds of toilet rolls, police said Monday, in a city wracked by shortages caused by coronavirus panic-buying.   Toilet rolls have become hot property in the densely packed business hub, despite government assurances that supplies remain unaffected by the virus outbreak.   Supermarkets have found themselves unable to restock quickly enough, leading to sometimes lengthy queues and shelves wiped clean within moments of opening.

There has also been a run on staples such as rice and pasta, as well as hand sanitiser and other cleaning items.     Police said a truck driver was held up early Monday by three men outside a supermarket in Mong Kok, a working-class district with a history of "triad" organised crime gangs.   "A delivery man was threatened by three knife-wielding men who took toilet paper worth more than HK$1,000 ($130)," a police spokesman told AFP.   A police source told AFP the missing rolls were later recovered and two suspects were arrested on scene although it was not clear if they were directly involved in the armed robbery.

Footage from Now TV showed police investigators standing around multiple crates of toilet roll outside a Wellcome supermarket. One of the crates was only half stacked.   Hong Kongers reacted with a mixture of bafflement and merriment to the heist.   One woman passing by the scene of the crime who was interviewed by local TV station iCable quipped: "I'd steal face masks, but not toilet roll."   The city, which has 58 confirmed coronavirus cases, is currently experiencing a genuine shortage of face masks.    The hysteria that has swept through Hong Kong since the coronavirus outbreak exploded on mainland China is partly fuelled by the city's tragic recent history of confronting a deadly disease.

In 2003, some 299 Hong Kongers died of Severe Acute Respiratory Syndrome (SARS), an outbreak that began on the mainland but was initially covered up by Beijing -- action that left a lasting legacy of distrust towards the authorities on public health issues.   The new coronavirus outbreak also comes at a time when the city's pro-Beijing leadership has historic low approval ratings after refusing to bow to months of angry pro-democracy protests last year.   Authorities have blamed online rumours for the panic-buying and say supplies of food and household goods remain stable.   But the panic-buying has itself created shortages in one of the world's most densely populated cities where supermarkets and pharmacies have limited
floor space.

Photos posted online have shown some people proudly stuffing their cramped city apartments with packets of hoarded toilet rolls.    On Sunday, the head of the city's Consumer Council warned people not to stockpile toilet rolls in their flats as they were prone to mould in the notoriously humid climate.   She also reiterated that there were ample stocks of paper.    Supermarket chain Wellcome called Monday's robbery a "senseless act", and called on people not to bulk buy or hoard toilet roll.    "We want to emphasize that we have sufficient toilet roll supply to meet demand," it said in a statement. "The temporary shortage was caused by the sudden and unusual surge in demand."
Date: Mon, 17 Feb 2020 10:11:30 +0100 (MET)

Tokyo, Feb 17, 2020 (AFP) - An additional 99 people have tested positive for coronavirus on a cruise ship off the Japan coast, Japanese media said Monday, citing new figures from the health ministry.   That would take the total number of positive cases on the Diamond Princess to 454. The health ministry declined to confirm the reports immediately.   It was also not clear whether the figures included 14 US citizens who tested positive for the virus but were allowed to board evacuation flights home.

The Diamond Princess vessel moored in Yokohama near Tokyo has become the second-largest cluster of coronavirus cases outside the epicentre in China.    Passengers have been largely confined to quarters since February 5 with only brief and occasional breaks to take air on deck -- with face masks.   The quarantine period is over on Wednesday but many countries have decided to repatriate their citizens after an alarming climb in cases on board.

The US was the first country to evacuate its citizens from the ship but Australia, Canada, Italy and Hong Kong have indicated they will follow suit.   On land, cases in Japan have risen to 65, with authorities warning that the outbreak is entering a "new phase" and advising people to avoid large gatherings.    A public celebration of the new emperor's birthday on Sunday has been scrapped and organisers of the Tokyo Marathon scheduled on March 1 are reportedly considering cancelling the amateur part of the race.
Date: Sat, 15 Feb 2020 15:25:00 +0100 (MET)
By Benoît Pavan à Moûtiers avec Thomas Rossi dans les Pyrénées

Moûtiers, France, Feb 15, 2020 (AFP) - French protests at planned labour reforms hit ski resorts on Saturday, with chairlift operators and other seasonal staff downing tools over fears their livelihoods could be on a slippery slope.   Hundreds of staff at a clutch of resorts in the Alps and Pyrenees walked out in response to calls for action by the CGT and FO unions, forcing some runs to be closed or partially closed.   They are concerned that reforms extending the required period of employment before people are eligible for benefits, set to take effect from April 1, could stop thousands of seasonal workers from claiming.

