15 more cases of locally transmitted Zika detected in Singapore

Channel NewsAsia 29 Aug 16;

SINGAPORE: The Ministry of Health (MOH) confirmed 15 more cases of locally transmitted Zika virus infection in Singapore as of noon on Monday (Aug 29).

Two cases work at the construction site at 60 Sims Drive and have recovered. 13 cases live or work in the broader Sims Drive/ Aljunied Crescent area, MOH and the National Environment Agency (NEA) said.

The two cases at the Sims Drive construction site were detected as a result of MOH’s look-back and testing of potentially infected persons. As of Monday, MOH said it completed testing of all workers at the construction site who had symptoms of fever and rash previously. It is also screening workers staying at the dormitories located in the areas of concern.


MOH said it will continue to work with GPs in the area to offer testing for patients who had fever and rash previously. The look-back exercise will likely uncover more previously undiagnosed cases of Zika, it added.

As of Monday, NEA has inspected about 3,600 premises out of an estimated 6,000 premises in the Aljunied Crescent/Sims Drive cluster to check for mosquito breeding, and also conducted ground checks in the vicinity. 36 breeding habitats – comprising 22 in homes and 14 in common areas/other premises - have been detected and destroyed. NEA has also inspected the on-site workers quarters at the construction site at Sims Drive.

NEA officers and grassroots volunteers have completed the first round of outreach efforts in the Aljunied Crescent/Sims Drive cluster, to distribute Zika information leaflets, and will be continuing with outreach to raise general awareness of Zika, the agency said.

NEA has also commenced vector control operations in areas of concern where cases from the Aljunied Crescent/Sims Drive cluster work or live. There is currently no evidence of local transmission in these areas of concern, MOH and NEA said.

The environment agency has also commenced inspections at the dormitories/residences at Kranji Road, Senoko South Road, Lor 101 Changi, Toh Guan Road East and Joo Chiat Place. One breeding has been detected and destroyed at the dormitory at Kranji. NEA said it has inspected more than 900 premises at Sembawang Drive, and detected and destroyed one breeding in a residence in that area. Thermal fogging, misting and indoor spraying of insecticides have been carried out at the inspected premises.


Senior Minister of State for the Environment and Water Resources and Health Amy Khor said in a Facebook post on Monday evening that aside from NEA's efforts, she hoped that residents would give their fullest cooperation to the more than 200 NEA officers carrying out inspections since the first local Zika case was detected.

"This is extremely critical and fundamental to our efforts to reduce the risk of further spread of the Zika virus," she wrote.

"It is also important that all of us, and not just those living or working in the affected areas, remain vigilant and take action to prevent mosquito breeding in our homes ... Let us all take care of ourselves, and watch out for one another."


Information on Zika cases released as soon as possible: Tan Chuan-Jin
Channel NewsAsia 29 Aug 16;

SINGAPORE: The Ministry of Health (MOH) put out information on the 41 confirmed cases of locally transmitted Zika infection in Singapore as soon as it was ready, said Minister for Social and Family Development Tan Chuan-Jin on Monday (Aug 29).

"I know that 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 MOH is quite particular that once information is ready, then it’s pushed out immediately – which has been the case," he said.

The Member of Parliament for Marine Parade Group Representation Constituency was visiting houses along Lorong 101 Changi and Joo Chiat Place, which have been flagged as areas of concern for the spread of the virus as some of the Zika patients reside or work in these locations.

Mr Tan stressed that there were no initial indications that the symptoms observed by doctors pointed to Zika, and that MOH had interviewed medical practitioners as soon as they flagged concerns. He also reiterated the timeline of events referred to by Minister of State for Health Chee Hong Tat to explain the jump in the number of Zika cases from one to 41 over the course of a day.

A clinic in the Aljunied area, Sims Drive Medical Clinic, informed MOH of an unusual increase in mild cases with fever, rash and joint pains on Aug 22. Health officials went down the next day, and the ministry announced the 41 locally transmitted cases on Aug 28 in a joint press briefing with the National Environment Agency (NEA).

“Once it was confirmed that it was Zika, the information was put out. It’s very important in times like this that the information put out be accurate, be factual," Mr Tan added.

“I can understand the anxiety that people may have, principally I think pregnant women … (But) I think it’s very important for us to stay focused on the facts, to stay focused on what actions we need to take."


Mr Tan said that efforts to manage the spread of Zika in his constituency would be similar to those already in place for dengue as the two diseases share the same carriers - aedes aegypti mosquitoes.

