Tuesday, August 30, 2016

MMWR: Hearing Loss In Infants With Zika Related Microcephaly


While microcephaly is the most obvious, dramatic, and medically devastating presentation of Congenital Zika Syndrome, the full spectrum of congenital defects caused by maternal infection with the Zika virus isn't yet known.  

Some are beginning to come to light (see Brazil: Expanded Spectrum of Congenital Ocular Findings in Microcephaly and BMJ: Congenital Zika Syndrome with Arthrogryposis), but other - more subtle defects - may not become obvious for months or years.

Today in an Early Release, the CDC's MMWR reports that researchers have tested 70 children with both microcephaly and evidence of Zika infection in Brazil, and found 5.8% had hearing loss without other potential cause.

Since this study only looked at microcephalic cases, it doesn't tell us much about the potential for hearing loss in children with less pronounced Zika congenital Syndrome symptoms, although researchers suspect  they too may be at elevated risk for hearing loss. 

It's a long, detailed report.  So I've only posted the Summary, and some excerpts from the discussion.  Follow the link to read it in its entirety.


What is already known about this topic?

Congenital Zika virus infection is characterized by microcephaly and other abnormalities of the brain and eye; orthopedic lesions have also been documented. While the full clinical spectrum of the syndrome is not yet known, the neurologic damage and corresponding radiologic brain imaging have been well described. Other congenital infections can cause hearing loss, which is diagnosed at birth or during later follow-up; however, few data exist regarding hearing loss associated with confirmed congenital Zika virus infection.

What is added by this study?

Congenital infection with Zika virus appears to be associated with sensorineural hearing loss. Among 70 children with microcephaly and laboratory evidence of congenital Zika virus infection, four of 69 (5.8%) were found to have sensorineural hearing loss without other potential cause.

What are the implications for public health practice?

Congenital infection with Zika virus should be considered a risk factor for hearing loss. Children with evidence of congenital Zika virus infection who have normal initial screening tests should receive regular follow-up, because onset of hearing loss associated with other congenital viral infections can be delayed and the loss can be progressive.

Hearing Loss in Infants with Microcephaly and Evidence of Congenital Zika Virus Infection — Brazil, November 2015–May 2016

Early Release / August 30, 2016 / 65

Mariana C. Leal, PhD1,2; Lilian F. Muniz, PhD2; Tamires S.A. Ferreira, MD1; Cristiane M. Santos, MD1; Luciana C. Almeida2; Vanessa Van Der Linden, MD3,4; Regina C.F. Ramos, MD5; Laura C. Rodrigues, PhD5; Silvio S. Caldas Neto, PhD2 (View author affiliations)

In this report of complete auditory function evaluation in a series of 70 children with microcephaly and laboratory evidence of congenital Zika virus infection, five (7.1%) infants had sensorineural hearing loss. The hearing loss varied in severity and laterality, which has been reported in hearing loss associated with other congenital infections (6,7).

If the one infant with bilateral profound sensorineural hearing loss who had been treated with amikacin (a known ototoxic antibiotic) before the hearing testing is excluded, the proportion of infants with sensorineural hearing loss was 5.8% (four of 69). This proportion, although lower than the 9% reported from a small sample of newborns with microcephaly associated with presumed Zika-virus infection tested by otoacoustic emissions (4), is within the range (6%–65%) reported for other congenital viral infections (6,7).

 In the majority of cases of hearing loss associated with congenital viral infection, the damage to the auditory system is within the cochlea (7). It is likely that similar lesions account for the hearing deficit in children with congenital Zika virus infection, although histologic studies are needed to confirm this. However, a concomitant central origin cannot be discounted, and behavioral auditory evaluation might provide additional information.

The findings in this report are subject to at least two limitations. First, auditory behavioral tests, in which an infant’s responses (e.g., quieting, eye-widening, or startle) to various calibrated sounds are recorded, and which can complement the hearing evaluation and provide information about processing of auditory signals, were not used.
Second, this series includes only children with microcephaly. It is possible that the full spectrum of congenital Zika virus infection includes children without microcephaly, but with auditory deficits, as occurs in congenital rubella and CMV infections, in which children born with no apparent structural anomaly can be found to have hearing loss at birth or later in life.