Some voiced their protest in song at the bottom of pistes at Serre-Chevalier close to the Italian border, chanting: "We're going down the mountain to get rid of Macron," referring to French President Emmanuel Macron.   The French leader's attempts to overhaul pensions and welfare have led to months of bitter protests and strikes.    "Our situation will become even more precarious with these reforms," explained Christophe Dupuis, who works as a ski patroller at La Plagne, one of the world's most popular ski areas.   "We will need six months instead of four before we can apply for unemployment benefit," added Dupuis, who works as a lifeguard during the summer.   "We don't have six-month seasons, not least as the winter seasons are tending to get shorter rather than longer," said Maud Goret, a seasonal worker and CGT member at Font-Romeu in the Pyrenees -- where half the workforce had downed tools.

Many relatively low altitude resorts are suffering from a lack of snow owing to climate change, compounding fears over what the future holds.   As the workers voiced their grievances, further signs of the shortage of snow increasingly hitting resorts came as local authorities at Luchon-Superbagneres in the French southwest told AFP they had decided to have extra snow helicoptered in to three areas running short.

A union official said some 50 tons were being brought in for between 5,000 and 6,000 euros ($5,500-6,500) "in the knowledge that in terms of return on the investment you need to multiply that at least by ten," for an operation lasting around two-and-a-half hours.   He added that it might not be a "particularly ecological" solution but "we had no choice" at the height of the season when many children in French are on half-term holiday.
Date: Wed 12 Feb 2020
Source: Teresina Municipal Health Foundation [in Portuguese, machine trans., edited]

Health Surveillance Directorate - Epidemiology Management
---------------------------------------------------------
Given the laboratory confirmation of 5 human cases of melioidosis (ICD-10 A24.4) that occurred in the state of Piaui in 2019 (including one death), the FMS Health Surveillance Directorate recommends Hospital Infection Control Commissions, to the Hospital Surveillance Centers, public and private microbiology laboratories, infectious disease specialists, pulmonologists, microbiologists, biochemists and physicians in general who are attentive, immediately report any case with a result of a culture of biological material (blood culture, urine culture, wound culture, tracheal secretion, cerebrospinal fluid, bronchial lavage, ascitic fluid, abscess, tissues, etc.) positive for the bacterium _Burkholderia pseudomallei_ (or _Burkholderia_ sp.). The notification must be made through the individual notification form of SINAN (available at <http://portalsinan.saude.gov.br/images/documentos/Agravos/NINDIV/Notificacao_Individual_v5.pdf>) and sent to the FMS, with the code appended ICD10: A24.4.

The positive bacterial isolate should be sent to the Central Public Health Laboratory, Dr. Costa Alvarenga (LACEN - PI) for confirmatory examination (Nested - PCR), upon registration in the GAL system (research: _Burkholderia pseudomallei_ sample: swab), in swab with Stuart's medium, at room temperature, along with a copy of the notification form.
======================
[This 2016 article (Limmathurotsakul D, Golding N, Dance DA, et al., Predicted global distribution of _Burkholderia pseudomallei_ and burden of melioidosis. Nat Microbiol. 2016;1:15008. <https://doi.org/10.1038/nmicrobiol.2015.8>; article available at <http://www.nature.com/articles/nmicrobiol20158.pdf>) for 2015 estimates the burden of melioidosis for the areas of major and some risk as follows:

Area / Population at risk in millions / Melioidosis cases in thousands / Melioidosis deaths in thousands
South Asia / 1525 / 73 / 42
East Asia and Pacific / 858 / 65 / 31
Sub-Saharan Africa / 602 / 24 / 15
Latin America and Caribbean / 246 / 2 / 1
Middle East and North Africa / 49 / less than 1 / less than 1

Although a classical infection in eastern Asia and northern Australia, cases have been acquired in Africa, the Caribbean basin, Central America, and, as in this case, South America. - ProMED Mod.LL]

Date: Tue 11 Feb 2020
Source: SABC News [edited]

A 56-year-old was admitted at the Klerksdorp Tshepong Hospital on Saturday [8 Feb 2020] with a history of tick bite followed by flulike symptoms including headaches and fatigue.