"Singapore is often regarded by many countries as a very good example of how we’ve managed (dengue) – we’ve not eradicated dengue, I’m not sure whether we will ever be able to do so … but I think we’ve managed to manage its outbreaks and the same effort needs to be done for Zika."

The minister said the area sees dengue outbreaks "from time to time", and authorities have therefore been constantly vigilant against the disease. "NEA has been very active here, and along with the grassroots we’ve been constantly visiting residents, reminding them of what they need to do, so we’re basically carrying on with what we’ve been doing in our efforts to deal with dengue. These are exactly the same efforts in terms of dealing with Zika."

He also urged the public to monitor information released by MOH and NEA about the disease and preventive measures that could be taken.

"The sort of response that we need to take as a society and as a community is very important," Mr Tan said.

- CNA/mz

Information on Zika cases released as soon as possible: Tan Chuan-Jin
TAN WEIZHEN Today Online 30 Jun 16;

SINGAPORE — While some people have sought to “cast aspersions” on why the Health Ministry (MOH) did not announce the outbreak of Zika cases earlier, Minister for Social and Family Development Tan Chuan-Jin said that it is important to stay focused on the facts and the actions to be taken, stressing that MOH has been releasing information as soon as it was ready.

His comments came after the Workers’ Party (WP) and Singapore Democratic Party (SDP) called for the Government to clarify the timing of the events that led to the public notification of the 41 locally transmitted Zika cases. The two opposition parties said that prompt alerts are important so that the public could take the necessary precautions.

Mr Tan, who was visiting private houses and condominiums near Sims Avenue, where there are cases of Zika infection, told reporters on Monday (Aug 29): “I know that there are some quarters that have been trying to, perhaps, cast aspersions on information not being forthcoming, but it’s quite clear to me that MOH is quite particular that once information is ready, it is pushed out immediately, which has been the case.” He stressed that it was important during such times that information put out is accurate and factual.

“We can make a lot of different speculations, but given the circumstances, even the doctors who noticed it in the first place didn’t immediately think of Zika. Going forward, this is (an area where) we want to be vigilant,” he added.

The MOH has come under scrutiny since it confirmed on Sunday that there were 41 locally transmitted cases.

Mr Leon Perera, WP’s Non-Constituency Member of Parliament, said in a statement on the party’s website: “Prompt public notification of Zika cases is important so that members of the public in the affected areas can take the necessary precautions and so that stakeholders can take vector control measures.”

SDP said that the public should be kept informed even if the matter was still developing. “Medical professionals do not withhold information from their patients even when illnesses are only suspected but need further testing for confirmation,” the party said in its online statement.

In a Facebook post late on Sunday, Minister of State for Health Chee Hong Tat said that attempts to cover up the cases were “certainly not true”. He added that staff members at the laboratory were working “way past midnight” to complete the tests, so that the results may be announced in a “timely manner”. ADDITIONAL REPORTING BY VALERIE KOH

Southeast Asia needs to up its game to combat Zika: Experts
Channel NewsAsia 29 Aug 16;

BANGKOK/KUALA LUMPUR: The spread of the Zika virus across tropical Southeast Asia is likely to be significantly under-reported as local health authorities fail to conduct adequate screening, regional experts said on Monday (Aug 29).

International travel hub Singapore confirmed 41 locally transmitted cases of the mosquito-borne virus on Sunday and said it anticipated more, raising fears about how quickly it could disperse throughout the region.

Other parts of Southeast Asia have reported dozens of cases of Zika, which in Brazil has been linked to thousands of suspected cases of microcephaly, a rare birth defect, but there are fears the true numbers are masked.

"Zika is under-reported and under-diagnosed," Khin Myint, head of the emerging virus research unit at Indonesia's government-funded Eijkman Institute, told Reuters. "We find many cases are not presented in hospitals because it's a relatively mild disease with mild symptoms and people are not going to doctors."

The World Health Organization (WHO) lists Indonesia, Thailand, the Philippines and Vietnam as countries with "possible endemic transmission or evidence of local mosquito-borne Zika infections in 2016."

But the Jakarta-based Eijkman Institute, the main body testing for Zika in Indonesia, said it tested only 1,000 people in the past year - a tiny number in Southeast Asia's most populous country. It found just one positive case, despite reports that Zika is prevalent in the country.

