Tang See Kit Channel NewsAsia 13 Sep 16;
SINGAPORE: It remains too early to tell if the Zika virus outbreak in Singapore will have any impact on the local tourism industry and, in turn, the broader economy, said Senior Minister of State for Trade and Industry Sim Ann in Parliament on Tuesday (Sep 13).
The Government is undertaking “strong coordinated actions” to contain the spread of the mosquito-borne virus and any possible spillover impact it could have on the economy, she said in response to questions from Nominated Members of Parliament (NMPs) Associate Professor Randolph Tan Gee Kwang and Thomas Chua Kee Seng.
As of Monday (Sep 12), there were 333 cases of locally transmitted Zika infections in Singapore. The first case – a 47-year-old Malaysian woman living at Aljunied Crescent – was confirmed more than two weeks ago.
Economists surveyed by Channel NewsAsia believed that the spread of the mosquito-borne virus will not be a significant threat to the already-struggling economy. Mr Ravi Menon, managing director of the Monetary Authority of Singapore (MAS), agreed but cautioned that it is “still early days” when it comes to determining what the impact might be.
For the tourism sector, Ms Sim said the impact on visitor arrivals “is currently contained”. In addition, discussions with industry players show that “there is no clear indication or trend of decline in arrivals” even as countries including Hong Kong and Australia issue travel advisories for visitors to Singapore following the Zika outbreak.
She added that Singapore “remains a safe travel destination”, and that the World Health Organisation (WHO) has yet to issue travel restrictions to Zika-affected areas.
Nevertheless, the Singapore Tourism Board (STB) is working closely with industry players to “proactively address concerns from potential visitors”. For instance, STB's frontline operations including its call centres and the Singapore Visitor Centre has been monitoring daily feedback from tourists and actively responding to queries regarding the virus.
For businesses, Ms Sim said that while it is too early to consider Zika-specific measures, companies can tap into existing schemes if they need help.
For example, small and medium-sized enterprises (SMEs) facing short-term cashflow issues may apply for the SME Working Capital Loan administered by SPRING Singapore. The agency is also joining hands with the Singapore Business Federation to help businesses develop business continuity plans to "ensure enterprise resilience in the event that operations are affected".
“MTI and its agencies will continue to closely monitor developments through the Ministry of Health and the National Environment Agency, and are prepared to develop and activate further support for businesses if necessary,” Ms Sim said.
No new Zika cases reported in Singapore on Tuesday
Channel NewsAsia 13 Sep 16;
SINGAPORE: There were no new Zika cases reported in Singapore, as at 3pm on Tuesday (Sep 13), according to the National Environment Agency's website.
This is the first time since Aug 27, when the first locally transmitted case was reported here, that no new confirmed case has been reported.
There remains a total of 333 confirmed cases of the virus since Aug 28, the website showed. Of these, 269 - slightly more than 80 per cent of the confirmed cases were from the main cluster in Aljunied, Sims Drive and Paya Lebar Way.
Multi-pronged strategy to tackle Zika: Gan Kim Yong
Linette Lim Channel NewsAsia 13 Sep 16;
SINGAPORE: There are 333 people who have tested positive for Zika as of noon yesterday, said Health Minister Gan Kim Yong in an update to Parliament on Tuesday (Sep 13). This included eight pregnant women, and involved seven clusters. Most of these people have recovered and are no longer symptomatic, he added.
Mr Gan also said that because Zika is a mosquito-borne disease with a majority of those infected asymptomatic, the Government will not isolate or hospitalise Zika patients. Efforts will instead focus on vector control.
Although Zika has been around since 1947, Mr Gan noted that it was only in Feb 2016 that “the World Health Organization declared that the recent cluster of microcephaly cases in Brazil, which are suspected to be linked to Zika, constituted a Public Health Emergency of International Concern”. The risk of microcephaly, which is a congenital condition that affects the development of the brain, means many pregnant women are "understandably anxious" about the Zika outbreak, he said.
In response to questions by MPs, Mr Gan outlined Singapore’s three-pronged Zika action plan involving preparation, response, and long-term management.
4,000 BLOOD SAMPLES WERE TESTED BEFORE FIRST CONFIRMED CASE
To prepare for Zika, the Ministry of Health (MOH) took several steps, including making Zika a notifiable disease under the Infectious Diseases Act from this January, working with partner agencies to prepare operational plans in case of an outbreak, and stepping up public education and issuing health advisories.
MOH also worked with the National Environment Agency (NEA)’s Environmental Health Institute to put in place a surveillance programme for Zika two years ago. In partnership with about 200 clinics, blood samples from selected patients with symptoms associated with Zika were collected, said Mr Gan. More than 500 samples a month were tested for Zika from this January, and close to 4,000 samples were tested between February and August, before the first confirmed case, he added.
ACTIVE BACK-TRACING WAS WHY ZIKA CASES JUMPED FROM 1 TO 41 WITHIN A DAY
In response to initial cases, MOH undertook screening of patients’ household members, and NEA deployed officers to conduct intensive vector control operations in affected areas. Mr Gan also touched on how MOH and NEA moved to actively detect cases and identify clusters to manage the spread of Zika.
“This active back-tracing was why the number of confirmed Zika cases increased from 1 reported on 27 August to 41 on 28 August. This sudden jump was surprising to some people, who wondered if these cases had in fact been identified earlier but held back by MOH. In reality, the number of confirmed new Zika-positive patients increased only by 5. The other 36 were from our proactive back-tracing of workers at the construction site (at Sims drive),” he told Parliament.
“Through the back-tracing, we also checked the onset of symptoms for each case to determine the epidemiology of the outbreak. The analysis showed that the earliest case had onset of symptoms on 31 July. Some people misinterpreted this as MOH having known of the first Zika-positive case since 31 July. This is not so. As I explained, we only confirmed the first locally transmitted Zika case on 27 August, and we released the information the same evening.”
NO MORE ISOLATION POLICY AND HOSPITALISATION FOR ZIKA PATIENTS
To manage Zika in the long-term, Mr Gan said that efforts will focus on vector control as it is a mosquito-borne disease. The Government will no longer practice an isolation policy as this has limited effect. “80 per cent of those with Zika are asymptomatic and... there are already mosquitoes in the community already carrying the virus,” he explained, adding that hospitalisation of Zika patients is also not necessary as most cases are mild.
Mr Gan reiterated that subsidized Zika testing is extended to all Singaporeans beyond the affected clusters. He also said that pregnant women will be supported as a special group, given the possible risks to their foetuses in case of infection.
Zika testing for asymptomatic pregnant women is not routinely recommended, but symptomatic pregnant women and those whose male partners are Zika-positive will be provided with free Zika tests at both public and private healthcare institutions if doctors assess that testing is needed, he said. Mr Gan also added that pregnant women who have tested positive for Zika will be referred by their doctors to an obstetric or maternal-foetal medicine specialist for counselling and subsequent follow-up.
“Regular ultrasound scans will be carried out to monitor the development of the foetus. Zika infection does not always result in abnormal foetal development,” he said, adding that microcephaly has been tracked by the National Birth Defects Registry since 1993, and that the MOH will work with our doctors to monitor the outcomes of babies born to women with Zika.
ZIKA FIGHT "A LONG ONE": GAN KIM YONG
Lastly, Mr Gan touched on public education and research efforts. Zika testing is currently done at the National Public Health Laboratory, NEA’s Environmental Health Institute and major public hospital laboratories, and there is no specific anti-viral treatment or approved vaccine for Zika at the moment.
"There are also ongoing research efforts in Singapore relating to Zika. Testing and
translating these to practical clinical use will take time," he said.
Earlier, the sequencing analysis of the Zika virus found in two patients from the ongoing outbreak revealed that it had sequences similar to the Zika strain which have been circulating in Southeast Asia since the 1960s.
“We cannot tell at this moment whether the viruses found here cause more or less severe disease than those in South America. Future research will be needed to shed light on this,” he said, adding that it is still “early days” to ascertain the long-term trend of Zika infections although the number of cases detected in recent days has been “coming down”.
“The journey in our fight against Zika is likely to be a long one, because of the presence of Aedes mosquitos here. Even if we can control the present outbreak, we will need to continue to guard against imported cases, as the Zika virus is still circulating among many countries, including several in the region. Therefore, as we tackle Zika, life must go on. By working together, we can succeed in managing Zika in the long-term,” he said.
Source reduction is key strategy to fight Zika and dengue: Masagos
Lim Jia Qi Channel NewsAsia 13 Sep 16;
SINGAPORE: The National Environment Agency (NEA) conducted about 748,000 inspections to uncover mosquito breeding habitats between January and July this year and more than 10,000 breeding habitats were destroyed during these inspections, said Minister for Environment and Water Resources Masagos Zulkifli in Parliament on Tuesday (Sep 13).
Of the 10,000 breeding sites that were destroyed, about half of them were found in homes and about five per cent were in construction sites, said Mr Masagos in his ministerial statement as he outlined strategies to tackle the Zika outbreak in Singapore.
Besides deploying some 850 officers to do inspections island-wide, Mr Masagos said NEA also conducts indoor spraying with insecticide and outdoor fogging within the cluster to kill adult mosquitoes, as well as oiling of breeding habitats to kill any mosquito larvae.
“Zika and dengue are conveyed by the same mosquito – the Aedes aegypti. Our key strategy for dengue control, and now Zika, is source reduction – the detection and removal of breeding habitats and larvae,” said Mr Masagos.
"This integrated vector management strategy is in line with the World Health Organisation (WHO)’s recommendations and remains especially critical now as we are in the traditional dengue peak season," he added.
But Mr Masagos also noted that it would not be wise to conduct fogging indiscriminately outside of the clusters as a preventive measure. That is because fogging is only effective if the chemical has direct contact with the mosquitoes, Mr Masagos explained.
"The overuse or indiscriminate use of chemical treatment may cause the build-up of resistance in the local mosquito population. Fogging should only be used when there are Zika or Dengue clusters or when the adult mosquito population is observed to be high so that we can mitigate the situation quickly," he said.
Enforcement actions and penalties have been stepped up over the years at construction sites, Mr Masagos added.
Between January and July this year, the NEA issued around 50 Stop Work Orders for work sites repeatedly found with poor housekeeping and mosquito breeding habitats. A total of 410 notices were issued to construction companies to attend court and 40 errant contractors were prosecuted for repeat offences.
Even as the NEA has given attention to construction sites, Mr Masagos stressed that a large number of mosquito breeding sites is in fact found in homes.
About 2,200 households were fined between January and July this year as they were found to have mosquito breeding sites.
To mitigate the risk of transmission, the Government has also put in resources for surveillance.
NEA has deployed about 37,000 Gravitraps around Singapore and the number is set to reach 48,000 by the end of the year, said Mr Masagos. Gravitrap allows the authorities to identify areas with a large Aedes aegypti population and take targeted mosquito control measures proactively even if there are no dengue or Zika cases reported.
“This sort of risk-based, preventive surveillance work will go on well ahead of any peak transmission season,” Mr Masagos added.
STEPS TAKEN TO CONTAIN ZIKA VIRUS
Several MPs including MP for Holland-Bukit Timah GRC Mr Christopher De Souza, Non-Constituency MPs Mr Dennis Tan and Associate Professor Daniel Goh asked about what steps have been taken by the Government to contain the Zika virus.
In response, Mr Masagos said the current mosquito control strategy has helped suppress dengue over the years and the same strategy has prepared Singapore well to tackle the Zika challenge.
He added that following the Ministry of Health’s announcement of the first locally-transmitted Zika case on Aug 27, around 300 NEA officers, contractors and volunteers have been carrying out vector control efforts and outreach in the affected clusters.
As of Sep 11, more than 31,000 premises in the various Zika clusters have been inspected for mosquito breeding.
“In the Zika clusters, thermal fogging outdoors and indoor spraying of premises have been carried out to kill adult mosquitoes and the drains have been flushed to remove any stagnant water as an added precaution,” said Mr Masagos.
The NEA has also inspected construction sites and workers’ dormitories in the Zika clusters.
A Stop Work Order was issued to the construction site at Sims Drive on Aug 27 to curb the local Zika transmission as the site had failed to maintain satisfactory housekeeping and to eliminate potential mosquito breeding habitats, said Mr Masagos.
Mr Masagos added that the NEA has been working regularly with the Singapore Contractors Association (SCAL) to remind its members to be more vigilant about mosquito control and to look out for any workers with Zika symptoms.
Stricter requirements have been imposed on four dormitories. They are required to check for mosquito breeding and carry out thermal fogging if the mosquito population is high, as well as mandatory residual spraying in their premises on a quarterly basis.
SINGAPORE REMAINS VULNERABLE TO MOSQUITO-BORNE DISEASES
Despite all these efforts, Mr Masagos told the House that Singapore remains vulnerable to dengue and other mosquito-borne diseases for a few reasons.
He cited that Singapore is in a dengue-endemic region and there are four different dengue virus serotypes circulating concurrently and a change in the predominant virus is usually followed by a spike in dengue cases.
The region’s warm climate and high humidity have also supported faster breeding and the maturation cycle of the mosquitoes, said Mr Masagos, adding that these have led to a higher mosquito population and the spread of diseases.
Mr Masagos also cited a large proportion of Singapore's population is susceptible to dengue due to the lack of immunity,
"In many other countries where dengue is endemic, the affected are often children. This is not the case in Singapore, which is good. Our success has, therefore, paradoxically lowered our herd immunity so that disease transmission occurs easily even with a very small mosquito population," said Mr Masagos.
“We must acknowledge that all these extraneous factors make it impossible to eliminate the Aedes aegypti here. Indeed, if we had done anything less, dengue and Zika would have spread throughout the whole island more quickly and thoroughly,” Mr Masagos added.
Mr Masagos stressed that everyone has a part to play in fighting Zika and dengue.
“Everyone – the Government agencies, premises owners, businesses, residents, and the community – has a role in our fight against Dengue and Zika,” he said.
Sufficient measures to prevent mosquitoes from breeding at construction sites: Masagos
Lim Jia Qi Channel NewsAsia 13 Sep 16;
SINGAPORE: There are currently sufficient measures to prevent mosquitoes from breeding at construction sites and the Government should not go overboard by implementing more measures, said Minister for Environment and Water Resources Masagos Zulkifli after delivering a parliamentary ministerial statement on the Zika outbreak on Tuesday (Sep 13).
Several Members of Parliament raised concerns about potential breeding spots in construction sites and whether more measures should be implemented to curb mosquito breeding.
MP for West Coast GRC Foo Mee Har asked if the Government is considering more stringent measures such as introducing a new regime that requires all construction contractors to engage an authorised pest controller to conduct independent checks and treatments at construction sites.
In response, Mr Masagos said the current measures are sufficient. He cited the Control of Vectors and Pesticides Act (CVPA) which allows the Government to impose Stop Work Orders for worksites repeatedly found with poor housekeeping and mosquito breeding habitats and the presence of Environmental Control Officers on site to ensure proper mosquito control measures in the construction sites.
Since 1999, the NEA has required all construction sites exceeding S$50 million in project value to employ full-time Environmental Control Officers, while sites between S$10-50 million are required to employ part-time ones.
“We should not go overboard by implementing more measures and also adding more costs when we can do things well properly,” said Mr Masagos.
“We have also extended our CVPA to the dormitories. Because I think this is a good precautionary measure although it is not a construction site. The workers live there and they may also spread or transmit to one another. Therefore this CVPA will require the dormitories' owners to step up their housekeeping of the premises,” Mr Masagos added.
Mr Masagos also responded to other questions including should the location of the construction site be considered for more stringent surveillance and if fogging can be done at more areas.
Other MPs asked questions:
Associate Professor Daniel Goh: Whether other than size, should the location of the construction site be considered for more stringent surveillance, namely how close the sites are to the residential areas?
Mr Masagos: The question on whether we should focus more on construction areas near residential sites – Singapore is a very build up area; most construction sites are around homes and therefore it's not the primary factor why we go to the site or not. We have other risk factors. Now, indeed we have extended the coverage to beyond the construction sites to the dormitories where the workers come from.
Dr Tan Wu Meng: There is about one breeding site per 128 homes. On the other hand, about one in nine construction sites have mosquito breeding sites discovered and destroyed. In light of this, would his ministry consider taking an even more robust approach to stamping out mosquito breeding sites in construction sites?
Dr Masagos: I wish the mosquitoes can calculate as well. But mosquitoes don't calculate they just go to where there are humans and where there is water to breed. Whether it's a construction site; home, they should be of equal concern to us. The real difference is accessibility. For construction sites, our officers can come in anytime; they can impose appropriate orders to them to clean up, to step up on their housekeeping.
But we can't say the same for homes. Therefore, even in terms of per home basis, we are actually far, far better than what has been prescribed by the World Health Organisation. We should not rest on our laurels. Every mosquito that hatches, a female mosquito will hatch a further 300 eggs. They grow exponentially if we just leave the breeding untouched, and therefore whether it's home or construction site, we must be as vigilant.
I think we should also educate our constituents that it's not just about the construction sites. We will do our best to suppress the source of breeding if it occurs there. But everyone must do their part to make sure they do the five-step Mozzie Wipeout as a daily habit to ensure that they don't give the mosquitos a chance to breed.
Mr Christopher De Souza: Can fogging be done at more areas? How effective is fogging and are there any side effects to fogging?
Mr Masagos: Fogging is effective if done properly and if done by licensed professionals. We have to fog when there is a cluster. Because it means there are adult mosquitoes infecting the population or to prevent those mosquitoes who are not yet infecting from infecting. So that is the primary reason we do fogging. But we cannot just do fogging. I know everyone likes fogging because it's very optically ... everyone can see it and everyone feels better. But it does not solve the problem. It must be done together with source eradication, whether it’s at construction sites, whether it's at our homes.
Indeed at our homes, whenever the fogging is done, they closed up their homes. And therefore it doesn't get into their homes. The other thing that we could do is misting which means that in some town councils as well as dormitories, we do misting to make the chemicals stick on the wall and they last long. But we can't do this very often either. Because I mentioned just now, there are also side effects of using the same chemical over and over again, so frequently that the mosquitoes may become immuned to those insecticides. And this has already happened. In fact some insecticides are not used at all nowadays because we have overused them.
Too early and not productive to assess if Zika is endemic: Gan Kim Yong
Linette Lim Channel NewsAsia 13 Sep 16;
SINGAPORE: It is “too early to say” and “not productive” to decide whether Zika is endemic in Singapore, said Health Minister Gan Kim Yong on Tuesday (Sep 13), after delivering a parliamentary statement on the Zika outbreak.
Responding to MP Tin Pei Ling’s question on whether Zika is considered endemic, and if eradication would be possible, Mr Gan said, “Our immediate task is to focus on vector control, to do our level best to try to eradicate as much as we can, if not, to minimise as much as we can.”
“I certainly hope that it will not be endemic, but it is something that we will have to monitor over a long period of time, before we can make a definitive assessment,” he added.
Mr Gan also answered other questions, including those on microcephaly and measures in place for construction sites to report suspected cases to the Ministry of Health (MOH):
Tin Pei Ling: Until there is greater clarity, can regular tests be made available to all pregnant women?
Mr Gan: WHO (World Health Organization) actually did not recommend regular, routine testing for non-symptomatic pregnant women, because there is a very narrow window to test them. You have to test them while they are infected. After a period of time, when they have recovered from the infection, it will be very difficult to detect whether the lady has been infected before. Therefore, the window is very narrow and it is not practical to keep testing… every day, or every week, or every other week. WHO did not recommend testing for those who are non-symptomatic and our Clinical Advisory Group also advised against it. For symptomatic pregnant women, the advice is for them to consult their doctor because each case is different; their risk factors are also different.
Alex Yam: Can we ascertain the origin of the local transmission? What is the number of known Zika microcephaly cases in Singapore since tracking began in 1993?
Mr Gan: It is very difficult to determine (the) first case… because Zika is not transmitted from person to person. For an epidemiology study, it is very difficult to trace… because there is an intermediary, vector, and that is the mosquito, and we are unable to trace the mosquito for obvious reasons. And therefore, we do not know who the first, so-called ‘index case’ is. It is also quite clear, to be careful not to identify the person with the earliest symptoms on 31 July as first case… because 80 per cent of the patients actually do not have symptoms.
Zika is not the only cause of microcephaly. Microcephaly can be due to a number of factors. It could be due to genetic and environmental factoss, such as Down syndrome, exposure to drugs and alcohol… rubella, as well as other infectious diseases. So even before we detected the first case of Zika, microcephaly cases were present in Singapore. Over the last five years, we have on average, between 5 to 12 microcephaly cases per 10,000 live births in Singapore. For those patients with microcephaly, we continue to provide support and manage them the same way as we manage children with congenital conditions.
Daniel Goh: What processes are in place to ensure construction sites, contractors will report high numbers of workers who display symptoms of Dengue or Zika infections to MOH in timely manner?
Mr Gan: The key gatekeeper is our primary care system. We work through our GPs, when they notice unusual trends, whether if its Zika or any other infection… so our frontline GPs are the most important. When they see cases they have doubts about, or when they see patterns that are unusual, that they cannot explain, they usually alert MOH and we work together with them to find out the truth. This is how we discovered the locally-transmitted case in the first instance.
Tang See Kit Channel NewsAsia 13 Sep 16;