Taiwan, Japan, and Hong Kong Face Potential Measles Outbreak
Hong Kong has reported its first case of measles, suggesting that East Asia faces the prospect of an outbreak of highly contagious measles across the region after Japan and Taiwan reported dozens of active cases earlier this month and placed thousands of people in quarantine.
On Mar. 29, 2018, Taiwan’s Centers for Disease Control (CDC) reported that a 30-year-old male resident of northern Taiwan had visited Thailand in the beginning of March before developing a fever and cough by mid-March. On Mar. 17, the male visited Okinawa, Japan and was hospitalized on Mar. 19 after developing rashes on his limbs. Upon his return to Taiwan on Mar. 26, he was placed under quarantine while local health authorities conducted an epidemiological investigation and contact survey, which determined that the man had acquired the measles infection in Thailand — Taiwan’s first case of imported measles in 2018.
Two more cases of measles — two flight attendants on the man’s Tigerair Taiwan flight from Thailand to Okinawa — were reported by Taiwan’s CDC on Apr. 4. One flight attendant began to show symptoms on Mar. 24 but did not seek treatment until Apr. 1; the CDC noted that the flight attendant had passed through “several public areas in Taiwan” — including the Taipei Metro, several buses, and a hotel in Taitung — and flew to Macau from Taoyuan International Airport for work before re-entering Taiwan via Kaohsiung International Airport while he was possibly contagious.
Japanese government officials issued warnings on measles on Apr. 12 after over 40 people in Okinawa Prefecture and a teenage male in Aichi Prefecture, central Japan, who had traveled through Okinawa for about one week in early April were confirmed to have the virus. One week later, the Okinawan prefectural government counted at least 65 active cases since the first diagnosis of measles on Mar. 20 and urged all potential visitors to Okinawa to receive vaccinations.
Okinawan officials and Japanese hotel industry representatives warned that cancellations of trips to Okinawa — a popular destination for domestic and regional tourism — would rise, most likely damaging the local tourism industry as the peak holiday season for Japan approaches. By Apr. 20, at least 170 trips had been cancelled, with the prefectural government receiving about 30 inquiries a day about the infections.
By Apr. 23, at least one junior high school in Okinawa suspended classes in the face of the widening outbreak while Japan’s National Institute of Infectious Diseases (NIID) warned that “there is a possibility that the disease will spread due to the consecutive Golden Week holidays.” NIID officials urged the Japanese public to be “fully vaccinated against the measles” after a female staffer who treated the case in Aichi Prefecture came down with measles.
Meanwhile, Taiwan’s Ministry of Health and Welfare announced on Apr. 18 that an investigation into budget carrier Tigerair Taiwan’s compliance with health and safety regulations would be carried out. Five new measles cases reported by Taiwan’s CDC on Apr. 19 were related to airline staff working at Taoyuan International Airport; the airport disinfected office areas while the CDC identified 3,536 people in Kaohsiung who had come in contact with the infected flight attendants for monitoring.
On Apr. 21, Kaohsiung City’s Department of Health fined the two Tigerair Taiwan flight attendants for violating the Communicable Disease Control Act by continuing to work on flights even after developing symptoms of measles. A separate cluster of measles cases appeared in Linkou Chang Gung Memorial Hospital in Taoyuan City on the same day, bringing the count of confirmed cases to 22.
Hong Kong’s Centre for Health Protection issued a press release on Apr. 25 noting the lack of community spread of measles in Taiwan and warning travelers to Okinawa to receive all relevant vaccinations. However, the Centre for Health Protection revealed on Apr. 27 that a 46-year-old male who had traveled to Thailand from Mar. 1 to Apr. 8 developed the symptoms for measles infection on Apr. 18 and sought medical attention. Local doctors in Hong Kong have warned that inconsistent vaccination practices make the population susceptible to further outbreaks.
As governments in the region scramble to contain the highly contagious virus, upcoming holidays and seasonal patterns of travel, especially to Southeast Asia, make region-wide spread of measles increasingly likely. Australia became the latest country to report an imported case of measles on Apr. 27 after a passenger on a flight from Singapore to Melbourne developed symptoms after leaving Melbourne Airport. The patient, like the other imported cases, had traveled through Thailand prior to entering Singapore and flying to Australia.