Local Zika infections jump to 151; new cases found in Tagore, Yishun, Harvey Crescent

Channel NewsAsia 1 Sep 16;

SINGAPORE: 31 new cases of locally transmitted Zika were confirmed on Thursday (Sep 1), including three cases not linked with any existing cluster, said the Ministry of Health (MOH) and National Environment Agency (NEA) in a joint statement.

These three patients live in Tagore Avenue in Upper Thomson, Yishun Street 81 and Harvey Crescent, which is in Simei.

Shortly before the new cases were identified, Prime Minister Lee Hsien Loong warned that Singapore "must assume Zika is elsewhere in (the country)" apart from Aljunied and Bedok, where the majority of cases so far have been.

An additional five cases were detected as a result of MOH’s look-back testing of previous cases. The authorities added that the look-back exercise is now completed. A total of 236 samples were taken, of which 52 tested positive, and 184 were negative.

Thursday's update brings the total number of locally transmitted Zika infections in Singapore to 151.

The new cases include the second pregnant woman in Singapore to be diagnosed with Zika. Like the first case, which was confirmed on Wednesday, the woman is living in the Sims Drive/Aljunied Crescent cluster, authorities said.

PRE-EMPTIVE CHECKS CARRIED OUT IN HIGHER-RISK AREAS: NEA

NEA said that vector control remains key to reducing the spread of the Zika virus. "NEA takes a systematic and holistic approach to arrest mosquito borne transmission in Singapore, through surveillance, prevention and control, outbreak management and outreach. The objective is to keep mosquito-borne disease incidence low through reducing the mosquito population and breaking the disease transmission chain."

The agency added that it not only conducts checks for mosquito-breeding habitats based on cases, but also takes a preventive and risk-based approach through pre-emptive checks in areas assessed to be at higher risk, even in the absence of cases.

This is similar to its approach to dengue cases, NEA said.

49 MOSQUITO-BREEDING SPOTS IN ALJUNIED DESTROYED: NEA

The agency added that it is continuing with vector control operations to control the Aedes mosquito population in the existing Aljunied Crescent/Sims Drive cluster.

49 breeding habitats – comprising 26 in homes and 23 in common areas or other premises – have been detected and destroyed, it said. Indoor spraying, misting and oiling were conducted, and daily misting of common areas is ongoing. Two rounds of thermal fogging have been completed and another round will be conducted this week.

NEA added that its officers and grassroots volunteers have completed outreach efforts to distribute Zika information leaflets in the Aljunied Crescent/Sims Drive cluster, and have begun their outreach in the expanded cluster areas in Paya Lebar Way/Kallang Way.

NEA also conducted vector control operations and outreach efforts in Bedok North Avenue 3, Punggol Way and Joo Seng on Thursday.

It called for residents to cooperate fully with NEA and allow its officers to inspect their premises for mosquito breeding and spray insecticide to kill any mosquitoes. NEA added that to ensure any breeding spots are destroyed quickly, its officers may use force to enter premises that are not accessible to them, after serving requisite notice on the premises' owners.


Second pregnant woman found to have Zika, 36 more confirmed cases
TOH EE MING Today Online 2 Sep 16;

SINGAPORE — While the Zika strain in local infections is still yet to be analysed — a process that will take weeks or months to complete — the authorities have assessed that it is likely to have come from the region, as 36 more cases were confirmed on Thursday (Sept 1), including a second pregnant woman.

The cases have also spread further afield, with three of the new cases in Tagore Avenue, Yishun Street 81 and Harvey Crescent.

Speaking during a joint briefing at by the Ministry of Health (MOH) and National Environment Agency (NEA) at MacPherson Community Club on Thursday, Dr Derrick Heng, group director for Public Health at MOH, pointed out that Zika is present in 57 other countries.

“If you factor in the travel volume, it is more likely that the virus came from within the region rather than from far away… But we decline to speculate further until the lab results are out,” he said.

In an update on Thursday night, the MOH said 31 of the 36 cases were new, and five were “look-back” cases — cases that were previously reported to have shown symptoms but were not tested for Zika. The ministry also said the look-back exercise has been completed.

A total of 236 samples were taken for the look-back exercise, of which 52 tested positive. Including the look-back cases, the number of locally-transmitted Zika cases in Singapore stands at 151.

The MOH said the pregnant woman whose case was confirmed on Thursday is linked to the Aljunied Crescent-Sims Drive cluster. “Her doctor is following up closely with her to provide support and counselling,” the ministry said.

The active transmission here has led to several countries issue advisories cautioning on travel to Singapore, among them Indonesia, Australia, and the United States. As of Wednesday noon, 57 of the infected are foreigners who live and work in Singapore. These comprise 10 Bangladeshis, 23 Chinese, 15 Indians, one Indonesian, six Malaysians, one from Myanmar, and one from Taiwan.

Commenting on the factors that could have contributed to the spread of Zika in Singapore, Infectious diseases expert Professor Leo Yee Sin, who was at the media briefing, said a “naive” population — a term used to describe a population lacks immunity — like Singapore’s would be more suspectible, as fewer have been treated for Zika.

Having a vector population like Aedes mosquitoes, along with Singapore’s highly “open environment” and high human traffic could have spurred the faster spread of Zika, she added.

On whether the virus has undetected remained in recovered patients, Prof Leo said that Zika is relatively new to the scientific world, and to more time is needed to carry out “intense research”.

“From what we know, a person who has Zika can overcome the infections, the immunity should stay within in them… Whether or not some part of the body will hold the virus for some time… Zika is new in Singapore, and we have the research community, and all of us are hungry to know about Zika in Singapore,” she said.

Mr Derek Ho, director-general of public health at NEA, noted that Singapore is still in the midst of its traditional peak dengue season, and stressed that for now, the key to tackling the problem is vector control targeting the “outbreak areas”, and looking at potential breeding sites like construction sites.

Apart from the Aljunied Crescent-Sims Drive and the Paya Lebar Way-Kallang Way clusters, the NEA also conducted vector control operations and outreach efforts in Bedok North Avenue 3, Punggol Way and Joo Seng on Thursday.

Asked whether the Zika outbreak had reached epidemic levels and if emergency measures are needed, Mr Ho said there was “no need to press the panic button”.

“As long as we have got the vector control, we need to continue with these efforts to ensure the mosquito vector is kept under control,” he said.

As suspect cases continued to be tested for Zika on Thursday, patients were kept waiting in separate quarters as they waited for test results, which typically take three to four hours.

Retiree Tam Ying Chee, however, found himself waiting far longer. Discovering that he had broken out in rashes at around 8am on Thursday, the 52-year-old headed to Geylang Polyclinic, and was transferred to the Communicable Diseases Centre (CDC) for tests. His test was done by 2pm but as of 10.30pm last night, he was still awaiting the results in a private ward at the CDC.

The Paya Lebar Way resident was unperturbed by the wait. “They said from two to three hours, then maybe four to eight hours, then maybe tomorrow.. But (it’s fine),” he said.


Foreign nationals account for 50% of Zika cases in Singapore
Today Online 1 Sep 16;

SINGAPORE — Half of the Zika cases in Singapore are foreigners who live or work here, said the Ministry of Health (MOH) on Thursday (Sept 1).

Out of 115 cases, 57 are foreigners. The largest group is 23 people from China, followed by 15 from India and 10 from Bangladesh. Six cases are Malaysians, and one case each from Indonesia, Myanmar and Taiwan.

"All had mild illness. Most have recovered while the rest are recovering well," said the MOH spokesperson.

Earlier on Sunday (Aug 28), the MOH said that 36 foreign workers at a construction site at 60 Sims Drive had been infected.

The ministry announced Singapore’s first case of locally-transmitted Zika on Saturday, involving a 47-year-old Malaysian woman who lived in Block 102 Aljunied Crescent.

Meanwhile, Malaysia reported its first Zika case on Thursday, involving a 58-year-old woman who visited her daughter in Singapore on Aug 19. Her daughter, a resident in Paya Lebar which has seen Zika cases, was confirmed as being infected with the mosquito-borne virus on Aug 30.

In Singapore, efforts to contain Zika’s spread continued on Thursday morning with thermal fogging operations observed in the areas surrounding Aljunied Crescent and Bedok North Ave 3, which has emerged as a potential cluster after three confirmed cases were reported. Health and environment officers were also spotted lifting drain covers to check for any breeding sites.

Residents in Bedok who spoke to TODAY on Thursday were largely unruffled by the latest development.

“Life still goes on... It’s just a pity that the virus has hit our island and spread like wildfire,” said Mr Stephen Gomez, 61, a resident at Blk 402 Bedok North Ave 3.

Housewife Madam Zhao Hai Ying, 27, said she would take more precautions by checking if her two young children had any mosquito bites. “But you can’t be so (fixated) on this, we just have to be a little more careful,” she added.

Office manager Sally Lim, 43, said that Zika was not “as serious” as SARS (severe acute respiratory syndrome), and that there was “nothing to be worried about”.

However, she noted that some of her relatives who had originally intended to visit her this weekend at her home in Bedok had decided to cancel the visit. ADDITIONAL REPORTING BY TOH EE MING


Challenging to contain Zika virus: Health experts
Lim Jia Qi Channel NewsAsia 1 Sep 16;

SINGAPORE: As the Zika virus spread from one area to a new potential cluster at Bedok North Avenue 3, medical experts told Channel NewsAsia that it may become increasingly difficult to contain the virus.

The authorities identified the Aljunied Crescent/Sims Drive area as the initial Zika cluster after more than 41 people working and living in the area tested positive for the virus.

But on Wednesday (Aug 31), the Ministry of Health (MOH) said the area around Bedok North Avenue 3, which is about five kilometres away from Aljunied Crescent/Sims Drive, could be the site of a new cluster.

As of Thursday, a total of 151 locally transmitted Zika infections were confirmed in Singapore, including three cases not linked to any existing cluster. On the same day, Prime Minister Lee Hsien Loong warned that Singapore "must assume Zika is elsewhere in (the country)" apart from Aljunied and Bedok, where the majority of cases so far have been.

Dr Asok Kurup, an infectious diseases specialist at Mount Elizabeth Hospital, said the spread was not surprising as Singapore is a small country and people can get around easily. He added that the virus could have already spread to other parts of Singapore.

“We are all very physically mobile within the country. It’s not unusual to find areas, clusters outside of there. Someone who works there can live in another part of Singapore; someone who has no symptoms can easily be a prey of the Aedes mosquito and it can spread to individuals in other neighbourhoods,” said Dr Kurup.

The Zika virus is transmitted by the Aedes mosquito. Symptoms of Zika include fever and rash as well as red eyes or joint pain. The disease can also cause microcephaly - a congenital condition in which the head size is much smaller than usual for a baby of the same age, race and sex.

DIFFICULT TO ERADICATE ZIKA: HEALTH EXPERTS

If Zika continues to spread across Singapore, Dr Leong Hoe Nam, an infectious diseases specialist at Mount Elizabeth Novena Hospital, is concerned that it may be difficult to eradicate the virus.

“The bigger the area to cover, the more difficult it will be to eradicate the virus. It means having to put more people on the ground, searching premises by premises and some of them are locked. Given this scenario, we will have more premises that are unchecked and more places where breeding can occur. When there are more areas for breeding, we are going to see a larger population of mosquitoes. This will translate to more cases of Zika and more cases of dengue,” said Dr Leong. "It will become inevitable that Zika may just take up permanent residence in Singapore."

His views were echoed by Dr Kurup, who said that apart from focusing on intensive vector control measures, other strategies including vaccines and the use of technology will be needed in the battle against Zika.

“We will not be able to eradicate Zika,” said Dr Kurup. “We have a huge challenge in that. We have no vaccine; we have no drugs; we have no targeted measures apart from what we have already done for dengue.”

Dr Wong Sin Yew, an infectious diseases specialist at Gleneagles Hospital, said the difficulty in eradicating the virus is that the majority of Zika cases are asymptomatic or mildly symptomatic.

“Eighty per cent of the people who are infected don't have any symptoms so it's possible for somebody who did not seek medical attention to be a source for mosquitoes to bite and infect others and these so-called 'silent carriers' could form a source of infection elsewhere and then develop other clusters,” said Dr Wong.

MOSQUITO CONTROL OPERATIONS UNDERWAY IN AFFECTED CLUSTERS

Vector control operations are underway in the Sims Drive/Aljunied Crescent cluster and Bedok North Avenue 3. This has been extended to Punggol Way and Joo Seng, where two isolated cases have been found.

NEA has inspected about 5,500 premises in the Sims Drive/Aljunied Crescent cluster which covers Aljunied Crescent, Sims Drive, Paya Lebar Way and Kallang Way. The cluster has about 7,000 premises.

More than 300 personnel were deployed each day between Aug 27 and Aug 30 to carry out vector control operations and outreach efforts.

On Thursday, MOH and the National Environment Agency (NEA) said that 49 breeding habitats - comprising 26 in homes and 23 in common areas or other premises - have been detected and destroyed in the Aljunied Crescent/Sims Drive cluster.

Indoor spraying, misting and oiling were conducted, and daily misting of common areas is ongoing. Two rounds of thermal fogging have been completed and another round will be conducted this week.

Even as authorities conduct vector control activities in the affected clusters, the community should also play an active role to prevent mosquito breeding, said Dr Wong.

“Every citizen should make sure that their house does not breed mosquitoes. If we reduce mosquito breeding throughout Singapore, we have a huge impact of reducing not just Zika but also dengue,” he said.

“The control efforts have been instituted and they are adequate. I would say that (in) two to three weeks ... we will be able to tell whether the number of cases will drop,” Dr Wong ventured.


Singapore must assume Zika is elsewhere too, aside from Aljunied and Bedok: PM Lee
Channel NewsAsia 1 Sep 16;

SINGAPORE: Prime Minister Lee Hsien Loong warned that Singapore "must assume Zika is elsewhere in (the country)" as well, even as authorities tackle the 115 cases that have been confirmed in Aljunied and Bedok.

In a Facebook post on Thursday (Sep 1), Mr Lee wrote: "The cases so far have been in Aljunied and Bedok, but we must assume that Zika is elsewhere in Singapore too."

The Prime Minister said: "We have been tracking Zika for a while now, and knew it was only a matter of time before it reached Singapore."

He added that scientists are still learning about this new disease. "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 mosquitos and destroy breeding habitats, all over Singapore. Do the 5-step Mozzie Wipeout. Let's all do our part to fight Zika, and dengue as well."


Chinese nationals, Bangladeshis, Malaysians among Zika cases in Singapore
Channel NewsAsia 1 Sep 16;

SINGAPORE: A total of 57 foreign nationals including Bangladeshis, Chinese, Indians and Malaysians who live and work in Singapore are among the 115 people who tested positive for Zika, said the Ministry of Health (MOH).

The breakdown of foreigners who have been infected is as follows:
- Bangladesh: 10
- China: 23
- India: 15
- Indonesia: 1
- Malaysia: 6
- Myanmar 1
- Taiwan: 1

Said MOH of the cases: "All had mild illness. Most have recovered while the rest are recovering well.”

Malaysia announced its first local case on Thursday (Sep 1). One of its citizens, a 47-year-old woman living in Aljunied Crescent, was the first case to be announced by Singapore authorities on Saturday.

The Bangladesh High Commission, Chinese Foreign Ministry and Indonesian Foreign Ministry said they have been notified of the cases by Singapore authorities.

"We have also been informed that the patients are presented with mild symptoms and have either recovered or recovering. We are in touch with the Ministry of Health in this regard," said Mahbub Uz Zaman, High Commissioner of Bangladesh to Singapore.

- CNA/mn

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