Thailand has recorded the highest number of cases in the region at almost 100 infected people across 10 provinces this year.

"Thailand's surveys have not been thorough enough," said Kriengsak Limkittikul, assistant professor at the Department of Tropical Medicine at Mahidol University in Bangkok, noting that people without symptoms are often not tested. "Screening is inadequate in other countries in the region, too, where health authorities are ill-equipped to test," he said.

Vietnam has recorded three cases of Zika infection, all locally-transmitted, while Cambodia has reported seven cases.

Hong Kong confirmed its first case of Zika on Friday, in a woman who had travelled to the Caribbean.

A major difficulty is that while Zika can cause mild fever, a rash and red eyes, an estimated 80 percent of people infected have no symptoms.

There is no vaccine or treatment for Zika, which is a close cousin of dengue and chikungunya and is transmitted by mosquito. There have also been a small number of cases of sexual transmission reported in the United States and elsewhere.


Some countries in the region began ramping up protective measures following the outbreak in Singapore.

Muhamad Subuh, a senior Indonesian health ministry official, said authorities are "in the process of stepping up health checks at main airports and ports, including in Batam," the island closest to Singapore.

Indonesia introduced thermal scanners at airports targeting arrivals from Singapore over the weekend, and plans to roll them out to ports. Authorities are also handing out printed warnings to all incoming passengers, noting Zika has an incubation period of around 10 days before presenting any symptoms.

Malaysian Health Minister Subramaniam Sathasivam said travellers who enter Johor Bahru, where up to 200,000 people commute daily to and from Singapore, will go through thermal screening at border checkpoints. People crossing in private vehicles will not be scanned but handed a pamphlet detailing the symptoms and asking them to report to authorities if they develop those.

Malaysia is also stepping up vector control mechanisms including fogging and larvicidal spraying in Johor Bharu.

"What we can do as a country comes down to how well we control our vectors, and at this point of time, dengue is still a bigger problem than Zika because people can die from dengue," Subramaniam said.

Other countries were not responding so quickly.

In Thailand, the Department of Disease Control said it was screening athletes returning from the Olympic Games in Brazil, but otherwise not changing its prevention methods. Vietnam and Cambodia made no immediate changes to their border controls.

"Different countries have different economic and political situations and it's not that they don't want to screen the virus, but they don't have the resources and capacity to do it at this stage," said Jasper Fuk-Woo Chan, a clinical assistant professor at the Carol Yu Centre for Infection at the University of Hong Kong.

(Reporting by Amy Sawitta Lefevre, with additional reporting by Kanupriya Kapoor in JAKARTA, My Pham in HANOI, Prak Chan Thul in PHNOM PENH, A. Ananthalakshmi and Joseph Sipalan in KUALA LUMPUR and Zoe Cooney in SYDNEY; Editing by Jane Wardell and Ian Geoghegan)

- Reuters/dt

MOH tightens checks as 15 more Zika cases confirmed

SINGAPORE — As the number of confirmed Zika cases continues to climb, the Ministry of Health (MOH) has tightened reporting protocol for general practitioners (GPs) by requiring suspected cases of infections to be sent by ambulance to the Communicable Diseases Centre (CDC) for further tests.

Adding to the 41 cases made public over the weekend, the MOH said that as of noon on Monday (Aug 29), 15 more cases of locally transmitted Zika virus infection have been confirmed. The figure is expected to rise further: At least two patients contacted by TODAY said they tested positive for the Zika virus later in the day.

Among the new confirmed cases reported by the MOH on Monday, two were workers at a construction site at 60 Sims Drive — identified as one of the hotspots — who have since recovered. The remaining 13 either live or work in the Aljunied Crescent-Sims Drive area, said the ministry.

GPs around the island received a circular from the MOH on Saturday afternoon — a few hours before the first locally transmitted case was announced by the ministry in the evening — stating that suspected cases be sent to the CDC for blood and urine tests via ambulances dispatched by the MOH. The circular described suspected cases as patients who have fever, skin rash, joint and muscle pains, headaches or red eyes, and had been in the vicinity of the Aljunied Crescent-Sims Drive area.

On Monday, five patients were sent in two ambulances from Sims Drive Medical Clinic, where the first locally-transmitted case was discovered. Of these, two are women, aged 18 and 54, and three are men who work at a construction site in the clinic’s vicinity. Across the road from the clinic, TJ Medical Clinic & Surgery’s Dr Tan Thai Keng told TODAY that he had written referral letters for four patients to undergo further tests and directed them to the CDC immediately. These patients — three women aged 24, 26 and 32, and a 44-year-old man — were not sent by ambulance, he said.

One of the patients who told TODAY they had tested positive for Zika virus was a 54-year-old woman who wanted to be known only as Madam Ho. She said she was shocked to wake up on Monday with red spots all over her body and face. Mdm Ho was speaking to reporters outside Sims Drive Medical Clinic in the morning. Her face and arms were visibly swollen, while her eyes were red-rimmed. After she had received her test results in the evening, she told TODAY: “I feel very tired… I am only worried that I may have spread it to my family members because I don’t know when I was bitten.” Madam Ho, who lives with her two children and son-in-law, said she has advised them to go for health checks.

Aljunied Crescent resident Amalina Yusoff was also diagnosed as a Zika patient on Monday. The 18-year-old student said she had recovered from fever on Sunday but started developing rashes all over her body.

Over the weekend, the MOH and the National Environment Agency (NEA) had warned that more cases could emerge. Beyond Aljunied Crescent and Sims Drive, other areas of concern include Khatib Camp, Sembawang Drive, Kranji Road, Joo Chiat Place, Senoko South Road, Toh Guan Road East and Lorong 101 Changi. On Monday, the MOH reiterated that “more previously undiagnosed” Zika cases would likely be uncovered, as it continues to work with GPs in the Sims Drive-Aljunied Crescent area to offer testing for patients who had fever and rash previously.

GPs and doctors said they are seeing women patients, including those who are pregnant, who are concerned about the outbreak.

Dr Beh Suan Tiong, who specialises in obstetrics and gynaecology at Thomson Medical Centre, said that some of his pregnant patients have requested to be tested. “We conduct tests based on necessity…If they do not exhibit the symptoms and have not travelled to Zika-affected countries or live in the Aljunied area, there are currently no guidelines for them to be tested,” said Dr Beh.

Members of Parliament (MPs) for the areas flagged by MOH said they are taking precautions to manage the situation. MacPherson MP Tin Pei Ling said her grassroots volunteers had visited households in Aljunied Crescent over the weekend. They have also compiled a list of seven pregnant residents whom they will check on regularly, said Ms Tin.

Marine Parade Group Representation Constituency (GRC) MP Tan Chuan-Jin, who is also the Minister for Social and Family Development, was out and about on Monday at Joo Chiat Place, visting residents and giving out brochures and mosquito repellents.

Jurong-Clementi town council chairman Ang Wei Neng and Sembawang town council chairman Lim Wee Kiak said that their grassroots volunteers will step up efforts to alert residents and dormitory operators about the outbreak. Dr Lim said: “We’ve done this before, when we had a dengue cluster... (Times like these are) a good reminder to residents and grassroots organisations (to) look out for one another.”

As of Sunday, the NEA has inspected about 3,600 out of 6,000 premises in the Aljunied Crescent-Sims Drive cluster for mosquito breeding. Thirty-six breeding habitats in homes and other common areas have been detected and destroyed. It has also commenced vector control operations in areas where cases from the Aljunied Crescent-Sims Drive cluster work or live. There is currently no evidence of local transmission in these areas, the NEA said.

Meanwhile, pharmacies islandwide are stocking up on mosquito repellent products following a surge in demand.

Unity Pharmacies said sales for mosquito repellent sprays and patches have gone up by about half in its 59 outlets across the island. A Guardian spokesperson said that compared to last week, sales of such products have, on average, doubled islandwide, with sales at its five stores in Aljunied increasing by more than four times.

Australia, Taiwan issue alerts on travel to Singapore after Zika outbreak
Today Online 30 Jun 16;

SINGAPORE — Both Australia and Taiwan have issued travel alerts for Singapore following 56 locally transmitted Zika virus infection cases.

The Australian government has urged pregnant women to avoid non-essential travel to Singapore and to adopt additional measures against mosquito bites if planning a trip here.

“This included deferring non-essential travel if pregnant and avoiding pregnancy for two months following a return. Australians should exercise normal safety precautions in Singapore,” the Australian government said in the Department of Foreign Affairs and Trade website.

Meanwhile, Taiwan’s Centre for Disease Control (CDC) raised the travel notice for Singapore to Level 2 and advised pregnant women not to travel to the country.

“Pregnant women and women intending to become pregnant are advised to take particular caution and travellers to the country must take precautionary measures against mosquitoes,” the statement said.

Under the CDC’s three-tier system, a Level 1 travel warning urges vigilance and health precautions, while Level 2 calls for a high degree of caution and strong protective measures, and Level 3 advises against travel to or from a specified destination.

The CDC now has a Level 2 travel alert in place for 58 countries and regions where Zika virus infections have been reported, including Malaysia, Thailand, the Philippines, Vietnam and Indonesia, countries with a heavy flow of people to and from Taiwan.

United Kingdom has also advised those who are pregnant or planning to become pregnant to discuss their travel plans to Singapore with their healthcare provider.

Singapore’s Ministry of Health (MOH) announced over the weekend 41 locally transmitted Zika cases and 15 more cases were confirmed on Monday.

The first case, which came to light on Saturday, involved a Malaysian woman living at Block 102 Aljunied Crescent. The other 40 cases, announced on Sunday, either lived or worked in the Aljunied Crescent-Sims Drive area.

How Zika got here could remain a mystery, say experts
TAN WEIZHEN Today Online 30 Jun 16;

SINGAPORE — Exactly how the Zika virus found its way to Singapore and triggered a local outbreak could remain a mystery, experts say, given that existing tests are unreliable for infections that are more than two weeks old.

Nonetheless, the infectious diseases experts whom TODAY spoke to believe that Patient Zero — or the source of the outbreak — was likely to have been infected with the virus overseas and brought it back to the country — specifically to the Aljunied Crescent and Sims Drive area where a cluster has emerged.

A mosquito could have bitten the person, got infected, and then transmitted the virus to other people. While transmission is possible through sexual intercourse, it is a less common means of infection.

Associate Professor Hsu Li Yang, programme leader of the antimicrobial resistance programme at the Saw Swee Hock School of Public Health, said: “If a compatible mosquito bites someone who has the virus in his or her blood, the mosquito becomes infected. After about a week, the virus can be detected in the mosquito’s saliva, and the mosquito can then infect all the other people that it bites.”

“If these other infected people are bitten by other mosquitoes during the days when the virus is circulating in their blood (which is usually three to 12 days after being bitten by an infected mosquito), the virus will be passed to these mosquitoes, and the cycle of infection will continue,” he said.

On the sexual transmission of Zika, Prof Hsu noted that based on reported cases, the virus can remain in semen for more than six weeks. “Almost all cases of Zika sexual transmission — with one exception — have been from men to women,” he said.

Prior to the Ministry of Health’s (MOH) announcement over the weekend that Singapore has discovered dozens of cases of locally transmitted Zika infection, a 48-year-old man who travelled to Brazil was diagnosed in May as the Republic’s first Zika patient. The Singapore permanent resident made a full recovery and tested negative for Zika before he was discharged. His family members also had not reported any symptoms of the mosquito-borne disease.

Infectious diseases expert Leong Hoe Nam, who diagnosed the first Zika case at Mount Elizabeth Novena Hospital, said: “This is a very mild disease. The infected person might not even see a doctor, and if he didn’t raise the alarm, he could become a source of infection. He might have thought that the travel made him unwell, had some rest and probably recovered after a couple of days. Meanwhile, he got bitten by a mosquito while he was ill, and the whole cycle started.”

By now, Patient Zero would be very hard to track down, said Dr Wong Sin Yew, an infectious diseases physician at Gleneagles Medical Centre. Tracing of cases would need to be done and a transmission link has to be established. “At present, we don’t have a good, reliable test for infections that are beyond two weeks,” he said.

Dr Wong said that based on MOH’s recommendation, blood and urine tests are carried out within the first week of infection. If it is beyond the first week, a urine test is used, because the virus tends to stay in the urine for a longer period of time.

Results of the urine and blood tests can be obtained at a laboratory within three or four hours, said the experts. But Dr Wong noted that test results could take days, if there is a huge number of cases.

While some have questioned the delay in the discovery and announcement of the Zika cases, Dr Leong stressed that the focus is on protecting Singaporeans and “not (playing) the blame game”. “The gatekeepers, who are now the family physicians, must be aware that Zika is mild and we must investigate (the suspected cases), especially (those) in a cluster,” he said.

The experts urged people to protect themselves from mosquito bites by using repellent or wearing more clothing, and not travel to Zika-infected countries. Pregnant women in their first trimester should take extra precautions as the risk to the foetus is highest, Prof Hsu said.

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