Monday, 16 May 2016

First Case of Zika Virus Infection in Singapore


* Singapore's first Zika patient fully recovered, discharged from hospital
Zika patient discharged from Communicable Diseases Centre
By Tiffany Fumiko Tay, The Straits Times, 18 May 2016

A 48-year-old permanent resident who was Singapore's first confirmed Zika case has made a full recovery, and was discharged from the Communicable Diseases Centre at Tan Tock Seng Hospital (TTSH) yesterday afternoon.

According to a joint statement by the Ministry of Health (MOH) and the National Environment Agency (NEA), the patient's blood samples tested negative for the mosquito-borne virus.

The statement added that his family members had not reported any symptoms of Zika.

The Zika virus is spread by the Aedes mosquito, which also transmits dengue.

The Watten Estate resident was confirmed as having the virus last Friday after contracting it during a business trip to Sao Paulo, Brazil, between March 27 and May 7. Brazil is the country most affected by Zika, with more than 91,000 cases reported there between Jan 3 and April 2.

The patient developed a fever and rash three days after his return, and was admitted to Mount Elizabeth Novena Hospital last Thursday, where he was isolated.

He was later transferred to the Communicable Diseases Centre at TTSH.

According to MOH, public contact with the patient was minimal as he stayed at home for most of the time after returning from his trip, and did not take public transport to the hospital.

Some 160 NEA officers, contractors and volunteers were out in full force over the weekend, fogging the Watten Estate area, inspecting homes and public areas, and distributing fliers about anti-mosquito measures.


Of the breeding sites found, 26 were in homes and 14 in common areas.

Some residents told The Straits Times that mosquitoes had been prevalent in the area.

MOH and NEA said yesterday: "We advise residents in the Watten Estate area to continue to monitor their health and seek medical attention if unwell, especially if they develop symptoms such as fever and rash. They should also inform their doctors of the location of their residence."

Zika symptoms are similar to those of dengue, though milder, and include fever, rashes and joint and muscle aches.

The virus has also been linked to serious birth defects in children whose mothers were infected while pregnant with them.





Man back from Brazil is first Zika case in Singapore
PR developed fever and rash on Tuesday, three days after his return; he was hospitalised, isolated and is recovering
By Adrian Lim, The Straits Times, 14 May 2016

A 48-year-old man who returned from Brazil tested positive for Zika yesterday, making him the first confirmed case of the mosquito-borne virus in Singapore.

The permanent resident, who lives in Watten Estate, in Bukit Timah, travelled to Sao Paulo between March 27 and May 7 and developed fever and rash three days after his return, on Tuesday.

He was admitted to Mount Elizabeth Novena Hospital on Thursday and isolated, the Ministry of Health (MOH) and National Environment Agency (NEA) said in a joint statement on the imported infection. He will be transferred to the Communicable Diseases Centre at Tan Tock Seng Hospital (TTSH) for treatment. They said he is currently well and recovering but will be discharged only after he is clear of the virus.

Though he is the first patient to be confirmed, they noted it is possible some transmission may have occurred before now, as the majority of people infected with the virus do not show symptoms. Passed through the Aedes mosquito's bite, Zika causes mostly mild symptoms, but is allegedly linked to microcephaly in newborn infants, a rare condition characterised by abnormally small heads and underdeveloped brains.

MOH and NEA said residents of Watten Estate, Casa Perla, Hillcrest Arcadia, The Arcadia and Watten Hill Condominium have been advised to monitor their health and seek medical help if they develop symptoms such as fever and rash.

Though Watten Estate is not an active dengue cluster, NEA will step up vector control operations in the areas around the patient's home. This includes inspection of premises, measures to kill adult mosquitoes through misting and fogging, and outreach to the public through the distribution of information leaflets and insect repellents. MOH is also screening his household members.



The Zika virus has swept the Latin American and Caribbean region - with Brazil being the most affected so far, and Singapore has anticipated it would receive imported cases.

In February, an infectious disease expert said it was unlikely Zika would spread in the same way in Singapore, as anyone with a confirmed infection would be isolated until he no longer has the virus. Dr Lim Poh Lian of TTSH said then that Zika is likely to be similar to chikungunya, another mosquito-borne illness first seen here in 2008, but whose numbers have remained low.

Holland-Bukit Timah GRC MP Sim Ann said on Facebook: "I hope he recovers fully and quickly. In the meantime, our grassroots will give NEA full support in conducting house visits and engaging our residents."










Minimal exposure from Singapore's first Zika patient
He mostly stayed home, did not go to work and did not take public transport to hospital
By Linette Lai, The Sunday Times, 15 May 2016

The first person in Singapore with the Zika virus had stayed home most of the time after returning from Brazil on May 7, and did not go to work before he was admitted to hospital.

The 48-year-old, who developed fever and rashes three days after landing here, also did not take public transport to Mount Elizabeth Novena Hospital on May 12, when he was admitted before testing positive the next day.

All this helped minimise the chances of him being bitten by mosquitoes, which could then spread the virus, revealed the Health Ministry yesterday, even as about 160 National Environment Agency (NEA) officers, contractors and volunteers stepped up anti-mosquito measures in Watten Estate in Bukit Timah, where the man lives.

They carried out fogging, conducted checks and distributed fliers explaining anti-mosquito measures to minimise the risk of the Zika virus spreading.


Singapore's first confirmed Zika case was announced last Friday. The man, a permanent resident, had been in Sao Paulo, one of the world's most populous cities, from March 27 to May 7 on a business trip. Brazil is the country most affected by Zika. Between Jan 3 and April 2, more than 91,000 Zika cases were reported there. The Zika virus is spread by the Aedes mosquito, which also transmits dengue.

Zika symptoms are similar to dengue, but milder, and include fever, rashes and joint and muscle aches. However, preliminary research has led the World Health Organisation to conclude it can cause microcephaly - or abnormally small heads - in unborn children if mothers are infected. It is also a cause of Guillain-Barre syndrome, a rare condition in which a person's immune system attacks his nerves.

"For most people, Zika is not dangerous, and some of them will not even have symptoms," said Minister for the Environment and Water Resources Masagos Zulkifli yesterday. "But we know from reports around the world that Zika may affect unborn babies, resulting in microcephaly, and therefore we are worried."

Asked if the authorities will implement temperature screening at Changi Airport for people arriving from Zika-affected countries, he said it would be "quite impractical" as symptoms can take a while to develop. In four out of five cases, those infected show no symptoms at all.

Mr Masagos encouraged all Singaporeans to keep up the fight against the Aedes mosquito, especially since this is prime breeding season. "We are at the tail end of the hot season and going into the wet season," he said. "This is quite a dangerous time for us as this is the right time for mosquitoes to breed."

NEA destroyed seven breeding habitats in the Watten Estate vicinity last Friday, including four in homes. Officers are expected to continue anti-mosquito measures there for two weeks.

NEA, along with MP for the Holland-Bukit Timah GRC Vivian Balakrishnan, urged the 800 or so households in the area to work with the authorities, or officers will have to enter homes by force to check for mosquito breeding.

Dr Balakrishnan, who was the Environment Minister before becoming Foreign Minister, visited the Watten Estate area yesterday and wrote on Facebook: "We now need residents to help by opening their homes for inspection and to enable NEA staff to conduct special misting to eliminate all adult mosquitoes and breeding areas.

"NEA also needs urgent access to all vacant homes and will take legal steps to gain access if necessary."

NEA said notices will be served to those whose homes are not accessible. They will be asked to make an inspection appointment.

If they fail to respond, NEA officials may enter by force, starting early this week.










 




30 mozzie sites destroyed, 500 premises checked in Zika battle
Amy Khor urges area's residents to cooperate with NEA; those not at home can make appointment for inspection
By Carolyn Khew, The Straits Times, 16 May 2016

More than 30 mosquito-breeding sites have been destroyed and 500 premises inspected in the area where Singapore's first case of the Zika virus was recorded.

A 48-year-old man who lives in Watten Estate in Bukit Timah had tested positive for the virus after returning from a business trip to Sao Paulo in Brazil, it was revealed last Friday.

Giving an update on control efforts yesterday, Dr Amy Khor, Senior Minister of State for the Environment and Water Resources, as well as for Health, said the man has since been transferred to the Communicable Diseases Centre at Tan Tock Seng Hospital and is recovering well.

She added that the patient, a Singapore permanent resident, will remain in isolation until he has been diagnosed as free from the virus.

"The idea is really to prevent him from getting mosquito bites, and mitigating local transmission," said Dr Khor.

The authorities have stepped up vector control efforts in Watten Estate and the surrounding areas.

Noting that most of the breeding sites were found in homes, Dr Khor urged residents to cooperate with National Environment Agency (NEA) officers, to let them in to carry out inspections and misting to eliminate all adult mosquitoes and breeding areas.

She urged those not at home when NEA officers call to make an inspection appointment. If home owners fail to respond, NEA officials may have to enter by force.



Symptoms of the Zika virus are similar to dengue, but milder. They include fever, rashes, and joint and muscle aches. However preliminary research has led the World Health Organisation to conclude that it can cause microcephaly - or abnormally small heads - in unborn children if mothers are infected.

It also causes Guillain-Barre syndrome, a rare condition in which a person's immune system attacks the nerves.

Both Zika and dengue viruses are spread by the Aedes aegypti mosquito and residents must remain vigilant, Dr Khor said.

Those who experience symptoms such as rashes after returning from Zika-affected countries should see a doctor so that the NEA and the Ministry of Health can take precautionary measures to prevent local transmission.

Zika outbreaks have been occurring in more than 30 countries, including Brazil and Mexico.

Professor Tikki Pang, visiting professor at the Lee Kuan Yew School of Public Policy at the National University of Singapore, who researches global health matters, said that while there is probably every likelihood that the virus will be established here, it is unlikely that Singapore will experience an outbreak on the same scale as Brazil and other Latin American countries.

"Singapore is already on high alert, the urban settings are different and intensive vector control measures are already taking place," said Prof Pang.

"Singaporeans should not be unduly worried and alarmed as the disease is fairly mild and self-limiting, though the population, especially pregnant women, should try to take every precaution from getting bitten by mosquitoes."










Going to Zika-hit places? Take precautions
Travellers should protect themselves from mosquito bites and monitor health for 14 days after they return
By Linette Lai, The Straits Times, 14 May 2016

People who visit countries where the Zika virus has been detected should protect themselves from mosquito bites, said the authorities in a health advisory yesterday.

For example, they can wear clothing that covers as much of their skin as possible, apply insect repellent and use wire mesh screens or mosquito nets.

In yesterday's joint statement, the Health Ministry and National Environment Agency also advised people who return from affected countries to monitor their health for 14 days.

If they show symptoms of Zika, such as fever, rashes or joint and muscle pains, they should see a doctor and let them know their travel history. Other common Zika symptoms are headaches and red eyes.

The authorities said a 48-year-old man tested positive for Zika yesterday after returning from Brazil, in the first case of a Zika infection here.

Infectious diseases expert Leong Hoe Nam said people should not worry unduly, as Zika infections tend not to be serious compared with dengue. Both have similar symptoms.

"The current understanding of Zika is that it is very mild," he said. "The main people who are at risk are pregnant women."

However, Dr Leong said those who live near Watten Estate in Bukit Timah - where the man lives - should see a doctor immediately if they show symptoms of Zika. It is transmitted when an Aedes mosquito bites an infected person and later bites someone else.

The Zika virus can cause a child to be born with microcephaly - a condition where babies have unusually small heads - if the mother is infected while she is pregnant.

In the advisory, the agencies suggested that pregnant women reconsider travel plans to areas where the Zika virus has been detected, especially if an outbreak is ongoing.

A place is considered to have an outbreak if there is a relatively large number of cases, and where transmission is widespread or has gone on for more than eight weeks.

More than 20 Latin American and Caribbean countries have ongoing Zika outbreaks, including Brazil, Mexico and Costa Rica.

If a pregnant woman finds herself developing Zika symptoms after visiting such places, she should see a doctor to get tested. Those without such symptoms but who are still worried about infection should also consult a doctor, the authorities said.

Men who have returned from Zika-affected areas should also make sure they practise safe sex - or abstain from sex - for at least four weeks. This is because the virus can also be transmitted sexually. If their partners are pregnant women, they should adopt the precautions for the duration of the woman's pregnancy.

Those who wish to know the latest Zika updates can refer to www.moh.gov.sg/zika








How Singapore’s first case of Zika infection was spotted
Symptoms so mild, only patient's Brazil trip led doc to suspect virus
By Olivia Ho, Cheryl Lin and Ang Qing, The Sunday Times, 22 May 2016

When Singapore's first confirmed Zika patient went for a check-up at Mount Elizabeth Novena Hospital 10 days ago, he almost did not get hospitalised.

According to Dr Leong Hoe Nam, the infectious diseases expert who first diagnosed him, his symptoms were so mild that it was "difficult to justify even getting him admitted".

The 48-year-old permanent resident had a fever, head and muscle aches, and rashes - symptoms easily mistaken for a viral fever.

But Dr Leong noticed that his eyes were red, "as if he was suffering from a hangover".

When he heard that the patient had returned from a business trip to Sao Paolo, Brazil, five days ago, alarm bells went off.

Dr Leong asked for a blood sample to be sent to the laboratory for analysis, and for the patient to be admitted to hospital.

When the test came back positive, he recalled thinking, siao liao, siao liao ("here comes madness" in Hokkien). He said: "I'd rather have been made to look like a fool than to have dropped the ball on this one."

The Zika virus is spread by the Aedes mosquito, which also transmits dengue. The virus has been linked to serious birth defects in children whose mothers were infected during the pregnancy.

Dr Leong said when they broke the news to the patient, his wife was "devastated and crying".

He tried to comfort the patient by telling him that his diagnosis could help medical research in Singapore. Because of the previous dearth of Zika-positive samples, existing test kits here are rudimentary.

"I told him that his blood is going to save thousands, and it is more precious than gold right now," Dr Leong said. "He told me he wanted to volunteer to help the people of Singapore in any way he could. "

The patient, who has not been named, was then transferred to the Communicable Diseases Centre in Tan Tock Seng Hospital. He has since made a full recovery and was discharged on Tuesday last week.

In Watten Estate - where the patient lives - the National Environment Agency (NEA) has inspected more than 700 premises. It has destroyed 43 mosquito breeding habitats, 28 of which were found in homes and 15 in common areas.

The NEA and Ministry of Health (MOH) have urged residents to "remain vigilant" as the possibility of a secondary infection in the estate remains until June 23.The incubation period for the Zika virus is typically three to 12 days.

Professor Paul Tambyah, an infectious diseases expert who is secretary-general of the Asia-Pacific Society of Clinical Microbiology and Infection, said: "People might think that they just have a flu-like illness, with a non-specific rash."

He added, however, that the risk that the virus continues to circulate silently in the neighbourhood is low, given heightened public awareness and the NEA's prompt action.

Residents said things are getting back to normal after the Zika scare. Housewife Jemane Ing, 43, said 10 people had attended her boxing class in a park on Thursday. Two days earlier, nobody turned up.

Students studying in schools in the area said they were not concerned about Zika and were still participating in outdoor activities such as physical fitness lessons - albeit with more mosquito repellent on.

National Junior College student Wang Rui Feng, 17, said: "They've been carrying out fumigation and misting the classrooms. I don't think there's a good chance of contracting Zika."

Watten Estate resident Louise Clark, 45, said: "Given the international nature of Singapore, Zika was bound to come in at some point. But, so far, there's been only one, so maybe it was an isolated case."



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First Case of Zika Virus Infection in Singapore

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