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Singapore: Joint MOH-NEA Update On Zika & MOH Guidance For Pregnant Women


In the four days since Singapore announced their first locally acquired Zika case we've seen a steady rise in cases, first to 41 on Sunday, then 56 yesterday, and today the number sits at 82 confirmed cases.

This rapid increase in cases appears to be the result of aggressive testing of residents in and around the areas where the first cases either lived or worked.

First, a statement from the MOH/NEA on the latest findings, followed by a link to the MOH's guidance for pregnant women.

Joint MOH-NEA statement (30 Aug) 

As of 12pm, 30 August, MOH has confirmed 26 more cases of locally transmitted Zika virus infection in Singapore. Another 111 individuals were tested negative over the last 24 hours.

17 cases live or work in the Sims Drive/ Aljunied Crescent area and five live or work in Kallang Way and Paya Lebar Way, north of Sims Drive/Aljunied. We are investigating the remaining four cases for their links to the affected area.

Vector Control & Outreach

As of 29 August, NEA has inspected about 5,000 premises out of an estimated 6,000 premises in the Aljunied Crescent/Sims Drive cluster to check for mosquito breeding, and also conducted ground checks in the vicinity. 39 breeding habitats – comprising 23 in homes and 16 in common areas/other premises - have been detected and destroyed. As of 29 August, NEA has served Notices on more than 400 inaccessible premises in the Aljunied Crescent/Sims Drive cluster to require the owners to contact NEA to arrange for an inspection, failing which NEA will proceed with forced entry. NEA has also inspected the on-site workers quarters at the construction site at Sims Drive. The Stop Work Order on the construction site at Sims Drive is still in force.

NEA officers and grassroots volunteers have completed the first round of outreach efforts in the Aljunied Crescent/Sims Drive cluster, to distribute Zika information leaflets, and we will be continuing with outreach in the areas of concern to raise general awareness of Zika, reiterate need for source reduction to prevent mosquito breeding, and advise residents to apply repellent as precaution.

NEA will be commencing vector control operations and outreach efforts in Kallang Way and Paya Lebar Way.

Advisory for Construction Sites and Dormitory Operators

In addition to inspecting homes and their common areas, NEA also inspects construction sites and engages dormitory operators. The latter plays an important role in helping to prevent and stem Zika transmission in their premises by ensuring a clean and hygienic environment. Some good practices include engaging dedicated pest control operator(s) for mosquito control, ensuring and sustaining proper housekeeping, and ensuring that all workers/residents apply insect repellent regularly.

Last updated on 30 Aug 2016

The MOH's initial guidance for Pregnant women along with an extensive Q&A section are available at:


MOH and clinical advisory group on zika and pregnancy provide guidelines for pregnant women

            The Ministry of Health (MOH) and the Clinical Advisory Group (CAG) on Zika and Pregnancy advise all pregnant women in Singapore with symptoms of Zika (fever and rash and other symptoms such as red eyes or joint pain), as well as those (with or without symptoms) with male partners who are Zika-positive, to be tested for Zika virus infection.  This is regardless of whether they have been to Zika-affected areas.

2.        Testing is not routinely recommended for other pregnant women who do not have symptoms of Zika and whose male partners are not Zika-positive.

3.        Testing for pregnant women as referred by their doctors, and who meet these criteria, is free at the public healthcare institutions. This is no different from the current practice for Zika testing for those with symptoms and who live, work or study in a Zika-affected area.

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mBio: 1st Colistin & Carbapenem Resistant E. Coli Infection In A U.S. Patient


Just over six years ago, in NDM-1: A New Acronym To Memorize, we looked at a Lancet Study by Walsh & Livermore et al., that examined the recent rise and export of an emerging antibiotic resistance gene dubbed New Delhi metallo-ß-lactamase-1 from Southeast Asia.

NDM-1 conveyed resistance to Carbapenems - drugs often used to treat difficult bacterial infections - including Escherichia coli (E. coli) and Klebsiella pneumoniae.

