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Taiwan
Summary of recommendationsMedicationsImmunizations
Recent outbreaksOther infectionsFood and water precautions
Insect and Tick ProtectionGeneral adviceAmbulance and Emergency Services
Medical facilitiesTraveling with childrenTravel and pregnancy
MapsEmbassy/Consulate Location

 

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Summary of recommendations:

All travelers should visit either their personal physician or a travel health clinic 4-8 weeks before departure.


Vaccinations:

Hepatitis A

Recommended for all travelers

Typhoid

For travelers who may eat or drink outside major restaurants and hotels

Yellow fever

Required for all travelers arriving from a yellow-fever-infected area in Africa or the Americas. Not recommended otherwise.

Japanese encephalitis

For travelers who may spend a month or more in rural areas and for short-term travelers who may spend substantial time outdoors in rural areas, especially after dusk

Hepatitis B

Recommended for all travelers

Measles, mumps, rubella (MMR)

Two doses recommended for all travelers born after 1956, if not previously given

Tetanus-diphtheria

Revaccination recommended every 10 years

Medications

Travelers' diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions, as outlined below. All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.

Most cases of travelers' diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.

If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.

Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.

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Immunizations

The following are the recommended vaccinations for Taiwan:

Hepatitis A vaccine is recommended for all travelers over one year of age. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF). Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.

Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.

Typhoid vaccine is recommended for all travelers, with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.

Japanese encephalitis vaccine is recommended for long-term (1 month) travelers to rural areas or travelers who may engage in extensive unprotected outdoor activities in rural areas, especially in the evening, during shorter trips. Japanese encephalitis has been reported in and around Taipei and the Kaohsiung-Pingtung river basins. Transmission occurs from April through October, with a peak in June and July. A total of nine cases were reported in the first six months of 2014.

The recommended vaccine is IXIARO , given 0.5 cc intramuscularly, followed by a second dose 28 days later. The series should be completed at least one week before travel. The most common side effects are headaches, muscle aches, and pain and tenderness at the injection site. Safety has not been established in pregnant women, nursing mothers, or children under the age of two months.

Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF). A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.

Tetanus-diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.

Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.

Polio vaccine is not recommended for any adult traveler who completed the recommended childhood immunizations. In October 2000, the World Health Organization certified that polio had been eradicated from the Western Pacific region, including China.

Cholera vaccine is not generally recommended. The only cholera vaccine approved for use in the United States has low efficacy and a high incidence of adverse reactions and is no longer being manufactured or sold.

Yellow fever vaccine is required for all travelers arriving from a yellow-fever-infected country in Africa or the Americas, but is not recommended or required otherwise. Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center, which will give each vaccinee a fully validated International Certificate of Vaccination. Yellow fever vaccine should not in general be given to those who are younger than nine months of age, pregnant, immunocompromised, or allergic to eggs. It should also not be given to those with a history of thymus disease or thymectomy.

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Recent outbreaks

An outbreak of dengue fever was reported in August 2010 from southern Taiwan, causing 1200 cases by November. In November 2009, a dengue outbreak was reported from Kaohsiung County and Pingtung County in southern Taiwan, causing 648 local cases and two deaths by December. The outbreak subsided by early spring, but was followed by an additional 227 cases between May and September 2010. A dengue outbreak also occurred in southern Taiwan in October 2008. In August 2008, a dengue alert was issued by the Taipei City Government after three cases were identified in Shezidao of Shilin District. A dengue outbreak was reported in October 2007 from Tainan city, on the southwestern coast of Taiwan, resulting in more than 500 cases. A dengue outbreak also occurred in July 2006, chiefly from the Kaohsiung-Pingdong region in the southern part of the country, causing more than 2000 suspected cases by December, more than twice as many as the previous year. A much larger outbreak occurred in southern Taiwan in July 2002, resulting in more than 5000 cases by the end of the year, chiefly from Kaohsiung (see ProMED-mail; July 15 and 22, November 11 and 26, and December 30, 2002; August 6, 2006).

Dengue fever, a flu-like illness sometimes complicated by hemorrhage or shock, is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. No vaccine is available at this time. Insect protection measures are advised, as below.

