26 more local Zika infections confirmed on Tuesday: MOH, NEA

Channel NewsAsia 30 Aug 16;

SINGAPORE: Twenty-six more cases of locally transmitted Zika virus infection have been confirmed in Singapore, the Ministry of Health (MOH) and National Environment Agency (NEA) said in a joint statement on Tuesday (Aug 30). This is on top of the 15 cases confirmed on Monday and the 41 cases on Sunday, bringing the total number of confirmed cases in Singapore to 82.

In their media release on Tuesday, the agencies gave more details of the new cases: 17 of them live or work in the Sims Drive/ Aljunied Crescent area and five live or work in Kallang Way and Paya Lebar Way, north of Sims Drive/Aljunied. The authorities are investigating the remaining four cases for their links to the affected area.

The agencies added that another 111 individuals were tested negative over the last 24 hours.

Earlier on Tuesday, MOH urged all pregnant women in Singapore with symptoms of Zika to be tested for the virus, regardless of whether they had been to Zika-affected areas.

5,000 OF 6,000 ALJUNIED/SIMS PREMISES CHECKED: NEA

NEA added that as of Monday, it has inspected about 5,000 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. Thirty-nine breeding habitats – comprising 23 in homes and 16 in common areas/other premises - have been detected and destroyed.

NEA also said it served notices on more than 400 inaccessible premises in the Aljunied Crescent/Sims Drive cluster to require the owners to contact NEA to arrange for an inspection, failing which NEA will proceed with forced entry. NEA has also inspected the on-site workers' quarters at the construction site at Sims Drive, where a number of cases work. The stop-work order on the construction site at Sims Drive is still in force.
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 in the areas of concern to raise general awareness of Zika, reiterate need for source reduction to prevent mosquito breeding, and advise residents to apply repellent as precaution.

NEA said it would also begin vector control operations and outreach efforts in Kallang Way and Paya Lebar Way.

INSPECTING CONSTRUCTION SITES, DORMITORIES

In addition to inspecting homes and their common areas, NEA is also inspecting construction sites and engages dormitory operators. It said: "The latter plays an important role in helping to prevent and stem Zika transmission in their premises by ensuring a clean and hygienic environment. Some good practices include engaging dedicated pest control operator(s) for mosquito control, ensuring and sustaining proper housekeeping, and ensuring that all workers/residents apply insect repellent regularly."

- CNA/dt


Singapore's health ministry advises pregnant women with Zika symptoms to get tested
Channel NewsAsia 30 Aug 16;

SINGAPORE: The Ministry of Health (MOH) and the Clinical Advisory Group (CAG) on Zika and Pregnancy on Tuesday (Aug 30) urged all pregnant women in Singapore with symptoms of Zika, as well as those with male partners who are Zika-positive, to be tested for Zika virus infection. This is regardless of whether they have been to Zika-affected areas, MOH said in a news release.

Symptoms of Zika include fever and rash and other symptoms such as red eyes or joint pain.

Testing is not routinely recommended for other pregnant women who do not have symptoms of Zika and whose male partners are not Zika-positive, MOH added.
Testing for pregnant women as referred by their doctors, and who meet these criteria, is free at the public healthcare institutions. This is no different from the current practice for Zika testing for those with symptoms and who live, work or study in a Zika-affected area.

MOH said the clinical guidelines have been updated following the localised community spread of Zika virus infection in the Aljunied Crescent/ Sims Drive area. A total of 82 cases have been announced over the past four days.

The guidelines are in line with that of the World Health Organization (WHO)’s current guidelines and are being shared with obstetricians and gynaecologists (O&G), and neonatology and paediatric specialists in Singapore's hospitals, as well as all polyclinics and general practitioners.

MOH’s CAG on Zika and Pregnancy met on Tuesday to review and update the guidelines in light of the latest Zika situation in Singapore, it said.

While there is currently no evidence that women are more likely to get Zika virus infection, the consequences can be more serious if a pregnant woman is infected, as Zika virus infection can cause microcephaly in the unborn foetus of pregnant women, the health ministry said.

Microcephaly is a congenital condition in which the head size is much smaller than usual for a baby of the same age, race and sex. According to MOH, Microcephaly can be caused by a variety of genetic and environmental factors, such as Down Syndrome, exposure to drugs, alcohol or other toxins in the womb, rubella and a few other infections during pregnancy. There is no specific treatment for this condition, MOH stated.