Of even greater concern, this NDM enzyme was carried by a plasmid – a snippet of portable DNA  - that can be easily transferred to other types of bacteria (see Study: Adaptation Of Plasmids To New Bacterial Species).

Since then, we've seen scattered variants of NDM-1 emerge around the globe, including  NDM-2, NDM-4, NDM-5, NDM-7 and NDM-9.  While ominous developments, there still remained a handful of drugs - most notably Colistin - available to treat these infections.

But last November the bad news broke (see MCR-1: The Return Of The Plasmids) of the discovery of another resistance gene in China - dubbed mcr-1 - that conveys resistance to Colistin.

The saving grace - at least at that time - was the initial samples with the MCR-1 resistance gene were still susceptible to Carbapenems, meaning they could still be treated.

The concern was that should  E. Coli, or CRE, pick up both resistance genes, we could find ourselves dealing with a nearly pan-drug resistant organism.

And in March of this year, in The Lancet's Emergence of the mcr-1 colistin resistance gene in carbapenem-resistant Enterobacteriaceae, we saw exactly that out of China; a report on two K pneumoniae isolates that carried the MCR-1 gene and the gene for NDM-5, providing it near pandrug resistance.

In May, we saw the CDC Statement On 1st MCR-1 Colistin Resistant Infection in U.S., - which, while still treatable with Carbapenems - sparked increased testing on new (and archived) samples looking for other cases.

Although it has been telegraphed in the media for the past 24 hours, today the open-access journal mBio has published the account of the first detection of a Colistin-Carbapenem resistant organism in the United States.
  • The good news, is while resistant to Colistin and Carbapenums, this E. coli bacteria was still susceptible to a small handful of drugs. 
  • The bad news, this sample was collected in 2014 - meaning it has been in this country at least two years, and likely more widespread than we know. 

The full report is available online, but below you'll find the abstract and summary.

Colistin- and Carbapenem-Resistant Escherichia coli Harboring mcr-1 and blaNDM-5, Causing a Complicated Urinary Tract Infection in a Patient from the United States

José R. Mediavillaa, Amee Patrawallab, Liang Chena, Kalyan D. Chavdaa, Barun Mathemac, Christopher Vinnarda, Lisa L. Deverd, Barry N. Kreiswirtha


Colistin is increasingly used as an antibiotic of last resort for the treatment of carbapenem-resistant Gram-negative infections. The plasmid-borne colistin resistance gene mcr-1 was initially identified in animal and clinical samples from China and subsequently reported worldwide, including in the United States.
Of particular concern is the spread of mcr-1 into carbapenem-resistant bacteria, thereby creating strains that approach pan-resistance. While several reports of mcr-1 have involved carbapenem-resistant strains, no such isolates have been described in the United States.
Here, we report the isolation and identification of an Escherichia coli strain harboring both mcr-1 and carbapenemase gene blaNDM-5 from a urine sample in a patient without recent travel outside the United States. The isolate exhibited resistance to both colistin and carbapenems, but was susceptible to amikacin, aztreonam, gentamicin, nitrofurantoin, tigecycline, and trimethoprim-sulfamethoxazole.
The mcr-1- and blaNDM-5-harboring plasmids were completely sequenced and shown to be highly similar to plasmids previously reported from China. The strain in this report was first isolated in August 2014, highlighting an earlier presence of mcr-1 within the United States than previously recognized.


Colistin has become the last line of defense for the treatment of infections caused by Gram-negative bacteria resistant to multiple classes of antibiotics, in particular carbapenem-resistant Enterobacteriaceae (CRE). Resistance to colistin, encoded by the plasmid-borne gene mcr-1, was first identified in animal and clinical samples from China in November 2015 and has subsequently been reported from numerous other countries.
In April 2016, mcr-1 was identified in a carbapenem-susceptible Escherichia coli strain from a clinical sample in the United States, followed by a second report from a carbapenem-susceptible E. coli strain originally isolated in May 2015. We report the isolation and identification of an E. coli strain harboring both colistin (mcr-1) and carbapenem (blaNDM-5) resistance genes, originally isolated in August 2014 from urine of a patient with recurrent urinary tract infections.
To our knowledge, this is the first report in the United States of a clinical bacterial isolate with both colistin and carbapenem resistance, highlighting the importance of active surveillance efforts for colistin- and carbapenem-resistant organisms.
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While detections of these dual-resistant organisms are still  exceedingly rare, this is the kind of nightmare resistance combination that could someday propel us into a post-antibiotic era, one where even minor infections are no longer treatable.

Lest anyone think this hyperbole, that is the exact phrase used by WHO Director General Chan more than 4 years ago (see Chan: World Faces A `Post-Antibiotic Era’).

For more on this newest antimicrobial threat - MCR-1 - you may wish to revisit:

Eurosurveillance Editorial: Plasmid-Mediated Colistin Resistance (MCR-1 gene):The Story Unfolds

The Lancet: Dissemination Of The MCR-1 Colistin Resistance Gene 

Monday, August 29, 2016

Yunnan Province Reports An H9N2 Infection

Yunnan Province - Credit Wikipedia


Between 1998 and 2014, the World Health Organization reported only 18 human H9N2 cases worldwide.  In 2015, that number jumped by 9, and so far in 2016, we've seen 5 more (see FluTracker's List).

Whether this sudden increase is due to better testing and reporting (a distinct possibility), or due to a change in the virus (also possible), is unknown. 

Whatever the cause, for the second time in a week (see last week's Guangdong Province Reports A Human Infection With H9N2), China is reporting a new H9N2 infection.

Yunnan found a case of H9N2 confirmed cases
Release Date: 2016-08-26 

Yunnan Provincial Health and Family Planning Commission August 26 briefing: Yunnan Provincial Health and Family Planning Commission after entering the flu and other respiratory diseases in spring and summer high season, stepped up surveillance of influenza, such as pneumonia of unknown causes.  
In monitoring, from one case of influenza-like illness were detected H9N2 avian influenza virus nucleic acid positive. August 25, Chinese Center for Disease Control and Prevention for further review of test results for influenza A H9N2 avian influenza virus nucleic acid positive. Expert consultation, clinical manifestations of cases, the results of laboratory tests and epidemiological history, diagnosis in this case as H9N2 cases. Children, male, 10 months old, now living in Mengzi City. Currently children have been cured, all close contacts without exception.
Experts believe judgments, of H9N2 virus is a subtype of influenza A virus, the source of the virus is poultry in bird flu more common for people is a low pathogenic virus. The case report of sporadic cases, the risk of transmission is very low, the situation does not appear human to human transmission.

H9N2 infections in humans - while still rarely reported - are almost certainly more common than we know, primarily because surveillance in humans is very limited in the regions where it circulates.

A 2014 seroprevalence study, however, found antibodies against H9N2 ranged from 5.9% to 7.5% among poultry exposed individuals in Egypt. 

On the positive side, H9N2 infection in humans has generally been mild, and no human-to-human spread has been detected.  H9N2 does reassort readily with other viruses, and has been picking up mammalian adaptations in recent years.

While the H9N2 virus may have some limited pandemic potential on its own accord, the bigger danger is that it could acquire more `mammalian' adaptations, and then share those (via reassortment) with other, more pathogenic, viruses.


Russia Gears Up To Fight Flu


While North America and parts of Western Europe enjoyed an unusually mild 2015-16 flu season, the same cannot be said for Russia and large swaths of Eastern Europe, which reported unusually high influenza morbidity and mortality for five weeks starting in early January.

In early February, Rospotrebnadzor - the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing - described the epidemic as `still rising', and they reported 11,470 schools, 2,298 kindergartens, 578 colleges,72 universities completely closed due to the epidemic. 

The Russian media was filled with stories of a `mutated' virus, which public health officials were quick to deny were behind the increased severity, stating:

The genomes examined to date strains indeed several mutations have been identified, but they are not associated with high pathogenicity, and are probably the result of conventional genetic drift.