An outbreak of hand, foot, and mouth disease was reported in May 2008, chiefly affecting infants and young children. The outbreak abated following the start of summer vacation in July 2008. As of September 8, a total of 352 severe cases and 11 deaths had been identified and the number of new cases had markedly declined (see ProMED-mail). The outbreak was caused by enterovirus 71, which may produce a particularly severe form of the disease. Six cases of enterovirus-71 were also reported in December 2008, even though these infections are usually uncommon in the winter. A major epidemic of hand, foot, and mouth disease caused by enterovirus 71 was reported among children in Taiwan from April through July 1998. Cases were complicated by neurologic involvement, including meningitis, encephalitis (inflammation of the brain), and acute flaccid paralysis, and by pulmonary edema (fluid in the lungs). Seventy-eight children died, chiefly from pulmonary edema. See Emerging Infectious Diseases and The Lancet (November 15, 1999) for further information. Smaller outbreaks of hand, foot, and mouth disease, mainly among children, have been reported annually since that time. Hand, foot, and mouth disease is characterized by fever, oral blisters, and a rash or blisters on the palms and soles, usually occurring in young children. Most cases resolve uneventfully, but a small percentage are complicated by encephalitis, pulmonary edema, or myocarditis (inflammation of the heart muscle). The disease is caused by enteroviruses, which are transmitted by exposure to fecal material from infected individuals. There is no vaccine. The key to prevention is good personal hygiene and scrupulous hand-washing, especially after defecation and before handling food. No travel restrictions are recommended.

A conjunctivitis ("pink-eye") outbreak was reported from Taiwan in October 2007. Most outbreaks of conjunctivitis are caused by enteroviruses or adenoviruses. In most cases, the illness resolves uneventfully, but may cause significant discomfort and temporary incapacity. Acute conjunctivitis may be prevented by frequent hand washing and by not sharing towels and bedding.

An outbreak of severe acute respiratory syndrome (SARS) was reported from Taiwan in March 2003, resulting in 674 cases and 84 deaths, chiefly from Taipei City and Taipei County. Most of the spread occurred within hospitals and other health care facilities. On July 5, 2003the World Health Organization announced that the outbreak had been terminated. In December 2003, a single case of SARS was reported in research scientist who had been working with the SARS virus in the laboratory. No cases have been reported since that time. No travel restrictions are recommended for Taiwan at this time.

The disease appears to be caused by a previously unknown virus belonging to the coronavirus family. The incubation period usually ranges from two-to-seven days, but may be as long as ten days. The first symptom is usually fever, often accompanied by chills, headache, body aches, and malaise. This is typically followed by dry cough and difficulty breathing, at times severe enough to require intubation and mechanical ventilation. For further information, go to the World Health Organization, the Taiwan Centers for Disease Control, the U.S. Centers for Disease Control, and Health Canada.

An epidemic of hand, foot, and mouth disease caused by enterovirus 71 was reported among children in Taiwan from April through July 1998. Cases were complicated by neurologic involvement, including meningitis, encephalitis and acute flaccid paralysis, and by pulmonary edema (fluid in the lungs). Seventy-eight children died, chiefly from pulmonary edema. See Emerging Infectious Diseases and The Lancet (November 15, 1999) for further information. Smaller outbreaks of hand, foot, and mouth disease, mainly among children, have been reported annually since that time, most recently in the spring of 2002. Enteroviruses are transmitted by exposure to contaminated stool (fecal-oral route). Infection may be prevented by frequent handwashing and good personal hygiene.

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Other infections

>Scrub typhus, which is transmitted by chigger bites, occurs in Taiwan. Approximately 300-400 cases are identified every year (see ProMED-mail; March 26, 2008). The illness is characterized by a thick black scab at the site of the initial bite and a rash which starts on the trunk, associated with fever, headache, sweating, pink-eye, swollen glands. The infection should be treated with doxycycline.

Eosinophilic meningitis, which is caused by a roundworm known as Angiostrongylus cantonensis, is reported from Taiwan, most often in children. In March 2009, a cluster of cases occurred among Thai workers who had consumed raw snails. Another case was reported in January 2013, also after eating undercooked snails.

Melioidosis is occasionally reported, usually from the southern part of the island. A small outbreak was reported from southern Taiwan in July 2005, most likely related to contamination of a local creek after Typhoon Haitang. A total of 15 confirmed cases, one of them fatal, were recorded in the first nine months of 2011. Most of them occurred in Kaohsiung City (Kaohsiung Special Municipality) and Pingtung County (Taiwan Province). See Emerging Infectious Diseases, Emerging Infectious Diseases, and ProMED-mail for further information.

Cases of hemorrhagic fever with renal syndrome, which is caused by a hantavirus, are occasionally reported. The virus is transmitted by inhalation of aerosols from rodent excreta. Most travelers are at low risk.

HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.

