16 new Zika cases confirmed on Monday, bringing total to 258

Channel NewsAsia 5 Sep 16;

SINGAPORE: 16 new cases of locally transmitted Zika were confirmed on Monday (Sep 5), the Ministry of Health (MOH) and National Environment Agency (NEA) said in a joint statement. This brings the total number of confirmed cases in Singapore to 258.

Of these, 11 cases are linked to the cluster spanning Aljunied Crescent, Sims Drive, Kallang Way and Paya Lebar Way. One case is linked to the Joo Seng Road cluster. The other four cases have no known links to any existing cluster.o

NEA added that it has been continuing with vector control operations and outreach efforts in Aljunied Crescent, Sims Drive, Paya Lebar Way and Kallang Way, as well as expanded operations and outreach efforts at the periphery of this cluster at Circuit Road, Geylang East Central and Geylang East Avenue 1.

The agency said that as of Sep 4, 63 breeding habitats – comprising 37 in homes and 26 in common areas or other premises – have been detected and destroyed.

NEA added that it is continuing with vector control operations and outreach efforts in Bedok North Avenue. As of Sep 4, 52 breeding habitats – comprising 42 in homes and 10 in common areas or other premises – have been detected and destroyed, it said.

It added that vector control operations and outreach efforts at Joo Seng Road are ongoing and no breeding habitats have been detected thus far.

Earlier on Monday, MOH announced that it would extend subsidies for Zika testing to all Singaporeans with symptoms of the infection, not just those who live, work or study in the affected areas. Suspected Zika cases will also no longer be isolated pending test results.

- CNA/dt


Subsidised Zika testing extended to all Singaporeans: MOH
Channel NewsAsia 5 Sep 16;

SINGAPORE: The Ministry of Health (MOH) will extend subsidies for Zika testing to all Singaporeans with symptoms of the infection, not just those who live, work or study in the affected areas. Suspected Zika cases will also no longer be isolated pending test results.

In a media statement on Monday (Sep 5), MOH said: "As more cases are found in other parts of Singapore, testing will no longer be focused on the clusters only, and we will provide a subsidy for the test by the public sector laboratories". It gave details as follows:

- Subsidised patients at public healthcare institutions will pay a subsidised rate of $60 if they have Zika symptoms regardless of where they live, work or study. Patients who need the test but cannot afford it can approach medical social workers for assistance, such as from Medifund.
- Private patients at public healthcare institutions, as well as patients at private clinics and private hospitals will pay the full cost of S$150 for the Zika test.
- Doctors will continue to make the clinical judgment on whether it is necessary to test individuals for Zika.

The Zika virus has been linked to birth defects like microcephaly, and MOH added that pregnant women will remain a special group to whom it will make Zika tests more affordable and accessible.

MOH said doctors will continue to make the clinical judgment whether testing of Zika is necessary. For those who have Zika symptoms or whose male partner is Zika-positive, public sector laboratories will continue to extend free Zika tests to patients at the public healthcare institutions, as well as those at private hospitals and clinics, it said.

The Health Ministry added that for those who are not pregnant, confirming a Zika infection generally does not have an impact on the clinical management, which is currently focused on relieving symptoms. However, confirmation is useful in directing vector control efforts, it added.

- CNA/dt


Subsidised Zika testing extended to cover more
TAN WEIZHEN AND AMANDA LEE Today Online 5 Sep 16;

SINGAPORE — As more Zika cases emerge outside the current three geographical clusters, the Ministry of Health (MOH) tweaked its battle plan on Monday (Sept 5) by announcing subsidised tests for the virus for all Singaporeans and permanent residents, regardless of where one lives, works or studies.

Sixteen new cases were found as of noon yesterday — bringing the number of locally-transmitted cases to 258 — with four of these not linked to the Aljunied Crescent/Sims Drive/Kallang Way/Paya Lebar Way, Bedok North Avenue 3 and Joo Seng Road clusters.

From Wednesday, subsidised patients need only pay S$60 for Zika tests at public healthcare institutions. This is provided they have fever, rash, and one other symptom of joint pain, muscle pain, red eyes or headache. Private patients or those who visit private clinics or hospitals will pay the full S$150.

Pregnant women with symptoms or those with male partners who are Zika-positive will continue to get free tests everywhere. Mothers-to-be who wish to be tested regardless will pay a subsidised rate of S$60 at public healthcare institutions.

Doctors will continue to make the call for patients, pregnant or not, on whether testing for Zika is necessary, said the MOH. Patients who need the test but cannot afford it can approach their medical social worker for assistance, such as from Medifund, it added.

In a statement, the MOH said its considerations for testing hitherto were based on the assumption that most cases came from the affected areas. Hence, the free tests for those who live, work or study in these locations, while others pay the full charges. “However, as more cases are found in other parts of Singapore, testing will no longer be focused on the clusters only, and we will provide a subsidy for the test by the public sector laboratories,” it said.