The North West Health Department says while no active bleeding was noted, treatment was started immediately.

Crimean-Congo fever, also known as Congo fever/haemorrhagic fever, is a disease caused by a tick-borne virus with a case fatality rate of 10% to 40%.

Transmission to humans occurs through contact with infected animal blood or ticks. It can be transmitted from one infected human to another by contact with infectious blood or body fluids.

Symptoms include high fever, vomiting and abdominal pain, but as the illness progresses, large areas of severe bruising and severe nosebleeds are also common.

Clinical Manager at the Klerksdorp Hospital Dr. David Leburu says: "Crimean-Congo fever can make a person bleed. It can make people bleed just like Ebola but not as aggressive as Ebola."
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[Occupational groups such as herders, farmers, abattoir workers, veterinarians/animal health workers, hunters and persons informally slaughtering domestic/wild animals are at higher risk of infection. These persons often have exposure to ticks on the animals and in the animal environment, and also often have exposure to animal blood/tissues (e.g., during castration of calves, vaccination, notching/tagging of ears, slaughtering).

Humans can become infected in the following ways:
- Being bitten by infected ticks;
- Squashing infected ticks (if fluid from the ticks enters into cuts/grazes on the skin, or splashes onto mucous membranes, including the eyes, nose and mouth);
- If blood/tissue from infected animals (during the short period that the animals have virus in circulation) comes into contact with cuts/grazes on the skin, or splashes onto mucous membranes, including the eyes, nose and mouth;
- Needle-stick/sharps injuries in healthcare workers from infected patients.

The patient in the above report had a history of tick bite, but no other epidemiological information is available.

Human CCHF cases have been reported annually from South Africa since 1981, when it was first recognized in the country; between 0 and 20 cases of CCHF are reported each year. Through nearly 30 years of passive surveillance, more than 180 cases have been laboratory-confirmed. Although cases have been reported from all 9 provinces in the past 30 years, more than half of the cases originate from the semi-arid areas of Northern Cape Province (31.5% of cases) and Free State Province (23% of cases) (<http://www.nicd.ac.za/assets/files/CCHF_FAQ-General_Public.pdf>). - ProMED Mod.UBA]

[HealthMap/ProMED-mail maps:
North West Province, South Africa:
Date: Wed 12 Feb 2020 05:23 PM EST
Source: ABC27/WHTM [edited]

Two Newberry Township [York County] men are getting treatments for rabies after a coyote that attacked them tested positive for the deadly virus.

One man was with his dog when the coyote attacked [Mon 10 Feb 2020] on Red Bank Road. The 2nd man was working nearby in his garage when the coyote entered and bit him.

A neighbour shot and killed the coyote the following day and gave the carcass to the Pennsylvania Game Commission. A test confirmed the animal was rabid.
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[[HealthMap/ProMED-mail map of Pennsylvania, United States:
Pennsylvania county map:

Rabies is a serious disease, and is always fatal in animals. In humans there is post exposure prophylaxis (PEP), which must be given within a prescribed amount of time. Individuals bitten by a rabid animal who do not seek treatment within the narrow window for PEP in all likelihood will die if they develop rabies. Heroic measures have succeeded in preserving the lives of only a handful of individual, and yet their live is never a complete return to normal.

Rabies is a serious disease and should be taken seriously by all individuals, whether you are a pet owner or not. Animal owners, regardless of whether your animal is a horse, or dog, or cow, or cat, or goat, or other animal, vaccinate the animal against this fatal disease. Protect your investment in your farm animals, and protect yourself by vaccinating farm animals and pets.

