Zika Virus Singapore updates

Update Jan 29th 2016: Zika virus is spreading explosively says World Health Organization today. According to a WHO scientist there may be 3 to 4 million cases in Latin America in the next year.

Update Jan 28th 2016 : Pregnant women are urged to not travel to Latin American and Caribbean countries where zika virus is spreading fast. This warning also includes women who plans to become pregnant.

The virus is linked to microcephaly, a rare and brutal condition that shrinks the brains and skulls of the newborns. Babies with microcephaly have an abnormally small brain and skull for their age, in the womb or at birth, with varying degrees of brain damage as a result. It has many potential causes: infections, viruses, toxins or unknown genetic factors.

Right now the list includes Barbados, Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Saint Martin, Suriname, and Venezuela. Here is the update list of countries with zika virus outbreak : Zika Travel Information.

If you're pregnant or thinking of getting pregnant, avoid traveling to places where the virus is circulating (Source : Vox)

Zika virus, a virus related to dengue, yellow fever, Japanese encephalitis, and West Nile viruses, has been a major public health concern since the possible link between the Zika virus infection in pregnancy and microcephaly in fetuses and new borns. Although zika–microcephaly link is not scientifically proven yet, most experts agree that it is highly likely that there is a link. Microcephaly is defined as abnormal smallness of the head and is a congenital condition associated with incomplete brain development. Zika–Microcephaly link came to light when the microcephaly cases jumped to thousands compare to a few hundred in previous years.

Before zika–microcephaly link was put forward, zika virus was not a concern at all because in adults, the virus causes mostly no symptoms or symptoms are mild.

What makes Singapore vulnerable is the aedes mosquito population here. This is the same mosquito responsible for the transmission of the dengue virus. Zika virus scare came at a time when 2016 aedes mosquito population and dengue fever cases exploded due to warmer than usual rainy season. The Ministry of Health and National Environment Agency (NEA) of Singapore is now introducing measures to guard against the Zika virus taking hold in Singapore.

Currently there is no detected cases in Singapore but the passenger traffic between the effected countries is large and Zika virus is already detected in many tourists returning from Latin America to Europe. It doesn't help that in South-east Asia, some zika cases have been detected in Cambodia, Indonesia, the Philippines, East Malaysia and Thailand in recent years.

Females of Aedes aegypti a.k.a  yellow fever mosquito is the principal vector for dengue fever. Aedes mosquitos are also vectors for zika virus.

Once established, zika virus would be very difficult to eradicate from an area since aedes mosquito is constantly present here. NEA says "There is a high risk of subsequent local transmission, as the Aedes mosquito vector is present here. As such, the virus may become endemic in Singapore".

Singapore authorities have advised returning travellers from affected areas to seek medical attention if they develop symptoms of Zika such as fever, skin rash, joint and muscle pain, headache and red eyes. But 80% of the adults with the virus shows no symptoms at all, so it will be a difficult task to isolate the infected people. 

Dengue in Singapore

Warm weather conditions have caused significant increase in dengue cases in Singapore in January 2016. In the week ending 16 January 2016, 628 dengue cases were reported which is higher than the cases in the same week in 2013 (last major outbreak in Singapore was 2013 dengue outbreak).

Warmer weather conditions are causing faster breeding and maturing cycle for aedes mosquitoes and there is thus an increase in the mosquito population.

What is Dengue Fever?

 Dengue Fever and Dengue Haemorrhagic Fever (a more severe form) is an illness caused by infection with a virus transmitted by the Aedes mosquito. There are four serotypes of this virus (DEN-1, DEN-2, DEN-3 and DEN-4) which can infect you.

There is currently no drug for dengue but there is an intense effort to develop a dengue vaccine. Most cases follow a classic, non-fatal virus infection but in a small proportion of the cases, the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure occurs.

Aedes aegypti a.k.a  yellow fever mosquito

Dengue is transmitted by several species of mosquito within the genus Aedes, principally Aedes aegypti. The mosquito can be recognized by white markings on its legs and a marking in the form of a lyre on the upper surface of the thorax (see below image). Also follow the link if you want to check out how does aedes mosquito looks like.

Females of Aedes aegypti a.k.a  yellow fever mosquito is the principal vector for dengue fever.

Active Dengue Clusters in Singapore

Singapore government hangs these big banners with red, green and yellow dots in dengue clusters *(see color coded dengue alert system) but these are easy to miss. Checking active dengue clusters in Singapore in National Environment Agency's Dengue page can help you to do simple plans to reduce your chance to have dengue. Today for example, I have realized that my workplace, my house and my kid's kindergarden are all just next to active dengue clusters only after checking the active dengue clusters web page. This means no outside park play around my house and kindergarden as well as using bus instead of walking from work to MRT.  

2013 Dengue outbrake in Singapore

Dengue fever outbreak of 2013 in Singapore claimed a second life. A 60-year-old Singaporean Chinese man hwho lived in Ang Mo Kio Avenue 3 has passed away on 9 June 2013. Here is the joint joint statement by the Ministry of Health and National Environment Agency:

The Ministry of Health (MOH) and the National Environment Agency (NEA) have been notified of the death of a dengue patient who lived at Ang Mo Kio Avenue 3. This is the second dengue death case this year.

The patient was a 60-year-old Singaporean Chinese male. He went to Tan Tock Seng (TTSH) emergency department (ED) on 5 June 2013 with fever, shortness of breath, vomiting and rash on his left leg. He was diagnosed with skin inflammation of the left leg and prescribed with antibiotics. He was also given an appointment to return to the polyclinic for a repeat blood test. 

The patient returned to TTSH ED on 7 June 2013 with difficulty in standing due to weakness in his left leg, as well as continuing fever and loss of appetite. He was admitted to the general ward and tested positive for dengue on 8 June 2013. Subsequently, his condition deteriorated and he was transferred to the Intensive Care Unit on 8 June 2013. The patient passed away on 9 June 2013. 

 NEA has stepped up its vector control operations to destroy any potential breeding sites at the vicinity of the case’s residence (Ang Mo Kio Avenue 3). Residents should cooperate fully with the NEA inspectors conducting ground operations. Although it is a non-cluster area, residents should remain vigilant and protect themselves with repellent and clear any stagnant water in their homes and vicinity. 

MOH and NEA wish to express our deepest condolences to the family of the deceased patient. We strongly encourage all Singaporeans to take appropriate precautions to prevent mosquito breeding by doing the Mozzie Wipeout weekly. More details on this can be found at www.dengue.gov.sg. Everyone needs to play their part and be socially responsible to stop the chain of transmission in the community. Persons who suspect they may have dengue should consult their doctors as early as possible and use mosquito repellents in order to reduce the risk of spreading the infection further.

Source : Second Dengue Death Case In Singapore

Back in In the 2005 a dengue outbreak in Singapore has become country's worst health crisis since the 2003 SARS epidemic and 13,984 dengue cases were reported with 19 deaths.In October 2005, there were signs that the dengue fever outbreak had peaked, as the number of weekly cases had declined and the outbreak of this infectious disease declined by the end of 2005.

Symptoms of Dengue fever - Source : Wikipedia

The dengue fever outbreak is not a problem unique to Singapore. By early 2013, Brazil was hit by dengue outbreak where in the first seven weeks of 2013 the number of cases reached 204,640 and there have been 33 dengue-related deaths in Brazil in the same period. The government of Paraguay declared a 60-day state of emergency on March 1 due to a rapid increase of dengue fever cases where there were 14,654 and 10 deaths as of March 1. In just 22 days, the situation gone worse and 35 people have died in Paraguay after contracting dengue fever, as almost 70,000 has been infected. As of March 2013:

In Peru, nearly 400 cases have been reported so far this year; two of them were fatal. Brazil has reported 53,146 dengue fever cases this year, with 300,000 cases in 2006. Mexico reported 22,810 dengue cases in 2006, an increase from 17,487 in 2005. Argentina reported 13 cases of dengue fever in the Formosa province, located north of Buenos Aires, which borders Paraguay. There were 397 suspected cases in Bolivia as of Feb. 7, up from 270 cases reported on Feb. 2. The majority of the cases were reported in Santa Cruz and Montero. Panama reported two fatalities due to hemorrhagic dengue fever in December 2006.