From Tuesday, the MOH will also no longer require suspected Zika cases to be isolated while waiting for test results. Confirmed patients will also not be required to be hospitalised unless medically necessary. They can return home to await their test results.

“As more cases emerge, there is evidence that there is transmission in the community with the presence of infected mosquitoes. Furthermore, most of the patients do not display symptoms. Therefore isolation of patients with symptoms will have limited effect,” said the MOH.

Elaborating on the change in an exclusive interview with Channel NewsAsia yesterday, Health Minister Gan Kim Yong said when the Zika cluster was first discovered, the MOH was not certain of the extent and whether there was already large-scale transmission. Therefore, it was important for them to isolate patients then to prevent further spread even as investigations were carried out, he said.

The ministry was also not sure whether the Zika cases in Singapore were likely to have very severe symptoms that will cause medical issues, so it decided to hospitalise them first, he added. Given that isolated cases have emerged in other parts of Singapore, Mr Gan said his ministry has to work on the basis that local transmission has spread outside the affected areas.

“Also bearing in mind that there are 80 per cent of our infected patients do not have symptoms and therefore they are not treated by our doctors. Just isolating 20 per cent of our symptomatic patients has very limited effect,” he added. “Therefore, isolation will no longer be very effective.”

Commenting on the move, Dr Leong Hoe Nam, an infectious disease specialist at Mount Elizabeth Novena Hospital, said: “We have lost the opportunity to control the virus. In that case, why waste resources on isolation when we can actually (use) the resources to kill the mosquitoes?”

He added that a person may have the Zika virus in his/her blood for seven to 10 days before the onset of the fever, “so isolating after the onset of fever doesn’t make a lot of sense”.

Dr Wong Sin Yew, an infectious diseases physician at Gleneagles Hospital said patients with a Zika infection usually have the virus circulating in their blood for three to five days. “This is the period that they may be infectious when a mosquito bites them,” he said.

The need for isolation depends on risk assessment and isolating such cases will have limited effects, he added. “The patients should continue to rest at home, preferably in an air-conditioned room while awaiting for the results of their tests,” he added.


Challenge is to stop mosquito breeding in homes: MPs
KENNETH CHENG Today Online 6 Sep 16;

SINGAPORE — Despite stepping up public education since the Zika outbreak and more stringent enforcement, getting all residents to stem mosquito breeding at home remains a challenge, said Members of Parliament, acknowledging that the message has not sunk in fully.

Although a large proportion of mosquito breeding habitats that have been detected are in homes, not all residents are taking the necessary precautions seriously or need to be reminded to do so consistently, they added. While they have ramped up house visits, the MPs noted that up to 60 per cent of households are away during these walkabouts.

Mr Zaqy Mohamad (Chua Chu Kang GRC) said that many residents were unaware that their homes could be potential breeding sites, and there was a need for “sharper” messaging.

“The messaging today is not very explicit (in) saying that most of it (mosquito breeding) is in the homes — people don’t seem to get it,” he said. “The impression is always that it always comes (from) outside, it’s never from my home.”

Although the majority of their residents take precautions, including practising the Five-Step Mozzie Wipeout, some do so intermittently or overlook some spots, said MPs.

“There will be a handful who either don’t see the news, or don’t see the need to take action in their own homes,” said Dr Lee Bee Wah (Nee Soon GRC). “Some people might clear stagnant water after an outbreak, but it’s human nature to forget it after a while.”

Mr Zaqy added that those who followed the steps cannot rid their homes of breeding sites “100 per cent”.

For instance, some breeding sites are found in obscure spots, such as wet patches behind toilet bowls, which are not part of the wipeout, and they may “get blindsided”.

For others, it was a matter of carelessness. Sometimes, said Ms Rahayu Mahzam (Jurong GRC), residents may have left something but forgot to check on it, which can be dangerous.

“We need to keep repeating the message often,” she said.

Over the past few weeks, experts and government leaders have warned that Zika was here to stay and vector control was the most effective defence.

On Sunday, Senior Minister of State (Health) Amy Khor said Zika cases — like dengue, both of which are transmitted by the Aedes aegypti mosquito — would continue surfacing over time. As of Sunday, 63 mosquito breeding habitats were found and eradicated in the Aljunied-Sims Drive cluster — 37 of them in homes and 26 in common areas or other premises.

At Bedok North Avenue 3, another Zika cluster, 52 breeding habitats — 42 of which in homes and 10 in common areas or other premises — were detected and removed. No breeding habitats have been detected in the Joo Seng Road cluster so far.

Residents from Aljunied Crescent said that the authorities were doing enough to combat Zika, and acknowledged that they were more focused on avoiding being bitten than on eliminating breeding spots.

Housewife Joyce Tan, 56, said: “Some people might think that since they are living their lives normally, (the outbreak) is purely due to external factors and may not be bothered to check their homes ... just as long as they take necessary precautions such as spraying and using patches, they think they will be fine.”

Given that the area has more elderly residents, retiree George Lee, 66, said family members need to chip in to spread the message about the seriousness of the Zika virus.

Another resident, 47-year-old drafter Ooi Tai Siong, added that elderly residents may need to be told directly, and in dialect, what needed to be done, since they may not understand the content in the flyers distributed. KENNETH CHENG AND ILIYAS JUANDA


Singapore should brace for long-term battle with Zika - experts
Channel NewsAsia 5 Sep 16;

SINGAPORE: Wealthy Singapore has the funds and expertise to fight Zika, but its warm, wet climate and one of the world's most densely packed populations mean the mosquito-borne virus may be controlled but not eradicated, at least for years, infectious disease experts say.

The tropical city-state, a major global financial and transit hub, is the only known place in Asia with active Zika transmission, according to the U.S. Centres for Disease and Prevention.

So far, the virus has been detected in 189 people since the first locally transmitted infection was reported six days ago, and the areas from where they have been reported are spreading.

In his first public remarks on the outbreak, Prime Minister Lee Hsien Loong said on Thursday: "We must assume that Zika is elsewhere in Singapore."

Zika can cause serious birth defects when pregnant women are infected, a link discovered last year with the virus's arrival in Brazil, where its impact has been greatest so far. It is primarily spread by the Aedes aegypti mosquito which also carries dengue, a potentially fatal virus that Singapore authorities have been battling for decades.

Hundreds of specialist workers conduct island-wide inspections for mosquito breeding grounds, spray insecticide and clear stagnant water. Residents of homes where water is allowed to stagnate in flowerpots or elsewhere can be penalised.

Entomologists and infectious disease specialists say Singapore's experience with dengue has primed authorities to contain Zika. A healthcare system ranked by the World Health Organisation (WHO) as among the top 10 in the world is also in Singapore's favour.

Singapore, with a "very technologically advanced health system", was able to identify the disease "very early", David Heymann, chairman of the WHO's emergency committee on Zika, said on Friday. "But in other countries where it might enter at some time, that might not be the case."

But almost daily downpours, average temperatures of 30 degrees Celsius (86 degrees Fahrenheit), large green areas and a population of more than five million people packed in a city that is half the size of Los Angeles, which has a population of 4 million, make Singapore a hospitable area for mosquitoes.

"As demonstrated by the inability to eradicate dengue, the same can be said for Zika virus," Cameron Webb, a medical entomologist at the University of Sydney, told Reuters.

"This is a mosquito that is not found in the swamps, it's found in the cities. Mosquito-borne disease is something that we are going to have to manage for many years to come."

Singapore health ministry officials did not immediately respond to requests for comment on their outlook for Zika.

More than 11,000 cases of dengue have been reported in Singapore so far this year, with the authorities warning the number could exceed 30,000 by year-end, a record high. In 2013, about 22,000 cases of dengue were reported.

Wong Sin Yew, an infectious disease physician at Gleneagles Medical Centre in Singapore, said it was unclear for now whether Zika would become as widespread as dengue. "If we keep having more and more cases, and more and more areas affected, then unfortunately it would indicate the infection has become established," he said.

STRICT REGULATIONS

The pace at which the infection numbers have risen in Singapore highlights how fast Zika can spread but equally, it also shows the government's ability to detect the virus.

Such efforts, along with scientific research into possible vaccines and methods to eradicate mosquitoes, could help Singapore contain the disease, experts say.

Singapore already has strict "no breeding" regulations for outdoor areas. The health ministry, in a statement on Friday, said it will be introducing several measures to "enhance the surveillance of the disease and protection of Singaporeans". It did not give details.

"We also urge all Singaporeans to take the appropriate precautions to prevent mosquito breeding as vector control is critical in preventing transmission and reducing the risk of the virus from taking root in Singapore," the ministry added.

Even if Singapore could contain the spread of Zika, its status as an international trade and transit hub puts it at risk of further infections. More than 55 million people pass through the airport each year and tourism arrivals topped 8 million in the first half of this year.

"Even if this outbreak of Zika virus was to stop tomorrow, there is no reason why an infected traveller may not bring Zika virus back to Singapore," said entomologist Webb.

However, there are some indications that these risks could ease in the next few years.

A study published by British scientists in July said the Zika virus infecting countries in Latin America could burn itself out in two to three years, as people develop "herd immunity", which occurs when a high percentage of a population has become immune to an infection either through developing natural immunity or through vaccinations.

(Writing by Marius Zaharia; Editing by Miral Fahmy and Raju Gopalakrishnan)

- Reuters