Rabies can be in wildlife, as these stories note. However, we seldom get one involving an otter. While otters are cute and playful on the nature programs, they are susceptible to rabies, as is any mammal, so it is imperative we be alert to the animals around us, no matter where we are or what animal is involved. - ProMED Mod.TG]
Date: Sat 8 Feb 2020 05:16 PM EST
Source: Fox 8 [edited]

A Florida mom says she had to tackle an otter to protect her daughter and dog, WFLA reports. We don't often hear about aggressive river otters. But by fighting its way inside a home in Florida, experts say the otter was definitely not acting normal.  "My husband's like 'you just alligator wrangled an otter in the living room!'" [CE] said. The otter learned to not mess with a mother's instincts. "I think life is full of surprises, and you should just be ready for whatever," [she] said.

The story starts after 17-year old [GE] let their dog Scooter out before dawn Tuesday morning [4 Feb 2020]. Scooter had found an enemy.  "I sprinted to the backdoor, and I was like 'Scooter!' All I saw was like a big black ball just all over the place. So he stumbled in the door, and I tried to shut it as fast as possible, but then the otter got stuck," [GE] said.

By this time, the whole house is awake and her mother bursts in.  "I snatched it by the tail," [CE] said. "And then I held it up like a prize. And the otter's going crazy. It was like clawing at me and grabbing on to the backs of the furniture in my house." [CE] tossed the otter outside and discovered it had bit her daughter in the leg.

Several rabies shots later, [GE] and Scooter are on the mend. Now Florida Fish and Wildlife is trying to find the otter. It is unknown whether the otter has rabies because it has not been caught. His behaviour was definitely abnormal.  "Any time an otter's onshore going for a human, there's something not right. Usually, they see you, they're gone," said Dustin Hooper, an animal trapper, and owner of All Creatures Wildlife Control.
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[HealthMap/ProMED-mail map of Florida, United States:
Florida county map:
Date: Tue 4 Feb 2020
Source: Robesonian [edited]

A 9-year-old boy is undergoing treatment after being bitten by a rabid fox, according to the [Robeson] County Department of Public Health.

The boy was riding his bicycle Sunday evening [2 Feb 2020] on Barnhill Road in Lumberton when he was attacked by a fox, according to the Health Department. The fox was killed at the scene and its head was submitted for testing on [Mon 3 Feb 2020]. The results came back positive for rabies on [Tue 4 Feb 2020].

The boy will undergo a series of shots to prevent the onset of rabies, according to the Health Department. Area residents have been alerted and advised to monitor their children's and pets' activities.

According to the Health Department release, Sunday's bite case was properly reported "and as such, the system responded correctly. After-hour calls go to communications who contact the Animal Control officer on call."

Sunday's attack by a rabid wild animal is the 1st confirmed case of rabies in Robeson County this year [2020], said Bill Smith, Health Department director.

"I believe we had 3 this past year," he said. Those cases were animal-on-animal attacks, Smith said. "I think they were all pets last year," he said.

County residents need to be aware there are many more rabid animals in the area, he said. But the rate of confirmed contact between rabid animals and humans or pets is low because Robeson County is a rural county with large tracts of forests.

In rural areas the most likely scenario is an animal attacking a pet or human and then running into the woods, where it will die without anyone knowing if it had rabies or not, Smith said. In urban areas, there is more contact between humans and pets and animals known to be rabid because the attacking animal has no woods into which to run and hide. Therefore, the animal is easier to catch and test.

If someone is bitten by an animal that runs into the woods and is not caught and tested then precautions have to be taken, he said.

"We would treat that as a rabid animal," Smith said.

Sunday's incident prompted the county Health Department to issue the following advisories:
- all dogs, cats, and ferrets 4 months and older are required to be vaccinated against rabies and wear a current rabies vaccination tag per North Carolina law;
- if an animal is destroyed, try not to damage the head because it jeopardizes the testing of the brain;
- avoid feeding wild animals. Foxes and raccoons are the main sources of rabies in the Robeson County area and feeding them increases the likelihood of interaction between the wildlife and dogs, cats and humans.
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[HealthMap/ProMED-mail map of North Carolina, United States:
North Carolina county map: