Monday, 29 August 2016

Zika Virus: Singapore confirms locally-transmitted cases

Zika Virus

MOH FAQs on Zika Virus / Zika Clusters



 





 










Number of local Zika cases rises to 41
Figure may go up as there is a high likelihood of more local transmissions: Health Minister
By Salma Khalik, Senior Health Correspondent, The Straits Times, 29 Aug 2016

The number of people in Singapore infected by the Zika virus has gone up, with the Ministry of Health (MOH) saying yesterday that 41, most of whom are foreign construction workers, have tested positive.

Thirty-four have fully recovered. The other seven, who are still showing symptoms and are potentially infectious, are recovering in Tan Tock Seng Hospital. All those infected either live or work in the Aljunied Crescent/Sims Drive area.

Health Minister Gan Kim Yong said the number is expected to rise as there is a high likelihood of more local transmissions. He highlighted that there may be Zika carriers who show no symptoms - such as fever, rash and red eyes - and do not seek treatment, but are still infectious.

Yesterday's update followed news on Saturday that a Malaysian woman living in Aljunied Crescent had tested positive for the Aedes mosquito-borne virus. As she had no travel history to infected countries, it was confirmed as a local transmission, making Singapore the 58th country in the world to report the spread of the disease within its borders. In May, a man returning from Brazil, where Zika is rife, was the first known Zika case here.



But the 47-year-old woman is not the first to catch the infection locally. One of the other 40 people infected was sick a month ago, but even he might not have been the first, the authorities said yesterday.


"They are not known to have travelled to Zika-affected areas recently, and are thus likely to have been infected in Singapore," they said. "This confirms that local transmission of Zika virus infection has taken place."

MOH said that at this point, the community transmission appears to be localised within the Aljunied Crescent/Sims Drive cluster.

 
Besides the Malaysian woman, who is said to be a worker at a coffee shop at Block 45 in Sims Drive, the other 40 people comprise 36 foreign workers who work at a construction site at 60 Sims Drive and four Singaporean men.

The Singaporean men include a father and son who live in Block 62, Sims Drive. The son is doing his national service at Khatib Camp. MOH is in touch with the Defence Ministry on this and has been told that no one there has symptoms.

Another Singaporean man works at the construction site and lives in Sembawang Drive. The fourth lives at Block 54, Sims Drive.

The foreign workers were among 118 working at the site who were tested. Some either live or work in Kranji Road, Joo Chiat Place, Senoko South Road, Toh Guan Road East and Lorong 101 Changi.

The National Environment Agency is fogging and misting those areas to wipe out Aedes mosquitoes.



Mr Gan said that having Zika here was "almost inevitable", given the country's position as a travel hub.

Four in five people infected with Zika do not get sick, and for those who do, the illness is brief, lasting three to four days. By the fifth day, the person is usually no longer infectious. But Zika is a worry because it can be harmful to unborn babies. The virus has been linked to microcephaly, in which the baby is born with an exceptionally small and misshapen head.



MOH is actively testing people living in the affected areas who have symptoms, as well as close contacts of the 41 confirmed cases.

After the initial report on the Malaysian woman, Malaysia's Health Ministry decided to step up health screenings at Johor checkpoints. Similar screenings will also take place at airports hosting direct flights from Singapore, such as in Penang and Langkawi.

Mr Gan highlighted how eliminating the Aedes mosquito population was the "most important strategy" in the fight against Zika and urged Singaporeans to do their part.











* Subsidised Zika test for those who meet criteria
Free testing for pregnant women who show symptoms extended to private patients
By Salma Khalik, Senior Health Correspondent, The Straits Times, 6 Sep 2016

Singaporeans across the island who show clear signs of a Zika infection will from tomorrow be able to test if they have the virus at a subsidised rate of $60.

Tests, however, will remain free for pregnant women who show symptoms or have a male partner infected with the Aedes mosquito-borne virus. This has been extended to private patients, the Ministry of Health (MOH) announced yesterday.

It will also no longer hospitalise those with Zika or isolate them while waiting to see if they are infected.

Instead, patients can return home to wait for their test results, and will be given advice on protecting themselves from mosquito bites. Those who test positive will be hospitalised only if their doctor thinks it necessary.

A doctor's referral is needed to qualify for free testing or a subsidised rate.

Explaining why the authorities are adjusting their strategy, Health Minister Gan Kim Yong told Channel NewsAsia that the Government is working on the basis that Zika is being transmitted outside the current clusters in parts of Aljunied, Bedok and Joo Seng.

That is why "we want to provide subsidy for Zika testing even for those who are not associated with existing clusters".



Till now, those living or working in Zika-affected areas and are suspected to be infected have been tested for free.

The authorities are changing tack after observing that most cases have proven to be mild.


Infected women in the first and early part of the second trimesters of their pregnancy have a small risk of having babies with microcephaly, or very small heads.

"Should a pregnant woman be tested positive for Zika, her doctor will follow up closely with her to monitor her health and the development of her baby," MOH added.



Patients who need the test but cannot afford the $60 can ask for assistance, such as from Medifund, said MOH. Private patients have to pay the full cost of $150.

Mr Gan stressed that moving forward, the key strategy to controlling the spread of the virus is to control the mosquito population.

"Zika is very difficult to eradicate totally from Singapore, primarily because we have a presence of Aedes mosquitoes here," he said.

"Therefore we need to work a long-term strategy in managing Zika in Singapore, and the primary focus is, of course, vector control."

As of noon yesterday, there were 16 new cases, bringing the total number to 258.

















PM Lee: Best way to curb Zika is to stop mosquito breeding
Virus likely to have spread in Singapore, he says, as MOH confirms new cases
By Jalelah Abu Baker, The Straits Times, 2 Sep 2016

The spread of the Zika virus has widened to areas in the north and east, after single cases were found in Yishun, Upper Thomson and Simei. The Ministry of Health (MOH) yesterday also revealed that a second pregnant woman has been diagnosed with the virus.

She has been linked to the original cluster in the Aljunied Crescent/Sims Drive area, where the other expectant mother lives.

The 31 new infections detected as of noon yesterday, and another five found through look-back testing, take the total number of locally transmitted Zika cases here to 151 - less than a week after the first case involving a Malaysian woman living in Aljunied was found.

In a Facebook post a few hours before MOH's latest update last night, Prime Minister Lee Hsien Loong said it was only a matter of time before the Aedes mosquito-borne virus reached Singapore.

"The cases so far have been in Aljunied and Bedok, but we must assume that Zika is elsewhere in Singapore too," he wrote, adding that scientists are still learning about Zika "But we know that for most people, it is mild, and in fact often causes no symptoms at all. Pregnant women are at risk, as they are with other viral infections like dengue and chicken pox. Do take precautions and get tested if you show symptoms.

"Our best defence is to eradicate mosquitoes and destroy breeding habitats, all over Singapore. Do the five-step Mozzie Wipeout. Let's all do our part to fight Zika, and dengue as well."



The National Environment Agency said it is determining areas where mosquitoes are more prevalent, and taking action to reduce the population there - even if the area has no known Zika case.

This is aimed at breaking the disease transmission chain, and preventing further spread.

After Aljunied Crescent/Sims Drive, cases have been found in Paya Lebar Way/Kallang Way, Bedok North Avenue 3, Punggol Way and Joo Seng. Yesterday, MOH said it has found that three cases are not linked to any existing cluster. The affected people live in Yishun Street 81, Tagore Avenue and Harvey Crescent.

By the end of today, there should be posters on Zika and how to wipe out mosquitoes in every Nee Soon South lift, said the area's MP Lee Bee Wah. Checks will also be stepped up to find any pools of water which could allow mosquitoes to breed.



Yishun residents took the news in their stride, highlighting that unless one is pregnant, an infection has little impact. The bigger worry for most was how the virus was spreading. Said bank executive Agnes Teo, 36: "When the first case was reported, it was so far away, and now it's in my neighbourhood."

A resident of a landed estate near Harvey Crescent in Simei, Ms Yip Ming Yen, 38, said her family had started to take precautions such as closing the windows and using insect repellent. "It's definitely a concern," said the lawyer.

Meanwhile, the mother-in-law of the first pregnant woman found to have Zika here told The Straits Times yesterday that the family is feeling a bit better now that she is well and returning home from hospital soon. "She just has to go back later for check-ups regularly."

Malaysia yesterday confirmed its first case of Zika linked to the outbreak here. Its Health Ministry said the 58-year-old financial consultant travelled to Singapore on Aug 19 to visit her daughter, who lives in Paya Lebar.

The daughter also tested positive for Zika, and is one of at least six Malaysians living here who have been infected. More than 50 cases involve foreigners, most of whom are from China and India.

Additional reporting by Yeo Sam Jo and Janice Heng















Zika outbreak: Pregnant MP visits residents, to show 'life can go on as normal'
By Olivia Ho, The Straits Times, 2 Sep 2016

Pregnant women must take extra precautions in the light of the Zika virus outbreak in Singapore. But expectant mothers should also know that their lives need not be drastically altered, said Pasir-Ris Punggol GRC MP Sun Xueling.

And the 37-year-old, herself seven months pregnant, is aiming to show that by stepping up efforts to raise awareness of Zika prevention after a Punggol Way resident was diagnosed with the virus on Wednesday.

Smelling of citronella, a natural oil used as an insect repellent, Ms Sun went door to door at Block 259A, Punggol Way, yesterday to hand out insect repellent and posters on how to prevent the spread of the mosquito-borne disease.

Her team visited four other blocks. She will visit more blocks, as well as coffee shops, tomorrow.

Punggol is a young estate, and 36 per cent of the residents in Ms Sun's ward are between 22 and 35 years old. She estimated that she meets an average of five expectant mothers a night.

"If they are concerned (about) living here, I want to be here to show concern for them," she said.

"It's important for them to see me walking around. I want them to know that life can go on as normal with Zika, so long as you take precautions."



Zika is associated with microcephaly, a birth defect in which babies of women infected during pregnancy are born with abnormally small heads.

Two pregnant women linked to the Sims Drive-Aljunied Crescent cluster have been found to have Zika.

Ms Sun said: "Motherhood is a stressful time, and for the affected mum-to-be to have to deal with the added uncertainty of microcephaly is very unfortunate."

The pregnant women she met on her rounds said they were worried about Zika in the neighbourhood, but not excessively so as they felt they had taken many precautions.

Human resource specialist Evelyn Tan, 31, who is eight months pregnant, was glad for the free insect repellent handed out by Ms Sun. "All the repellent and patches are out of stock everywhere, even though we went as far as Chinatown Point to look," she said. "We had to get friends to buy some from Malaysia."

Administrative executive Charlene Go, 29, went out to buy two ultrasonic pest repellers at $20 each after the outbreak. She is seven months pregnant with her third child.

Some expectant mothers said their friends and families were even more paranoid than they were.

Accountant Soo Ee, 32, who is due to give birth in two weeks, said: "My mum did ask me if I wanted to induce labour, but I don't think I will."

Housewife Dayana Danel, 31, who is seven months pregnant, has no Zika symptoms, but her husband wants her to be tested for it anyway, even if it costs him hundreds of dollars.

Said the 32-year-old civil servant, who gave his name only as Mirza: "To know how healthy my baby daughter is, that's priceless."











Test needed only if you have key symptoms
By Linette Lai, The Straits Times, 2 Sep 2016

Doctors are advising pregnant women that there is no need to get tested for Zika, unless they show key symptoms, such as a fever and rash.

On Wednesday, a pregnant woman took to Facebook to say that a doctor at Woodlands Polyclinic would not refer her for a free test even though she had "all (Zika) symptoms besides rashes". So she paid $300 for the blood and urine test for her peace of mind.

The Health Ministry and Clinical Advisory Group on Zika and Pregnancy advise that unless a pregnant woman has clear symptoms of Zika - fever and rash, and another symptom such as red eyes or joint pain - there is no need to get regular blood or urine tests.

Those in the private sector, such as obstetrics and gynaecology (O&G) clinic A Company for Women, have also released advisories along these lines.

Dr Christopher Ng of GynaeMD Women's and Rejuvenation Clinic said that he has been getting at least one call a day from his patients inquiring about the possibility of getting tested.

He generally asks them to come in to discuss the issue, adding: "I wouldn't be surprised if some people want to go ahead anyway, despite MOH's general advice against doing so."





Zika outbreak: Why free testing for mums-to-be islandwide who show symptoms
Zika advisory group fears virus could have spread beyond current outbreak area
By Salma Khalik, Senior Health Correspondent, The Straits Times, 1 Sep 2016

Singapore's Zika Clinical Advisory Group was unanimous about offering free testing to pregnant women islandwide with Zika symptoms, as these experts fear that the virus could have spread beyond the current outbreak area.

Professor Arijit Biswas, who chairs the nine-member group set up in February, said the biggest concern about Zika is its effect on pregnancy.

That is why the group, which advises the Ministry of Health on developing clinical protocols to manage Zika, did not want to restrict the tests to only those in the current outbreak area around Aljunied. "We might miss some (cases)" if this were done, he said. "So we decided to make the net wider."

But these women should have had at least three Zika symptoms within the past two weeks. The symptoms are:

• a fever, usually low-grade;

• a rash that is usually red, flat and itchy and in more than one part of the body;

• any one of the following: joint or muscle ache, red eyes or headache.



Prof Biswas, who is clinical director of Maternal and Fetal Medicine at the National University Hospital, said women who have not exhibited such symptoms in the past fortnight should not go for the tests.

What would happen if Zika becomes endemic here, the way dengue is, and thousands of people get infected every year? "The most important message to pregnant women is, they should take precautions against mosquito bites," he said. And that would apply whether Zika becomes endemic or even now.

"Use mosquito repellents available in Singapore which are safe, wear long sleeves and pants in light colours, stay in air-conditioned rooms and use a mosquito net if possible," said Prof Biswas.

His other piece of advice for pregnant women is: "Either abstain, or practise safe sex throughout your pregnancy." This is to prevent any possible infection from a partner, who might not know he has Zika.

Prof Biswas also answered other questions about Zika. His answers have been paraphrased.

Q: If a pregnant woman has Zika, how accurate are the tests to check if the baby is affected?

A: Microcephaly, the most common birth defect linked to Zika infection, cannot always be picked up early. In some cases, it is spotted only after birth. But some features might be picked up during tests, like structural abnormality. If the baby looks structurally abnormal, a second test of the amniotic fluid can be done, but this carries a 0.5 to 1 per cent risk. Things that can go wrong include leakage from the womb, early contractions and even infection.

Q: If the tests cannot accurately tell if the baby is compromised, what's the point of regular monitoring?

A: The majority of pregnant women who have been infected with Zika give birth to perfectly normal babies. Monitoring the baby's development can give reassurance.

Q: If scans show the baby has a small head, should parents abort?

A: A small head alone is not enough to show the baby has microcephaly. There must be other symptoms such as extra fluid in the brain, or calcification. Also, about 15 per cent of babies born with microcephaly can live normal lives.

If abnormalities are found, you should discuss it with your doctor, as each case is different.

Q: Why can't women whose babies are likely to suffer from microcephaly abort if they have been pregnant for more than 24 weeks?

A: A foetus older than 24 weeks can survive unaided, but one that is less than 24 weeks can't. This is why 24 weeks is the legal limit for abortion.

Q: If the virus stays in the body for only two to four weeks, why do women infected with Zika have to wait two months, and men six months, before trying for a child?

A: This is to be really safe, as there are reports that the virus can stay in the semen for up to six months.





Family of pregnant woman felt anxiety, then relief
By Seow Bei Yi and Rachel Oh, The Straits Times, 2 Sep 2016

It started with a regular day last week at the playground near their Housing Board flat for the pregnant woman and her daughter.

But on Saturday night, the young girl came down with a fever.

Her family took her to the polyclinic and they were eventually referred to the hospital.

The diagnosis: Zika.

But the more troubling news came on Wednesday, when the mother, who is more than five months pregnant with her second child, found out she had been infected as well. She suffered "mild symptoms" and was taken to KK Women's and Children's Hospital.

She became Singapore's first pregnant woman to be infected with the Zika virus, the authorities announced that night.

"We were so anxious and couldn't sleep well," said her tearful mother-in-law, as she recounted the ordeal to The Straits Times at their home in the Aljunied Crescent and Sims Drive area yesterday.

All seems well now, after two days of checks at the hospital, and her expectant daughter-in-law will be returning home soon, she added with relief.

She declined to be named.

"We were worried and afraid, but we are feeling a bit better as my daughter-in-law is well now.

"She just has to go back later for check-ups regularly," said the woman in Mandarin.

Her daughter-in-law is still in hospital, and her health and her baby's development are being closely monitored. She will also be referred to a maternal-foetal medicine specialist for counselling.

Unborn babies in the first trimester and early part of the second trimester are most vulnerable to the Zika virus' effects.

This means that the baby of the woman - who is now in the later part of her second trimester - may still face some risks.

Dr Leong Hoe Nam, an infectious diseases specialist at Mount Elizabeth Novena Hospital, however, counselled perspective.

Unborn babies whose mothers are infected by the Zika virus may be born with microcephaly, a condition where a baby has an abnormally small head. The risk of this ranges between 1 per cent and 13 per cent.

But Dr Leong said the data is "horribly skewed" by Brazil, which reports a higher rate of microcephaly.

In French Polynesia, the risk stands at 1 per cent, and Dr Leong believes Singapore is likely to face a similar rate.

If there had been a change in the virus, the risk of microcephaly in Brazil would have extended to Colombia, but this is not the case, which means the risk depends on situational change, he added.

Dr Leong also said that in all live births, the risk of defects is around 1 per cent as well.

The pregnant woman is among a total of 151 Zika cases in Singapore as of yesterday noon. It is unlikely that she was infected because of her daughter or vice versa, as their symptoms emerged around the same time, said health experts at a briefing on Wednesday.

The mosquito-borne disease's symptoms are generally mild in adults.











Zika outbreak: No real reason to delay having children, say doctors
By Linette Lai and Olivia Ho, The Straits Times, 2 Sep 2016

To wait or not - this question is on the minds of couples planning to have a child after the spread of Zika to several areas in Singapore.

The advice from doctors is that there is no real reason to delay, since it seems unlikely the virus will be eliminated from these shores.

Instead, those planning parenthood should accept that this is likely to be the "new normal" and take precautions against being bitten by the Aedes mosquito - which spreads Zika - and make sure their homes are mosquito-free.

"The transmission vector is a mosquito which is endemic in Singapore. You might want to delay pregnancy but when do you think Zika is going away?" said Dr Christopher Ng of GynaeMD Women's and Rejuvenation Clinic.

The same point was made by infectious diseases specialist Leong Hoe Nam of Mount Elizabeth Novena Hospital: "If we can't clear the Zika cases in the next few weeks, chances are that it will stay rooted in Singapore. But life must go on."

While a Zika infection is typically mild, with symptoms of fever and rash along with others such as sore eyes and joint ache, it can have serious effects on unborn children. Pregnant women who catch the disease may give birth to babies with unusually small heads - and this could lead to developmental problems.

Said massage therapist Suhailah A. Samin, who has two sons: "We were planning for a third child but decided not to have more kids during this Zika period. We're afraid we may not be able to cope with the pregnancy and will suffer... more worries with all the 'what-ifs'."

Other couples, however, are taking any risk in their stride.

"We are no longer young," said renovator Sky Yong, 41.

Both he and his wife, finance manager Ashley Low, 39, work fairly near Aljunied, where the first cluster of local Zika transmission was detected.

"We love children... Zika, Aids, whatever virus is out there, we will still go for it. We can't live controlled by fear," added Mr Yong.

Housewife Christina Chong, 36, and her husband, lab officer Ong Wai Chung, 37, are also undeterred. "We have been waiting for so long, planning for two or three years, before the virus came along. We are just avoiding the affected areas but there's nothing much you can do."

Senior Minister of State Josephine Teo, who oversees the National Population and Talent Division, said it is natural for prospective parents to be concerned. She encouraged them to find out more about the disease and its potential health risks, and speak to doctors if necessary.

"I hope they are not overly deterred because, as with dengue and chikungunya, we have to deal with Zika through taking regular precautions such as using mosquito repellents when going outdoors and looking out for symptoms," she said.










Zika spreads to Bedok; first mum-to-be hit by virus
Woman lives in initial Aljunied Crescent/ Sims Drive cluster; number of cases rises to 115
By Salma Khalik, Senior Health Correspondent and Linette Lai, The Straits Times, 1 Sep 2016

There was a double dose of bad news on the Zika front yesterday, as the outbreak potentially spread to another cluster - in Bedok North - while, elsewhere, a pregnant woman was infected by the virus.

The expectant mother lives in the Aljunied Crescent and Sims Drive area. A member of her household had earlier been diagnosed positive for the virus. Zika poses the greatest danger to pregnant women as it can potentially harm their unborn children.

Just four days after the first locally transmitted case emerged on the island, it appears that the virus has quietly spread its tentacles.



The Ministry of Health (MOH) revealed yesterday that a new potential cluster had emerged in Bedok North Avenue 3, where three previously reported cases live.

One of them works in the Aljunied Crescent/Sims Drive area, which was the first cluster to be identified. The other two had no known links to that area.

Joo Seng Road and Punggol also find themselves on Singapore's Zika map; among the additional 24 cases revealed yesterday, there was one resident each from both areas.

This brings the total to 115 Zika cases in Singapore to date.



Health Minister Gan Kim Yong said: "Over time, we expect Zika cases to emerge from more areas. We must work and plan on the basis that there is Zika transmission in other parts of Singapore and extend our vector control efforts beyond the current affected areas."

The National Environment Agency (NEA) is launching its vector control operations in Bedok North Avenue 3, an area with 6,000 premises. It will do pre-emptive checks in areas assessed to be high risk, even if there are no known cases.

NEA has already been deploying 300 personnel each day in its war on mosquitoes in the Aljunied Crescent and Sims Drive area, which is home to the expectant mother who found out yesterday that she had been infected.

She had suffered "mild symptoms" and has been taken to KK Women's and Children's Hospital.

"She is generally well, quite well," said Mr Derrick Heng, group director of public health at MOH, at a joint briefing by the ministry and NEA late last night.

The woman's identity, race and nationality were not disclosed.

But while the six-member panel was careful not to specify which stage of the pregnancy she is at, it appears that she is in her first two trimesters.

Zika afflicts most severely unborn babies whose mothers are in the first trimester and early part of the second trimester of pregnancy. Some of these babies could suffer from a condition known as microcephaly, that is, an abnormally small head. The risk of this ranges between 1 per cent and 13 per cent.

"Her doctor is following up closely with her to monitor her health and the development of her baby," said the ministry. The woman will be referred to a maternal-foetal medicine specialist for counselling.

If scans suggest that an unborn child has been harmed by the virus, abortion is a possibility if the mother is less than 24 weeks pregnant, said Professor Arijit Biswas, who chairs Singapore's Zika Clinical Advisory Group.

Whether or not to terminate the pregnancy is "a very personal decision", he added.

Looking ahead, there will be "very close monitoring of the foetus", said Mr Heng. Scans will be conducted, but even so, the results may not be clear. "If the scans are totally normal, I think all is well. If the scans are very abnormal, then I think the result is clear.

"But sometimes there will be borderline cases and I think that's where there will be very difficult decisions."










Lifetime immunity after infection
By Salma Khalik, Senior Health Correspondent, The Straits Times, 1 Sep 2016

Zika is a new infectious disease of great concern to many people, especially as not very much is known about it. AskST shares answers to some questions that people are asking about the disease.

Q Can a person get Zika many times, like we can with dengue? Or does getting infected once confer immunity?


A One infection should confer lifetime immunity against the disease, said Professor Leo Yee Sin, a senior infectious diseases consultant at the Communicable Disease Centre.


Q In that case, should young couples try to get infected so they do not get the disease when they want to raise a family?


A Prof Leo said that while this may sound logical, not enough is known about the disease to advise this course of action.


Associate Professor Benjamin Ong, director of medical services at the Ministry of Health, said: "It would be unwise of us to tell people to go and get infected just because they might want to get pregnant (in future)."





Q Are there home kits I can use to diagnose Zika, the way diabetics use test-strips?

A No, both urine and blood must be tested in a laboratory.


Q Should all pregnant women check to see if they have been infected with Zika, even if they have no symptoms, since four in five people infected do not get sick?


A No, because the tests work only if they are carried out within a month of infection. So those infected more than a month ago would not be able to tell if they have been infected. It is better to monitor the development of the baby and to discuss it with your doctor if anomalies appear.











* Get tested, mums-to-be with signs of Zika urged
Testing with doctor's referral is free; new cases found outside initial cluster
By Abdul Hafiz, Deputy News Editor, The Straits Times, 31 Aug 2016

All pregnant women who develop fever and rash, along with other signs of possible Zika infection such as red eyes or joint pain, have been advised to test for the virus.

This is regardless of whether they have been to Zika-affected areas. Those whose male partners are found to carry the Zika virus are also being urged to get tested, even if the women are not showing symptoms of the virus.

Testing after referral by a doctor is free at public healthcare institutions, added the Ministry of Health (MOH) last night, when it was revealed that the infection had spread beyond the initial Aljunied Crescent/Sims Drive cluster.

Of the 26 more cases confirmed yesterday, five involved people living or working in Kallang Way and Paya Lebar Way, areas just north of Aljunied and Sims Drive.

This brings the total number of local transmissions to 82, three days after a Malaysian woman living and working in Aljunied was identified as the first known case of a person being infected locally.

While a Zika infection is mild for most, it can have very serious consequences for pregnant women and unborn children. The Aedes mosquito-borne virus has been linked with microcephaly - a condition in which the baby is born with a much smaller head.

After a meeting yesterday of the Clinical Advisory Group on Zika and Pregnancy, the MOH released updated guidelines.

Highlighting how prevention is the best protection, expectant mothers were urged to "undertake strict precautions against mosquito bites". These include wearing clothing that covers the limbs, and sleeping under mosquito nets or in rooms with wire-mesh screens or air-conditioned rooms. Seek medical help immediately if Zika symptoms show, the advisory stressed.

A person with the infection typically develops a fever and rash, and shows at least one other symptom such as red eyes or joint pain.



While the virus is mostly spread by the Aedes mosquito, a small number of cases of sexual transmission has been documented. That is why pregnant women who show no symptoms, but with male partners who are Zika-positive, should be tested as well.

If a pregnant patient is confirmed to be infected by Zika, she will be referred to a specialist for counselling. The MOH said it will also arrange for her admission to a public hospital if needed.

Describing the news of the 26 new cases as "troubling", MacPherson MP Tin Pei Ling yesterday said the Marine Parade Town Council has been conducting extra fogging in Aljunied Crescent and this will be expanded to her ward.

Yesterday, Minister of State for Manpower Teo Ser Luck, during a visit to an Aljunied construction site where 39 cases of Zika were found, said the authorities have stepped up checks of worksites.
















MPs take steps to educate, support pregnant mums
They make house visits, set up website, distribute pamphlets
By Felicia Choo and Carolyn Khew, The Straits Times, 31 Aug 2016

Members of Parliament from various constituencies have stepped up their fight against Zika, by educating pregnant women about the disease and providing support.

Mr Alex Yam, an MP for Marsiling-Yew Tee GRC, said that this weekend, residents and volunteers will hand out pamphlets to inform residents how they can protect themselves from the virus.

His team has also set up a Mummy Safe Singapore website which contains information on microcephaly - a condition which causes babies to have small heads - and insect repellents which are safe for expectant mothers to use.

"Zika is very frightening to people right now because it is associated with images of microcephaly," said Mr Yam, who has received e-mail from worried mothers-to-be.

He hopes that the website will reassure them that the chance of their babies getting microcephaly is quite small. Studies have shown that between 1 and 10 per cent of expectant mothers who are infected during pregnancy will give birth to babies with microcephaly.

"Whether we like it or not, we have to accept that Zika will very much become a fact of life," added Mr Yam. "I don't think there's any way to say that we can eradicate it tomorrow."



Yesterday, MacPherson MP Tin Pei Ling visited five pregnant women living in Aljunied Crescent and gave them a letter with information on Zika.

Her grassroots team also visited 20 other pregnant women in the MacPherson area yesterday.

She also plans to pay house visits to pregnant mothers living in the new affected area of Paya Lebar Way "as soon as possible".

As of press time, there were four mothers-to-be on the list. In addition, Ms Tin created a special e-mail account for these women to contact her about Zika-related matters.

Ms Tin, who gave birth to her first child last year, explained that she wanted to "connect everyone" and "make sure we have a channel to share information and updates".

She added: "We will continue our efforts to work with agencies very closely to curb breeding of mosquitoes and to drive down as much as possible the potential spread of the disease - whether it's Zika or dengue."

One concerned mother-to-be living on the second floor of Block 103, Aljunied Crescent has been taking precautions since the first case of Zika was reported there last Saturday.

"I'm quite worried about the baby for these next two months... My husband and I use mosquito coils in the home and spray mosquito repellent on ourselves," said Ms Sulaiha Ngatiman, 30, who is seven months pregnant with her fifth child. She has four sons aged three, seven, nine and 10.

"We also try to avoid other affected areas when we go out."










Checks stepped up at construction sites
Operators take extra precautions to prevent spread of Zika virus
By Joanna Seow, The Straits Times, 31 Aug 2016

The authorities have stepped up checks on worksites around Singapore, after a cluster of Zika cases was reported last week to have originated from a site in Sims Drive.

Minister of State for Manpower Teo Ser Luck, who visited the Sims Urban Oasis construction site yesterday, said he was glad to see that the operator had taken more precautions.

"We need all operators to reinforce their preventive measures right now to assure the community, the workers on the sites as well, that although the symptoms may be mild, we can't take anything for granted," Mr Teo told the media.



He added that his ministry has sent out an advisory to site operators and will step up inspections.

"For those who are a bit more negligent in this field, we will work with you but we may take action against you if you don't take preventive measures because it's a very serious issue," he said.

Thirty-seven cases of Zika were first discovered over the weekend to have originated from the same site, and another two surfaced on Monday. No new fever cases were found yesterday, said the site's main contractor Woh Hup.

A stop-work order was issued to the 23,900 sq m site last Saturday. Woh Hup construction manager Yong Jian Rong said the company is working closely with the Ministry of Manpower and the National Environment Agency on when the order can be lifted.

"We've briefed all our workers, sub-contractors, staff and anybody who's involved in the site based on reports on what the symptoms of the virus are and how to personally protect themselves," he said.

Besides fogging and misting the site, the contractor increased the number of mosquito traps from 50 to about 500. These are installed throughout the condominium site, along the perimeter and in the workers' dormitory.

Workers must have their temperatures taken twice a day, and have been given repellent sprays, mosquito patches, repellent bands or clips and arm coverings. Netting was added to dorm room windows.



Mr Yong said the workers' morale has been "okay" since news of the cases was reported. "We've been telling workers every day not to worry, and that if anything happens, the company will take care of your health and give you the full medical attention you need."

Some 490 workers - a mix of staff from Woh Hup and its sub-contractors - stay at the on-site dormitory. Those recovering from Zika are given separate rooms with Wi-Fi and have their meals delivered to them.

The workers who fell sick were from a mix of companies and dormitories. Several, including Mr Baskaran Murugan, 33, recovered from their symptoms before it was discovered they had the Zika virus.

Mr Murugan, who had a fever, headache and conjunctivitis two weeks ago, said he told his safety officer about his fever in the morning and was taken to a nearby clinic as soon as it opened. The doctor gave him two days' medical leave and medicine, while the company gave him several additional days of rest and vitamin C.

When asked whether he was afraid when he fell sick, he said he did not know it was Zika. "It was not difficult for me, it was just like a normal fever."

Contractors whose sites are not within the Aljunied cluster are also taking more stringent precautions in addition to measures that were already in place to combat dengue.

CHL Construction workplace safety and health officer Richard Teo said the company held a briefing yesterday for workers at all its sites to teach them about the symptoms of Zika. It also set up a buddy system to check workers for rashes and conjunctivitis, and implemented temperature checks.

Migrant Workers' Centre chairman Yeo Guat Kwang said in a statement that the group will scale up its outreach at dorms and popular areas in the coming weeks to remind workers and employers to be vigilant.

"Zika is generally a mild disease. Therefore there should be no reason for (workers') work tenure in Singapore to be affected," he said.
















NEA, MOH step up fight as Zika cases rise to 56
Officials fan out across outbreak cluster and beyond as total number of infections hits 56
By Salma Khalik, Senior Health Correspondent and Fabian Koh, The Straits Times, 30 Aug 2016

The authorities stepped up efforts to contain the Zika virus yesterday even as 15 new cases surfaced.

This brings the total number of people who have been locally infected to 56 - and more are likely to be uncovered, warn the authorities.

National Environment Agency (NEA) officials fogged, misted and sprayed the cluster of Aljunied Crescent and Sims Drive, where the outbreak has taken place.

They inspected over half the 6,000 premises and destroyed 36 mosquito breeding habitats - 22 in homes and 14 in common areas and other spots. NEA has also inspected more than 900 premises at Sembawang Drive, and detected and destroyed one breeding site in a residence in that area.



Meanwhile, the Ministry of Health (MOH) is advising mothers- to-be to avoid areas with "local transmission" of the virus, according to its website.

The mosquito-borne viral infection is generally mild, except for its effect on unborn babies. It can cause brain damage in a small number of babies if the mother is infected during pregnancy, especially in the early months.

One mother-to-be is not taking any chances. Yesterday, 28-year- old housewife Sherynn Ellyadi, who is 38 weeks pregnant, moved out of her flat in Block 54, Sims Drive, where she lived with her mother and five children, her mother Lela Noordin, 60, told The Straits Times. Ms Sherynn has moved to her in-laws' home in Woodlands.

In a joint statement with NEA, MOH said it expects more cases to emerge as it continues its probe into people living around Sims Drive and Aljunied Crescent who previously had symptoms of the Zika infection.

"MOH will continue to work with GPs in the area to offer testing for patients who had fever and rash previously," they said.

"The look-back exercise will likely uncover more previously undiagnosed cases of Zika."





People who tested positive
The Straits Times, 29 Aug 2016

The Health Ministry yesterday confirmed 41 cases of locally transmitted Zika. They are:

• A 47-year-old Malaysian woman who developed fever, rash and conjunctivitis from last Thursday. She was referred to the Communicable Diseases Centre (CDC) at Tan Tock Seng Hospital, where she tested positive for Zika on Saturday. She has since been warded for observation at CDC.

• 36 foreigners from a worksite of Sims Urban Oasis, a condominium at 60 Sims Drive. Seven of them are warded at CDC; the rest have fully recovered.



• A 30-year-old Singaporean man who works at the same construction site and lives in Sembawang Drive. He developed symptoms since Aug 22, and was warded at CDC on Saturday.

• A Singaporean man and his son who live at Block 62 Sims Drive. The father is a retiree aged 65, and his son, 21, is a full-time national serviceman from Khatib Camp. They developed symptoms from Aug 23 and Aug 21 respectively, and were warded at CDC on Saturday.

• A 44-year-old unemployed Singaporean man who lives at Block 54 Sims Drive. He developed symptoms on Aug 23 and is now warded at CDC.









Zika outbreak: All-out effort to protect mums-to-be
MP Tin Pei Ling compiling list of pregnant women in constituency
By Priscilla Goy and Fabian Koh, The Straits Times, 29 Aug 2016

MacPherson MP Tin Pei Ling is drawing up a list of pregnant women in her constituency to keep them "updated and assured" about the Zika situation, after a female resident became the first known locally transmitted Zika case.

Ms Tin also responded within minutes after a pregnant woman living near Aljunied Crescent posted on Facebook that she was "starting to freak out" after hearing about the outbreak.

Ms Samantha Ng wrote: "I'm staying in the MacPherson area and currently in my last trimester. Hopefully (I) will be safe and good."

Within minutes, Ms Tin asked Ms Ng to send her a private message to let her know where she lives.

On Saturday, it was revealed that a 47-year-old woman living in Aljunied Crescent was the first locally transmitted case of Zika. The area is part of MacPherson constituency.

She is the only Zika patient living in Aljunied Crescent among all 41 reported cases of locally transmitted Zika, Ms Tin wrote on Facebook as she assured residents who were concerned about the situation.

While Zika is mild for most, it can be fatal for unborn children. Infected pregnant women could also give birth to babies with small heads - a condition known as microcephaly - and other brain defects.

Ms Tin said she and grassroots leaders are keeping a list of pregnant women as they walk around MacPherson to give out leaflets and insect repellent, and urge people to keep their premises mosquito-free.



They have been knocking on doors at five Housing Board blocks since Saturday night and also visited a food centre at 117, Aljunied Avenue 2 yesterday. Ms Tin said: "We are actively looking out for pregnant women, taking down their particulars so we can follow up with them on a regular basis - to share with them information about Zika, so they are kept updated and assured."

There were at least 10 names on the list yesterday, and grassroots leaders will visit them again on Wednesday to check on them.

"We've asked (the pregnant women) to watch out for possible symptoms and seek medical attention if anything arises," said Ms Tin, who gave birth to her first child last year.



Senior Minister of State for Health Amy Khor and grassroots leaders also gave out leaflets and repellent in Sims Drive yesterday.

Officers from the National Environment Agency (NEA) have stepped up misting and fogging to kill adult mosquitoes.

Dr Khor said "a couple" of residents were not willing to open up their homes to vector control officers. "I want to encourage all residents to cooperate," she said. "This is really very important. It is fundamental to our efforts to prevent or reduce the risk of the further spread of the Zika virus, particularly in this area."

Ms Mary Wee, a staff member of Bethel Assembly of God in Aljunied, said the church yesterday called off its monthly visit to homes of needy families as a precaution.

Meanwhile, residents said they felt assured by the increased efforts to combat the disease.

Mr Abdul Rahim Mohamed Yassim, 63, who lives in Aljunied Crescent and owns a stall at a food centre, said: "The grassroots leaders visited my home yesterday. I'm glad that they're giving us information on Zika. I'm not too worried, but I'll be more careful as I also don't want the virus to spread to others."










Impact of Zika virus on unborn babies
The Straits Times, 29 Aug 2016

Q: Who is at greatest risk?

A: Unborn babies are the most at risk should their mothers become infected with the Zika virus.

Between 1 per cent and 10 per cent of women infected during pregnancy give birth to babies with defects. The most common defect is microcephaly, where the baby is born with a much smaller head, sloping forehead and damaged brain.


Q: Is the baby at risk throughout the pregnancy?

A: Associate Professor Arijit Biswas, head of obstetrics and gynaecology at the National University Hospital, said the risk is highest during the first trimester and the early part of the second trimester of pregnancy.

Though the risk is lower in the third trimester, the virus could still cause fatal outcomes such as stillbirth.


Q: If a pregnant woman has Zika, what can be done to prevent its effects on the baby?

A: Dr Derrick Heng, group director for public health at the Health Ministry, said: "Once the mother is infected, there is nothing much we can do to prevent the effect on the baby."

However, more than nine in 10 pregnant women infected with Zika will deliver normal babies.





Q: What can pregnant women do to protect their babies?

A: They need to take stringent precautions against becoming infected. This includes preventing themselves from getting bitten by mosquitoes, by wearing long-sleeve tops and slacks, and using mosquito repellents.

Another precaution is to ensure that women have only protected sex during pregnancy, since the virus can also be passed through bodily fluids.

Four in five people who become infected with Zika do not show any symptoms but could be infectious, so the fact that the husband is not sick is no guarantee that he does not have the virus.


Q: What can a pregnant woman do if she has Zika?

A: Her doctor will monitor the development of the baby. If it is confirmed to have a major defect, and it is within 24 weeks of conception, abortion is a choice.


Q: What are the symptoms?

A: Symptoms of Zika include a fever, an itchy rash, body aches, headache, red eyes and, occasionally, nausea and vomiting.





Info on cases issued as soon as ready: Minister
By Priscilla Goy, The Straits Times, 30 Aug 2016

The authorities had released information on the 41 confirmed cases of locally transmitted Zika as soon as they could, said Minister for Social and Family Development Tan Chuan-Jin yesterday.

"I know some quarters have been trying to perhaps cast different aspersions about information being not forthcoming, but I think in this particular instance, what is quite clear to me is that (the Health Ministry) is quite particular that once information is ready, then it's pushed out immediately - which has been the case," he said.

"It's very important in times like this that the information put out be accurate, be factual."

He was speaking after visiting residents in Joo Chiat Place and Lorong 101 Changi, which are areas of concern as some of the Zika patients live there. He is an MP for Marine Parade GRC and his Kembangan-Chai Chee ward covers those areas.



The day before, Minister of State for Health Chee Hong Tat also said there had been no attempt to cover up the spread of the Zika virus here. Writing on his Facebook page shortly before midnight on Sunday, he said: "Some people have been wondering why the number of locally transmitted Zika cases increased from one case on Aug 27 to 41 cases on Aug 28. A few even asked if there had been attempts to cover up these cases. This is certainly not true."

He said officers in the Health Ministry and National Environment Agency had been "working hard over the past few days" to provide updates on the latest developments and to coordinate with residents, community leaders and healthcare professionals on the follow-up actions. "This includes colleagues from the laboratories who are doing confirmation tests for suspected cases - they have been working till way past midnight to complete the tests, so that the results can be announced in a timely manner," he wrote.

Mr Chee and Mr Tan took to Facebook to encourage residents to take precautions to reduce the risk of Zika infection. Mr Tan wrote: "Stay calm and read the health advisories... Combating dengue and Zika is a community effort. Everyone has a role to play."









Zika outbreak: Tracing under way before case confirmed
Checks started after clinic flagged unusual rise in cases of fever, rashes and joint pain
By Janice Heng, The Straits Times, 29 Aug 2016

By the time the first locally transmitted case of Zika was confirmed last Saturday, the authorities were already tracing past cases of fever in the area.

This allowed them to move swiftly on Zika testing of another 123 people last Saturday, said the Ministry of Health (MOH) and National Environment Agency (NEA) in a joint press conference yesterday.

Most of the results came in on Saturday night. As of noon yesterday, results were pending for five cases.

Said Professor Leo Yee Sin, senior consultant at the Communicable Disease Centre: "The minute the first case was made known - in other words, the blood was detected positive - a lot of investigations had already taken place to find out as much as possible."

The MOH was first alerted on the evening of Aug 22, when Sims Drive Medical Clinic flagged an unusual increase in cases of fever, rashes and joint pain.

The next day, MOH officials visited the clinic. The cases that the GP had seen were mild. The initial hypothesis was that a mild viral illness was being spread from person to person.

At that point, Zika was not specifically suspected.



The MOH told the clinic to refer any new cases to the Communicable Diseases Centre (CDC) for testing, and to start tracing past cases.

The MOH also told clinics in the vicinity and supervisors of a nearby construction site at 60, Sims Drive, to report any cases to the ministry.

Last Thursday, as part of tracing, the MOH approached the construction site's contractor for records of workers who had had fever.

That same day, a 47-year-old Malaysian woman developed a fever, rashes and conjunctivitis. She visited Sims Drive Medical Clinic last Friday, and was referred to the CDC.

The next day, it was confirmed she had Zika.

The MOH jumped into action that day, alerting the NEA and testing another 123 people for Zika, including 118 construction workers. The tests take three to four hours.

The NEA intensified anti-mosquito measures in the area, including inspections, misting and fogging, and increasing the frequency of drain flushing and oiling. These will continue for 14 days, with surveillance for another 21 days afterwards.

The NEA also started outreach efforts in the Aljunied Crescent and Sims Drive area.

Asked about the jump from one case last Saturday to 41 cases announced yesterday, Health Minister Gan Kim Yong noted that part of the reason more cases were discovered was because the MOH went back to past cases to "re-test, relook at the test results" last Saturday.

Of the 41 cases, 36 were found through the MOH's active testing of potentially infected people.

One reporter also asked him: "So it's not like you knew about it earlier and were keeping quiet about it?"

Mr Gan said: "No, of course not."
















Zika outbreak: How events unfolded
The Straits Times, 29 Aug 2016

MONDAY, AUG 22

Sims Drive Medical Clinic, having noticed an unusual increase in cases with fever, rashes and joint pains, notifies the Ministry of Health (MOH) in the evening.

TUESDAY

MOH officials visit the clinic and discuss the cases with a doctor there. The initial belief is that there is a cluster of a mild viral illness.

MOH makes arrangements for the clinic to refer new cases to the Communicable Disease Centre (CDC) for testing, and to start tracing past cases.

Nearby clinics and supervisors of a nearby construction site are also told to increase vigilance and report cases to MOH.

THURSDAY

MOH asks the construction site's contractor for records of workers who had had fevers. Meanwhile, a 47-year-old Malaysian woman working in the coffee shop at Block 45 Sims Drive develops a fever, rashes and conjunctivitis.

FRIDAY

She visits Sims Drive Medical Clinic and is referred to the CDC.

SATURDAY

The woman is confirmed to have Zika. The National Environment Agency (NEA) is notified and starts anti-mosquito measures as well as inspections. NEA also begins outreach efforts to 14 blocks of flats in the Aljunied Crescent and Sims Drive area.

MOH tests another 123 people with Zika-like symptoms, including 118 construction workers.

CDC reports preliminary positives for three of these cases.

SUNDAY, AUG 28 

By noon, 41 of the 124 people tested are found to have Zika. Most of the results came in late on Saturday night. Another 78 tested negative. Test results are pending for the remaining five.

A joint press conference by MOH and NEA is held just before 4pm to announce the findings.

NEA completes outreach efforts in Aljunied Crescent and Sims Drive. It starts similar efforts in the Sembawang Drive residential area, where one of the Zika cases, a 30-year-old Singaporean man, lives.










Beer promoter the only woman to get Zika virus here
By Fabian Koh, The Straits Times, 29 Aug 2016

A coffee shop beer promoter here has been confirmed as the only female case of Zika which has been transmitted locally.

The Straits Times understands that the woman works at Y2000 Beer Garden coffee shop in Block 45, Sims Drive.

According to the Ministry of Health (MOH), the 47-year-old Malaysian - who has not been named - developed a fever, rash and conjunctivitis last Thursday.

She was referred to the Communicable Diseases Centre (CDC) at Tan Tock Seng Hospital, where she tested positive on Saturday.

She was hospitalised for observation, but has since recovered and been discharged.

A member of her household was also screened for Zika, but had no symptoms.

According to colleagues, she has been working at the coffee shop for about five years. She works from 3.30pm to 10.30pm daily except on Mondays. She took leave on Thursday when she felt unwell.

"On Thursday afternoon, she popped by to check out the beer stock," said drinks seller Zhang Jing, 31. "I saw that she had a lot of rashes all over her body, on her hands, her face and her legs. She also had a fever."

Another drinks seller said that the woman went to see a doctor at Sims Drive Medical Clinic, in Block 53, Sims Place.

She called on Friday to inform the management that she had a medical certificate, and that she needed someone to cover her shift.

Odd-job worker Francis Boy, 52, who meets his friends for drinks at the coffee shop regularly, said he noticed the beer promoter had not turned up at work since Thursday and was wondering where she had gone.

He was surprised to learn about her condition as he had met her at a Seventh Month dinner in the estate just last Wednesday.

"She was still healthy," he said. "She was still chatty and going from table to table, laughing."





37 Zika cases linked to one construction site
By Fabian Koh, The Straits Times, 29 Aug 2016

Thirty-seven cases of Zika stem from one construction site - the Sims Urban Oasis condominium at 60 Sims Drive.

According to its website, the 23,900 sq m site is being developed by GuocoLand and has an estimated date of vacant possession till June 2020.

A total of 118 people working at the construction site have been tested for Zika. Among them, a 30- year-old Singaporean man who lives in Sembawang Drive developed a fever and rash last Monday.

He was warded at the Communicable Diseases Centre (CDC) on Saturday. Of the other 36 foreign workers who tested positive, seven are warded at the CDC and the rest have fully recovered.

On Saturday, NEA followed up on an inspection last Wednesday to re-inspect the site and conduct misting and thermal fogging.

"A Stop Work Order was issued to the construction site on Aug 27, as the housekeeping of the construction site was found to be unsatisfactory with potential breeding habitats favourable to mosquito breeding," said a joint press statement by NEA and the Ministry of Health (MOH).

"The construction site is required to rectify these conditions and step up preventive measures."

Workers were informed by supervisors on Saturday morning that they could not continue construction works. Mr Ge Zheng Ying, 47, told The Straits Times: "We have been told we were not allowed to continue working, and had to clean up the area, both our working areas and living quarters."

They were also instructed to wear long sleeves and trousers.

Mr Andrew Ng, 42, who lives with his wife and two sons at Block 54, Sims Drive beside the site, said the situation was "dangerous and worrying", adding: "My sons have been having fever since Thursday, but their temperatures have been fluctuating. If tomorrow the fever is still not gone, I think I will take them for a blood test."





Malaysia steps up health screening at entry points
By Fabian Koh, The Straits Times, 29 Aug 2016

PENDANG/KUALA LUMPUR • Malaysia's Ministry of Health (MOH) is stepping up health screening at the border entrance to Johor following reports of a Malaysian woman infected by the Zika virus in Singapore.

Similar health screening is also being implemented at airport terminals which host direct flights from Singapore, such as in Penang and Langkawi, the New Straits Times yesterday quoted Deputy Health Minister Hilmi Yahya as saying in Pendang, Kedah.

He advised Malaysians who have travelled to Singapore and who are down with fever to go for medical examination and treatment.

Director-General of Health Noor Hisham Abdullah said: "As a precautionary step, MOH has increased monitoring at the two main entry points in Johor Baru and distributed pamphlets about prevention against Zika infection.

"The precautionary monitoring includes preparing a group of paramedics at the entry points to manage the situation if there are visitors exhibiting signs of Zika."

The ministry told The Straits Times that thermal scanners will be set up.



The Malaysian authorities have been monitoring visitors from countries affected by Zika since the outbreak started last year and, so far, no cases of infection have been found.

"We have also examined 784 blood samples of those showing an active possibility of the infection and found that the results were all negative for the virus," said Dr Noor Hisham.

"Visitors from the affected countries were also given a Health Alert Card as a precautionary measure."

The 47-year-old Malaysian woman in Singapore contracted the virus locally as she had not visited any of the affected countries.

She started to have a rash, fever and conjunctivitis last Thursday and saw a doctor the day after before being taken to the Communicable Diseases Centre at Tan Tock Seng Hospital.

"We are in close contact with the Singapore Health Ministry to better understand this situation and get updated information on the local spread of the virus. "This is to ensure that all prevention and containment methods can be carried out," said Dr Noor Hisham.










Singapore’s first local Zika infection: Residents step up anti-mozzie efforts
NEA officers fan out in Aljunied to educate residents about disease, prep them for battle
By Lin Yangchen, The Sunday Times, 28 Aug 2016

While details of Singapore's first local case of Zika infection are only beginning to emerge, the National Environment Agency (NEA) has already taken steps to monitor the situation at Aljunied Crescent and prepare residents for battle.

When The Sunday Times visited last night, posters had been put up at the lift landings of Block 102, providing background information on Zika. Another poster informed residents that fogging of the area would take place this morning. Five NEA officers were seen in the area last night distributing leaflets and bottles of insect repellent spray.

A 47-year-old Malaysian woman who lives in the block was yesterday confirmed to have the Zika virus. It is the first locally transmitted case in Singapore.

MacPherson MP Tin Pei Ling said she is in touch with the Ministry of Health for regular updates.

"I urge pregnant ladies to monitor your health especially carefully, as Zika can affect the development of an unborn child. As a mother, I am deeply concerned about this and had in fact raised this issue in Parliament earlier this year," she said.

She noted on Facebook last night that Block 102 is not an active dengue cluster, but added that NEA will be thermal fogging the area today as a precautionary measure.



Mr Aloysius Yeo, 33, an oil and gas project engineer living on the 12th floor of the block with his family, said two NEA officers came to his flat in the afternoon to do chemical-spraying, and others later came around to give him a leaflet and a bottle of repellent.

He said there have been many mosquitoes in the area in the past year and, after learning about the latest Zika case, he now puts repellent on his three children and has stopped them from going to the playground downstairs.

Ms Vidya Viswanathan, 25, who came to Singapore five months ago to pursue a master's degree in accounting at James Cook University Singapore, said: "I'm worried my exams and assignments and everything will suffer if I get it."

Her mother Jeyashri Krishnamurthy, 54, a chartered accountant who is visiting her from India, said : "I'm really getting worried about this Zika thing. We take every precaution - no plants, no water anywhere. I hope it (Zika) stops here."

Polyclinic maintenance worker Myo Min Soe, 40, and his colleague Kyaw Soe Thet, 34, had not heard the news when The Sunday Times visited them on the third floor of Block 102. They said they had taken the stairs and had not seen the posters at the lift landing.

Mr Myo Min Soe, who had been living there for about eight months, said: "We are going to start protecting ourselves with insect repellent."

But he and Mr Kyaw Soe Thet are not that worried. "It's not just this place, we need to be careful everywhere," he said.

Although the latest Zika patient has not been to Zika-affected countries recently, Mr Myo Min Soe suggested she may have caught it from someone who has.

Meanwhile, also remaining vigilant are members of Team Singapore who competed at the recently concluded Rio Olympics. Mr Low Teo Ping, Chef de Mission for Team Singapore, said its members had returned to Singapore symptom-free and are being monitored closely.





WHAT WE KNOW ABOUT ZIKA
By Chua Siang Yee, The Sunday Times, 28 Aug 2016

WHAT IT IS

A virus first identified in 1947 in Uganda. The first human case was reported in 1954 but infections were initially rare and there were no outbreaks - until 2007 on the Micronesian island of Yap.

The alarm was truly sounded last year when more than 4,000 cases of microcephaly caused by the Zika virus were reported last year. It has since spread to more than 40 countries.

SYMPTOMS

Similar to those of dengue fever, including fever, rashes, joint or muscle pains, and headaches. Red eyes or conjunctivitis are other symptoms.

Zika symptoms, however, tend to be milder, and only about 20 per cent of those infected with Zika display these symptoms.

HOW IT IS SPREAD

Transmitted through the bite of an infected Aedes aegypti mosquito, the same mosquito that transmits dengue, which typically bites in the day . Zika can also be spread through sex.

EFFECTS

Infection during pregnancy can cause microcephaly, a birth defect which causes the baby to have a smaller head and brain. Some of those infected also developed Guillain-Barre syndrome, an auto-immune disorder.

TREATMENT

The disease is usually mild and needs no particular treatment. The World Health Organisation advises people with Zika to rest more, drink more fluids and treat the pain and fever with common medicine. If symptoms worsen, they should see a doctor. There is currently no vaccine, although experts from the United States' National Institutes of Health began a clinical trial of a vaccine candidate early this month.

FIRST CASE IN SINGAPORE

A 48-year-old man tested positive for Zika in May. He had travelled to Sao Paulo for work between March 27 and May 7. He was transferred to the Communicable Diseases Centre at Tan Tock Seng Hospital for treatment.









Related
Zika Virus
First Case of Locally Transmitted Zika Virus Infection -27 Aug 2016
Localised Community Spread Of Zika Virus Infection With More Cases Confirmed -28 Aug 2016
Joint MOH-NEA media statement on Update on Zika situation in Singapore -29 Aug 2016
MOH and clinical advisory group on zika and pregnancy provide guidelines for pregnant women -31 Aug 2016
Potential Zika Cluster at Bedok North Ave 3 and First Case of Pregnant Woman Tested Positive -31 Aug 2016
Joint MOH-NEA statement -1 Sep 2016
Joint MOH-NEA statement -2 Sep 2016
Cessation of isolation, MOH to subsidise Zika testing for all Singaporeans with symptoms -5 Sep 2016

First Case of Zika Virus Infection in Singapore

NEA to release male Wolbachia-infected mosquitoes as part of field study in October 2016

Singapore a role model in handling Zika outbreak: World Health Organisation

Zika in Singapore: Ministerial Statement by MOH, MEWR








No cases of birth defects linked to Zika in Singapore so far
2 women diagnosed with virus while pregnant have since had babies free of microcephaly
By Jalelah Abu Baker, The Straits Times, 8 Nov 2016

Two women who were diagnosed with Zika while pregnant have given birth, and their babies have no signs of microcephaly, a birth defect linked to the virus. The mothers have also recovered from Zika.

To date, there are no reported cases of Zika-linked microcephaly in Singapore, the Ministry of Health (MOH) told The Straits Times.

The defect is marked by babies having small heads that can lead to severe developmental problems. As of Nov 1, 17 pregnant women were confirmed to have Zika, an MOH spokesman said.

"Their doctors are following up closely with them to provide support and counselling," she added.

The family of a third woman found to have Zika during her pregnancy said her unborn baby's development has been healthy so far.



MOH is exploring plans to set up a national surveillance programme to monitor the development of babies born to pregnant women with Zika.

Still, pregnant women here are not taking any risks. Ms Christine Koh, now 26 weeks pregnant, armed herself with mosquito patches, repellents and air diffusers, after the Zika outbreak here was first reported in late August.

Over two months on, the housewife, who lives in Telok Kurau, a frequent dengue cluster, still does so. She also ensures her home has no stagnant water, a breeding site for the Aedes mosquito which can spread Zika and dengue.

"Since the wet season is here, we may expect more mosquitoes. It's better for me to keep up with the measures I have adopted. They give me peace of mind," Ms Koh, 31, said. She is due to give birth in February.

Consumers are still snapping up anti-mosquito products, despite fewer new Zika cases reported.

Supermarkets and pharmacies said that while sales of anti-mozzie products have slowed in recent weeks, they remain higher than before the Zika outbreak here.

A spokesman for supermarket chain Sheng Siong said demand for such products is still about 30 per cent higher than before the Zika outbreak here, but a drop from its peak.

Dairy Farm, which runs Cold Storage and Giant, said sales of anti-mozzie products have slowed but are still two to three times higher than average compared to the pre-Zika outbreak period. At the outbreak's peak, outlets across several supermarket chains ran out of these items in early September.

Pest control firms said that while interest in their services has gone down, it remains high.

Mr Declan Ee, director of pest control firm Ikari Services, said when the Zika outbreak here was first reported in August, there was a 100 per cent jump in inquiries. This has now dipped to about 30 per cent more than usual.

Infectious diseases expert Leong Hoe Nam said: "Zika has, fortunately, raised the profile of mosquito-borne diseases."

Experts say residents should continue to look out for stagnant water.

Professor Leo Yee Sin, director of the Institute of Infectious Diseases and Epidemiology at Tan Tock Seng Hospital, said that while fewer Zika cases is a good sign, there is no room for complacency.

"A significant proportion of Zika virus infections are asymptomatic or so mildly symptomatic that symptoms are not noticeable. It is therefore important to stress environmental safety and vector control."

Additional reporting by Seow Bei Yi





* Babies born to Zika patients to be monitored until age 3: MOH


Monitoring babies of mums with Zika 'can fill info gap'
Doctors say tracking the children till age 3 offers optimal time to detect abnormalities
By Lin Yangchen, The Straits Times, 3 Jan 2017

A new national programme to monitor babies of mothers infected with Zika during pregnancy will not only help babies suffering Zika-related developmental problems, but will also help advance medical knowledge, doctors said.

The Ministry of Health (MOH) said last Tuesday that it has set up the monitoring programme to address the risk of microcephaly in babies infected with Zika while in the womb.

Babies with microcephaly have abnormally small heads and may develop conditions such as intellectual disability, abnormal facial features and problems with speech and movement, as well as glaucoma and hearing loss.

Under the MOH programme, babies will be monitored until three years of age, but the duration may change as knowledge improves, said Professor Arijit Biswas, clinical director of the Department of Obstetrics and Gynaecology at the National University Hospital.

The monitoring will include vision and hearing tests, and infants suspected to have problems will be referred to specialists for further evaluation and treatment, said Prof Biswas, who heads the Clinical Advisory Group on Zika and Pregnancy set up by MOH.



Why monitor the babies for three years?

A period of three years is an optimal duration, as most abnormalities can be detected by then and it is still feasible in terms of resources and cost, said Dr Leong Hoe Nam, an infectious disease specialist at Mount Elizabeth Novena Hospital.

A shorter period may be insufficient for differentiating normal slow learners from those who really have problems.

Dr Leong said that although microcephaly can be diagnosed at birth, monitoring is still important because it is not yet known whether babies at risk of Zika-related developmental problems will necessarily exhibit microcephaly.

This is where Singapore has an opportunity to contribute to a better understanding of Zika's effects on babies, by monitoring a control group of unaffected babies and comparing them with Zika-affected ones, said Dr Leong.

"No one knows... no one has found anything, because no one has tried looking for anything," said Dr Leong. "Singapore is going to fill the gap... There's a wealth of information there, and this will help the general population and the whole world."

For parents of such babies, Dr Leong said that while many of the microcephaly-related conditions are not fully curable, all is not lost.

"You maximise the potential (of the child)," said Dr Leong. "For example, if he has problems hearing well, you teach the person how to lip-read... If he cannot see, then you try to develop the sense of acute hearing."

Physiotherapists trained in looking after children will also be able to assist parents, he added.

MOH said that as of Dec 27, 17 pregnant women were known to have had Zika. Four of them have given birth and their babies show no signs of microcephaly.

One case of Zika in the general population was reported on Dec 28, the National Environment Agency website shows.

MOH said a low rate of Zika infection would probably continue, as Singapore is a travel hub and the Aedes mosquito that carries the virus is present here.

The ministry said people should remain vigilant and continue with their efforts to reduce mosquito breeding.




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