If a pregnant patient is confirmed to have Zika infection, she will be referred to a maternal-foetal medicine specialist for counselling and advice and the O&G doctor may recommend regular ultrasounds to monitor for foetal growth and abnormalities, the health ministry said. MOH will also arrange for her to be admitted to a public hospital for further management and care if necessary.

"It is important to note that a positive Zika test does not mean that the foetus is infected or harmed. Depending on the population studied and the research methodology, the estimated risk of microcephaly associated with Zika virus infection during pregnancy can vary widely. A recent study published in the New England Journal of Medicine found that the risk of an infected mother giving birth to a child with microcephaly is between one to 13 per cent," MOH said.

- CNA/ly



Singapore manpower ministry urges worksites to step up Zika safeguards
Justin Ong Channel NewsAsia 30 Aug 16;

SINGAPORE: Minister of State for Manpower Teo Ser Luck on Tuesday (Aug 30) said authorities have been taking steps to ensure all construction sites across Singapore install preventive measures against the Zika virus, which has so far infected 56 individuals locally.

Mr Teo spoke on the sidelines of a visit to the Sims Urban Oasis construction site, where 39 people have been infected. “I wanted to get some assurance that immediate measures have been taken, and I’m glad that when I inspected the site.. stronger measures have been taken,” he said.

“In fact before (the Zika cluster) happened, this worksite operator actually already had preventive measures in place. When it happened, they doubled and reinforced their measures - for example the number of mosquito traps were doubled.”

Added Mr Teo: “The workers and operator are cooperating with each other and they know certain measures have to be strictly followed, like taking temperature daily and cleaning up their areas so there’s no accumulation of water.”

The site’s construction manager Yong Jian Rong said: “We already have had several measures in place even before news broke - like blacklight traps, netting… We’ve continued our temperature monitoring. If staff or workers have any signs of illness we bring them immediately to seek medical attention.”

“We also brief our workers, subcontractors and anybody involved here on what are the symptoms and how to personally protect themselves. We have definitely beefed up on that aspect, in terms of having additional repellent, arm sleeves, and keeping themselves covered at all times.”

He added: “We have been telling the workers everyday not to worry, if anything happens the company will definitely take care of their health and wellbeing and give them the full medical attention required.”

Workers at the site told Channel NewsAsia that before the Zika outbreak, they were subjected to temperature checks twice daily. Those with fever would be sent to a clinic before being isolated at the dormitory. Since news of the Zika spread broke, they have been asked to wear anti-mosquito patches, arm sleeves and repellent bracelets at all times, said workers.

The construction site has also been served with a stop-work order by the National Environment Agency (NEA). Asked when this would be lifted, Mr Teo said: “We are working with NEA closely on this. They will take a few days to monitor the situation and make sure preventive measures are in place, like mass fogging. Once we have assurance, they will work with us on whether we should lift the work order. But it’s most important to keep the community safe from the spread of Zika.”

WHOLE OF GOVERNMENT DOING ITS PART: TEO SER LUCK

Mr Teo also stressed that it was “important” for the Ministry of Manpower (MOM) to ensure that beyond the Sims Urban Oasis site, all construction sites in Singapore take preventive measures against Zika.

“We have already stepped up inspections and will continue to do so, not just for sites within (the Aljunied and Sims cluster) but all others,” he said. “The Zika virus itself reinforces some of the things we are doing and at this point in time we want to reassure the community that the whole of the Government; the ministries are doing their part to make sure we reinforce measures.”

“We have sent out advisories and messages to all operators and worksites… asking them to take as many preventive measures as they can.”

Added Mr Teo: “We are trying to use this opportunity to tell operators that these are some things you should have done already. At worksites, we expect certain standards they have to meet. We hope operators take care of their workers and worksites and dormitories and these measures are, to us, very basic things you have to do.”

He also said it was imperative that “everyone understands the seriousness of the situation”. Operators must “make sure every single worker is educated and aware”, Mr Teo noted.

“If anyone doesn’t, we will take action because this is a very important matter to follow through and we need all the stakeholders to come together so we can curb this issue.”

"Workers also have to have their own self-discipline,” he said. “If they feel a bit unwell, they should tell their supervisor and get immediate medical attention. It’s very important. Even mild fever, rashes, or any symptoms associated with Zika, please highlight and come forward.”

- CNA/jo


Zika and pregnancy: Frequently asked questions
TODAY Online 31 Aug 16;

Amid an outbreak of locally-transmitted Zika cases, concerns have been raised over how pregnant women should cope. The Ministry of Health has released a list of Frequently Asked Questions on Tuesday (Aug 30). We reproduce it in full here.


FREQUENTLY ASKED QUESTIONS ON ZIKA AND PREGNANCY

(A) FOR COUPLES PLANNING PREGNANCY

1. If a woman who is not pregnant is bitten by a mosquito and infected with Zika virus, will her future pregnancies be at risk?

Zika virus infection does not pose a risk of birth defects for future pregnancies.

2. If a couple is planning for pregnancy, what is MOH’s advice if either one lives, works or studies in an affected area?

If both the man and woman are well

They should take strict precautions against mosquito bites, and if they have further questions, consult their doctor.

If woman is symptomatic

(with fever and rash and other symptoms such as red eyes or joint pain)

She should seek medical attention promptly, and if confirmed positive for Zika, she should practise safer sexual practices or abstain from sexual intercourse for at least 8 weeks after recovery, before trying to conceive.

If the man is symptomatic

(with fever and rash and other symptoms such as red eyes or joint pain)

He should seek medical attention promptly, and if confirmed positive for Zika, he should practise safer sex through the correct and consistent use of condoms or abstain from sexual intercourse for at least six months after recovery.

(B) FOR PREGNANT WOMEN AND THEIR PARTNERS

Testing and Prevention

3. Are there any tests which can be done to determine if a pregnant woman is infected with Zika?

Currently, the only reliable test available for Zika is the reverse transcriptase-polymerase chain reaction (RT-PCR) test which looks for genetic material of the virus in blood or urine. However, RT-PCR test is only able to detect Zika infection in blood within 5-7 days of onset of symptoms and in urine within 14 days of onset. Therefore, the time window in which a pregnant woman can be tested using RT-PCR is very short.

At present, there is no reliable serological test (which looks for antibodies in the blood) for Zika.

4. If I am pregnant and my male partner is tested positive for Zika, do I need to get tested if I do not have any symptoms?

If you have had sexual intercourse with your partner, you should consult a doctor and inform him/her of possible exposure to Zika so that he/she can arrange for Zika testing.

5. If I am pregnant and asymptomatic, but worried about possible exposure to Zika, where should I go to get tested?

WHO’s May 2016 guidelines, and MOH’s August 2016 clinical guidelines on Zika virus infection and pregnancy do not recommend routine Zika testing for asymptomatic pregnant women. If you are concerned, you should discuss further with your doctor.

6. Should a woman who is pregnant get regular blood/ urine tests for Zika, to make sure that she is not infected?

No, unless she has symptoms of possible Zika Virus Infection (fever and rash and other symptoms such as red eyes or joint pain).

7. Is it safe for pregnant women to use insect repellent?

Yes, insect repellents sold in Singapore are safe for use for pregnant women.

You can also prevent mosquito bites by wearing long, covered clothing, and sleeping under mosquito nets or in rooms with wire-mesh screens or air-conditioned rooms to keep out mosquitoes.

8. If I am pregnant and have recently visited a Zika affected area in Singapore, what should I do?

There is no need to see your doctor, if you are well. You should continue to take strict precautions against mosquito bites. If you have symptoms of possible Zika virus infection (fever and rash and other symptoms such as red eyes or joint pain), you should seek medical attention immediately, and consult your Obstetrics and Gynecology (O&G) doctor.

9. If I am pregnant and live, work or study in a Zika affected area in Singapore, what should I do?

You should take steps to prevent mosquito bites and consult a doctor if you develop a fever and rash and other symptoms such as red eyes or joint pain after possible exposure to Zika. You should tell the doctor where you live, work or study.

10. If my female partner is pregnant and I am tested positive for Zika, what should I do?

You should practise safe sex through the correct and consistent use of condoms, or abstinence, for at least the whole duration of your female partner’s pregnancy.

11. If my female partner is pregnant and I live, work or study in a Zika affected area in Singapore, what should I do?

You should practise safer sex through the correct and consistent use of condoms, or abstinence, for at least the whole duration of your female partner’s pregnancy.

You should take steps to prevent mosquito bites by wearing long, covered clothing, applying insect-repellent, and sleeping under mosquito nets or in rooms with wire-mesh screens or air-conditioned rooms to keep out mosquitoes.

You should consult a doctor if you develop a fever and rash and other symptoms such as red eyes or joint pain after possible exposure to Zika. You should tell the doctor where you live, work or study.

Pregnant women/ Mothers with Zika

12. What is being done in other countries to manage pregnant women with Zika? Is Singapore doing the same?

In countries with community transmission of Zika Virus Infection and in line with WHO’s guidelines, pregnant women with Zika are advised to follow up closely with healthcare practitioners to detect any fetal abnormalities. Singapore has also adopted similar recommendations.

13. If I am pregnant and my blood tests positive for Zika, will I need to be hospitalised?

Like other patients tested positive for Zika, you should be referred to a hospital and managed by an O&G doctor.

14. If I am pregnant and positive for Zika Virus Infection, will my baby have microcephaly?

Currently, even if a pregnant woman is confirmed to be infected with Zika virus, there is no test that will predict the future occurrence of microcephaly. We advise that you follow-up closely with your doctor.

15. If a pregnant woman is positive for Zika virus Infection, should she consider termination of pregnancy?

A pregnant patient with confirmed Zika infection will be arranged for admission to a public hospital with a referral to an O&G doctor for further management. Serial ultrasounds and amniotic fluid testing may be considered after the potential risks and interpretation of results are discussed. The termination of pregnancy is a personal choice which should be carefully made by the parents in consultation with their doctor.

16. Can mothers with Zika infection breastfeed their baby?

Zika virus has been detected in breast milk but there is currently no evidence that the virus is transmitted to babies through breastfeeding.

(C) QUESTIONS ON ZIKA VIRUS AND MICROCEPHALY

17. What is Microcephaly?

Microcephaly is a congenital condition in which the head size is very much smaller than usual for a baby of the same age, race, and sex.

Microcephaly can be caused by a variety of genetic and environmental factors, such as Down Syndrome, exposure to drugs, alcohol or other toxins in the womb; rubella and a few other infections during pregnancy.

There is no specific treatment for this condition. Infants with microcephaly showing developmental delay might benefit from early intervention programs or developmental, physical, and occupational therapy, as well as interdisciplinary programmes.

18. Does Zika cause microcephaly?

There is evidence that Zika can cause microcephaly.

19. What is the impact of microcephaly on an infant?

Microcephaly can be an isolated condition, meaning that it can occur with no other major birth defects, or it can occur in combination with other birth defects. Infants with microcephaly may have concurrent disabilities. Different symptoms and signals associated with microcephaly (very small head, difficulty feeding, high pitched crying, fits, stiffness of arms and legs, developmental delays and disabilities, among others) have been described.

Infants with suspected microcephaly should be evaluated by a healthcare professional. In addition to clinical evaluation, neuroimaging tests to evaluate possible structural deformities may be required.

20. Can microcephaly be picked up through pre-natal screening? If so, what options are available to pregnant women if it is detected?

Microcephaly may be picked up during pre-natal screening, such as through ultrasound of the fetus. However, not all cases may be picked up in the early stages of pregnancy (i.e. within the first trimester). Some may not be diagnosed until after late in the pregnancy or after the birth of the child. This is similar to other congenital conditions, such as Down Syndrome. Similarly, a small head measured on ultrasound does not necessarily confirm the diagnosis of microcephaly. A significant proportion of fetuses with small heads on ultrasound turn out to be neuro-developmentally normal.

If this condition is picked up through pre-natal screening, the parents should consult with their healthcare professional on their options.

21. Can amniocentesis tests be used to detect Zika Virus Infection in the fetus?

If the woman is not known to be infected with Zika virus, amniocentesis is not recommended for detecting Zika virus infection in the fetus. If the woman is confirmed to be positive for Zika, the O&G doctor will assess and counsel her on the pros and cons of doing such a test.

22. I think my child’s head is smaller than usual. Does he have microcephaly?

Having a seemingly smaller head may not mean that your child has microcephaly. Just as importantly, having a small head does not automatically mean that the child will have developmental concerns. The child should be evaluated by a healthcare professional. More tests may be needed to determine if there are any issues of concern.

23. Can microcephaly be treated? What support can be provided to a child born with microcephaly?

Treatment and support depend on whether the child has any disabilities and if so, the type and degree of disability. Treatment and support will include rehabilitative measures which may include environmental stimulation, physiotherapy, speech therapy and occupational therapy.

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