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Food and water precautions

Do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, sea bass, and a large number of tropical reef fish.

All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if accompanied by nausea, vomiting, cramps, fever or blood in the stool. Antibiotics which have been shown to be effective include ciprofloxacin (Cipro), levofloxacin (Levaquin), rifaximin (Xifaxan), or azithromycin (Zithromax). Either loperamide (Imodium) or diphenoxylate (Lomotil) should be taken in addition to the antibiotic to reduce diarrhea and prevent dehydration.

If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.

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Insect and Tick Protection

Wear long sleeves, long pants, hats and shoes (rather than sandals). Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accommodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night.

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General advice

Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity.Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.

Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.S. State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.

Pack a personal medical kit, customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag, discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.

Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.

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Ambulance and Emergency Services

For an ambulance in Taiwan, call 119. Taiwan regulations require ambulances to have emergency equipment and supplies and to be staffed by trained medical personnel. Taiwan Police also offers a 24 hour telephone line for foreigners in English: 0800-024-111.

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Medical facilities

State-of-the-art, Western-style medical care is widely available. Many physicians in Taiwan have been trained in the United States and speak English. Many expatriates use the Priority Care Center (Adventist Hospital; tel. 2776-2651, 2776-2654), the Health Promotion Program (HPP) at Sun Yat-Sen Cancer Center (tel. 2897-0320; 24 hour nurse on call after-hours), or the Special Clinic (Cathay General Hospital). For complicated medical problems, the leading facility is the National Taiwan University Hospital (No.7 Chung San South Road, Taipei; tel. 886-2-2312-3456; website http://ntuh.mc.ntu.edu.tw/english/; member of the international networks of the Massachusetts General Hospital and the New York-Presbyterian Hospital, two leading U.S. hospitals).

Other leading hospitals include Min-Sheng General Hospital (No. 1028, Sanmin Road, Section 3, Taoyuan City; tel. 03-3179599, 03-4794151) and Taipei Medical University-Wan Fang Medical Center (No. 111, Section 3, Hsing-Long Rd, Taipei 116, Taiwan, R.O.C; tel. 886-2-29307930; website http://www.wanfang.gov.tw/english/index.html; owned by Taipei City government but run by Taipei Medical University). Both have been accredited by the Joint Commission International. For further information about health care in Taiwan, go to the the American Institute in Taiwan website.

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Traveling with children

Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed (see the American Institute in Taiwan website).

All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics. Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule).

When traveling with young children, be particularly careful about what you allow them to eat and drink (see food and water precautions), because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever, which are transmitted by contaminated food and water, are not approved for children under age two. Baby foods and cows' milk may not be available in developing nations. Only commercially bottled milk with a printed expiration date should be used. Young children should be kept well-hydrated and protected from the sun at all times.

Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.

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Travel and pregnancy

International travel should be avoided by pregnant women with underlying medical conditions, such as diabetes or high blood pressure, or a history of complications during previous pregnancies, such as miscarriage or premature labor. For pregnant women in good health, the second trimester (18–24 weeks) is probably the safest time to go abroad and the third trimester the least safe, since it's far better not to have to deliver in a foreign country.

Before departure, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency obstetric care if necessary (see the American Institute in Taiwan website). In general, pregnant women should avoid traveling to countries which do not have modern facilities for the management of premature labor and other complications of pregnancy.

Strict attention to food and water precautions is especially important for the pregnant traveler because some infections, such as listeriosis, have grave consequences for the developing fetus. Additionally, many of the medications used to treat travelers' diarrhea may not be given during pregnancy. Quinolone antibiotics, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin), should not be given because of concern they might interfere with fetal joint development. Data are limited concerning trimethoprim-sulfamethoxazole, but the drug should probably be avoided during pregnancy, especially the first trimester. Options for treating travelers' diarrhea in pregnant women include azithromycin and third-generation cephalosporins. For symptomatic relief, the combination of kaolin and pectin (Kaopectate; Donnagel) appears to be safe, but loperamide (Imodium) should be used only when necessary. Adequate fluid intake is essential.

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Maps

Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names.

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Embassy/Consulate Location

(reproduced from the U.S. State Dept. Consular Information Sheet)

The American Institute in Taiwan (AIT) is authorized by law to perform American citizen services. U.S. citizens are encouraged to register at AIT Taipei or AIT Kaohsiung, and to obtain updated information on travel and security. Registration can be done on-line by visiting the AIT website at http://www.ait.org.tw. The American Institute in Taiwan is a full passport services agency. Processing time for routine passports is about two weeks.

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