41 Local Zika Cases Reported In Singapore

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41 confirmed cases of Zika in Aljunied

A day after confirming the first locally transmitted case of Zika, the Ministry of Health (MOH) revealed that 40 more patients have been confirmed in the Aljunied Crescent-Sims Drive area, through the tracing of past cases.

29 Aug 2016

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Aedes Mosquito
Intensified operations to control mosquito breeding, which began on Saturday, will continue in Aljunied Crescent and Sims Drive over the next two weeks.

These operations include inspecting all premises, ground and congregation areas, ultra-low volume (ULV) misting and spraying of premises and thermal fogging of outdoor areas, more frequent drain flushing and oiling to prevent breeding, and public outreach and distribution of insect repellent.

They will also be carried out in “areas of concern” flagged by the authorities, namely Khatib Camp, Sembawang Drive, Kranji Road, Joo Chiat Place, Senoko South Road, Toh Guan Road East and Lorong 101 Changi.

Yesterday, the Ministry of Health (MOH) revealed that there were 41 confirmed Zika cases in the Aljunied Crescent and Sims Drive area — the first cases of local transmission here. The area includes a construction site at Sims Drive and dormitories and workers’ quarters.

In total, the National Environment Agency’s (NEA) operations and checks are set to cover more than 6,000 premises including 5,000 HDB flats and workers’ quarters.

More than 200 NEA officers were deployed on Saturday to inspect the area, conduct vector control, as well as to reach out to residents. The NEA said it has successfully accessed more than 1,800 premises to carry out checks for mosquito breeding.

Nineteen breeding habitats were detected and destroyed, of which 13 were in homes and six in common areas. Of the two dormitories in Kranji and Senoko South that were inspected, one breeding site was detected in Kranji. A stop work order was also issued to the construction site at Sims Drive on Saturday, for creating conditions for mosquito breeding.

The NEA said its staff had visited 14 blocks in the vicinity of Aljunied Crescent and Sims Drive, distributed Zika information leaflets and insect repellent, and continued to reach out to the rest of the blocks in the area yesterday. NEA staff started visiting residents in Sembawang Drive yesterday evening.

From as early as 9am yesterday, the typically sleepy residential estate of Aljunied Crescent was abuzz with a flurry of activity, as officers conducted fogging and misting operations, checked drains, and knocked on residents’ doors to hand out flyers and bottles of insect repellent.

Senior Minister of State for Health and Ministry of Environment and Water Resources Dr Amy Khor, who was distributing flyers to residents in the Sims Drive area, said that residents so far had been “cooperative” and were willing to open up their homes for officers to check for potential mosquito breeding areas and let their premises be misted. Homeowners who were not in will find letters left for them instructing them to make future appointments.

When asked if the ministry would expand efforts islandwide, Dr Khor would only say that the priority is to reduce the size of the Aedes mosquito population. “Residents should play their role in helping to control the population by taking steps like the five-step mozzie wipeout, checking their homes are free of mosquito breeding sites and being vigilant by informing a doctor of potential symptoms, as well as (sharing) their travel history, especially if they have been to areas affected by Zika.”

Speaking to reporters after a media briefing on the spate of cases yesterday, Health Minister Gan Kim Yong said that vector control efforts need to be “redoubled”, to reduce mosquito breeding sites and minimise the risk of transmission.

“I think this is an effort that must be sustained, and we must continue to do so. It’s not easy to achieve good results, partly because of weather conditions in the tropical area, which is very conducive for mosquitoes to breed. Therefore, we need to re-double our efforts in managing our vector control,” he said.

In a joint statement, the MOH and the NEA advised those working or living in the Aljunied Crescent and Sims Drive area, especially pregnant women, to monitor their health.

They should seek medical attention especially if they have symptoms of fever and rash, and inform their doctors of the location of their homes and workplaces.

Pregnant women are especially susceptible as Zika, which is transmitted by the bite of an infected Aedes mosquito, can cause microcephaly, a birth defect where the head of the infant is abnormally small, in their unborn foetuses. - See more at: https://www.gov.sg/news/content/today-online-41-confirmed-cases-of-zika-in-aljunied#sthash.AgoXPha5.dpuf

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Channel NewsAsia - Locally transmitted Zika cases: A timeline

There have been 41 cases of locally transmitted Zika virus infections in Singapore.

29 Aug 2016

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HDB7 mockup
There have been 41 cases of locally transmitted Zika virus infections in Singapore, with the transmisson likely to be localised within the Aljunied Crescent-Sims Drive area, say authorities.

Health Minister Gan Kim Yong confirmed on Sunday (Aug 28) that it was the report of the first locally transmitted case that prompted the Ministry of Health (MOH) to look back into past cases “where people were seen by doctors but were not suspected to have Zika”.

In a press briefing, officials from MOH and the National Environment Agency (NEA) said that fresh blood and urine tests conducted on some of these individuals picked up the Zika virus, which can be detected “up to a month” after recovery. Based on these tests, the earliest case of locally transmitted Zika infection is likely to have occurred on Jul 31, according to MOH.

TRANSMISSIBILITY OF ZIKA VIRUS

According to MOH, Zika is a generally a “mild” illness, with four in five people not showing symptoms. For the one in five who develop symptoms, it causes a viral fever with skin rashes, body aches and headache. Mild or asymptomatic cases may still transmit the infection.

Patients are usually not infectious after the fifth day after developing symptoms, as the transmissibility period is between three and five days, said Professor Leo Yee Sin, Senior Consultant of the Communicable Disease Centre (CDC) at Tan Tock Seng Hospital.

TIMELINE OF EVENTS

Aug 22: A clinic in the Aljunied area, Sims Drive Medical Clinic, informed MOH of an unusual increase in cases with fever, rash and joint pains. Cases were mild.

Aug 23: MOH visited the clinic and discussed the cases with the GP. The initial hypothesis was a cluster of mild viral illness transmitted from person to person. MOH then made arrangements for the clinic to refer new cases to the CDC for further testing and to start tracing past cases for review, and testing if appropriate. The ministry also communicated with nearby clinics and construction sites to increase vigilance and report cases to them.

Aug 25: MOH approached the contractor of a nearby construction site for records of workers with fever. At the same time, a 47-year-old Malaysian woman, who is the first reported locally transmitted case, developed fever, rash, and conjunctivitis.

Aug 26: The woman, the only female among all 41 cases to date, visited the same GP and was referred to the CDC.

Aug 27: The woman was confirmed by the CDC to have the Zika virus infection. She was warded. As she was assessed to have been infected in Singapore, NEA was notified and they commenced vector control (anti-mosquito breeding) operations. Members of the woman's household were screened. Tests were conducted on 123 people who were recently or currently symptomatic. This includes 118 construction workers of the nearby construction site. 

Aug 28: MOH and NEA hold a press briefing during which it is announced that 41 locally transmitted Zika cases have been identified, with 34 patients making a full recovery. The remaining seven are recovering in hospital. The authorities say more cases are likely. - See more at: https://www.gov.sg/news/content/channel-newsasia-locally-transmitted-zika-cases-a-timeline#sthash.9gM0FFhd.dpuf

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Why the MOH did not announce the Zika cases earlier

MOH explains why.

29 Aug 2016

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Q) When was the earliest case that Ministry of Health backtracked to?

Dr Derrick Heng (MOH Group Director for Public Health Group): The (earliest) case that we know of was July 31. We would not have picked up on all the cases, (so) we would not be able to pinpoint definitively the first index case (patient zero).

Mr Koh Peng Keng (MOH Group Director, Operations): The first case we knew of was patient A (the 47-year-old Malaysian woman whose case was reported on Saturday). The rest of it we had to work with the GPs, to do a lot of tracking to try and look back.

Dr Heng: We went back to look at people who were part of the GP (cases), and (at the) construction site, the people who had reported symptoms in the past. We took samples...the samples (tested) positive sometime late last night (on Saturday).

Mr Koh: The GP alerted us of this unusual cluster of cases with mild symptoms, it’s only (then) we went back to check....most of them had already recovered. So it was a look back...Initial hypothesis was that it was just some mild viral infection that transmits from person to person. Zika was not specifically suspected at that point when the GP was seeing this group.

Q) Saturday was confirmation that the woman (patient A) had Zika. But you had preliminary results, did you start looking before Saturday, or did you only start work on Saturday when you had confirmed results?

Dr Heng: We started preparations when the preliminary results (came out). But we had to wait for confirmation in order not to create false alarm.

Q) Patient A was at CDC on Aug 25, and it takes about three hours to do the test. So you should have known by that night.

Professor Leo Yee Sin (clinical director of Communicable Disease Centre): Her presence at CDC from the time we received her as a case, to the time she did the blood test, all this is actually a very compressed period of time, including getting her back for further assessment.

Q) The first case was announced on Saturday, and it jumped to 41 cases. Could the MOH have announced all these cases earlier?

Health Minister Gan Kim Yong: Part of the reason that we have discovered more cases is because we have now gone back to the cases that were seen before by doctors. They were not suspected to have Zika, because they have no travel history and so on. Now that we know there is a case ...we’ve therefore gone back to all these cases that were surfaced before, and checked their blood tests, and that’s why we have discovered more cases, as a result of the first case. So out of the 41 cases, I think some 36 cases were a result of this active testing of the patients who were in the areas of concern, whom we felt there was the potential they would be infected by Zika. Then we went back to relook at their test results. Some were even retested to determine whether they were infected by Zika.

Q) Why did it take two days before the MOH announced patient A’s case?

Mr Gan: Some required double confirmation. So first we tested them on the urine test...various steps of testing.

Q) So it’s not like you knew about it earlier, but was keeping quiet about it?

Mr Gan: No, of course not.

Source: TODAY Online - See more at: https://www.gov.sg/news/content/today-online-why-the-moh-did-not-announce-the-zika-cases-earlier#sthash.48IMgP2m.dpuf