Although some of the reports coming out of Russia were confused and incomplete (see Updating Russia's Flu Outbreak) they were concerning enough that on February 8th we saw the release of an ECDC Risk Assessment : Reports Of Severe A(H1N1)pdm09 In Europe, which warned:

There are strong indications from some EU/EEA countries that the A(H1N1)pdm09 virus is responsible for the hospitalisation of a large number of severe cases. This includes hospitalisations for severe outcomes for both risk groups and otherwise healthy young adults. A similar pattern of severity is likely to be observed in other countries as the season progresses.

Despite the ECDC warning, and a HAN advisory for severe flu expected in the United States, Western Europe and North America managed to avoid a severe flu season.   

Hoping to avoid another crippling influenza epidemic, this year Russian public health officials began a highly publicized flu vaccination drive in Mid-August, with almost-daily reminders appearing in the Russian press.

For the very first time - starting September 5th, and running through November 1st - free flu vaccines will be offered at Moscow Metro stations, in an an ambitious attempt to vaccinate 5 million Muscovites.

Muscovites will be free to make the flu shot in subway stations

MOSCOW, Aug. 22 -. RIA Novosti Capital Federal Service in conjunction with the Department of Health in Moscow and the Moscow Metro for the first time to hold a campaign of vaccination against influenza subway passengers, the press service of Rospotrebnadzor.

"Vaccination will be carried out in mobile vaccination points at Moscow metro stations The event is designed, primarily, to the employees working Muscovites.", - Said in a statement.

The mobile units of the capital residents will be able to apply from 5 September to 1 November from 8.00 to 20.00. In "Grippol plus" will be used as a vaccine.

Before citizens will be vaccinated, the doctor will examine each. All vaccinated against influenza will be issued a certificate prescribed form. In order to obtain this certificate, residents of the capital have to be in possession of an identity document, and the policy of obligatory medical insurance.

Vaccination is free.

List of metro stations, where they will be vaccinated, will be placed on the websites of Rospotrebnadzor in Moscow control of the capital city of Moscow Health Department and the Moscow subway and on the electronic scoreboard in the subway cars.

Now, according to the release, the situation on the incidence of influenza and SARS in Moscow is stable. Since August 25, in the capital will start vaccination campaign against influenza. During vaccination plan to inoculate more than 5 million people, which is 700 thousand more than the previous season.

While last year's flu season tells us very little about how the next flu season will play out, given last year's bad experience, the Russian government seems anxious to blunt this year's impact as much as they can.

Sunday, August 28, 2016

Singapore Confirms Local Zika Transmission: Finds 41 Cases


Only 24 hours ago Singapore's MOH announced their 1st Locally Acquired Zika Case, and today we learn they have now identified at least 41 locally acquired cases, 7 of which are still symptomatic and have been hospitalized to prevent forward transmission.

Given Singapore's population density (#3rd in the world with nearly 8,000 per sq. km), it's location just 1 degree north of the equator, and an ample supply of  Aedes mosquitoes, the Zika virus appears to has a lot going in its favor.

Working in vector control's favor - June, July, and August are the driest months of the year in Singapore - and the true `rainy season' doesn't begin until November.

Also, although it was planned months ago to help with the suppression of Dengue, yesterday Singapore's National Environment Agency (NEAannounced plans to Conduct Wolbachia-Aedes Small-Scale Field Study At Three Selected Sites From October 2016.

You may recall we looked at the potential uses for Wolbachia infected mosquitoes in the fight against Zika last May in Cell Host & Microbe: Wolbachia Blocks Zika Virus In Brazilian Aedes Aegypti Mosquitoes.

Here is the full MOH announcement on 40 additional locally acquired Zika cases, including their expectation that more will be detected.

Localised Community Spread Of Zika Virus Infection With More Cases Confirmed

    News Highlights

       The Ministry of Health (MOH) has confirmed 41 cases of locally transmitted Zika virus infection in Singapore. Of these cases, 36 were identified through active testing of potentially infected persons.

Aljunied Crescent/ Sims Drive Cluster

2.    All the cases are residents or workers in the Aljunied Crescent/ Sims Drive area.  They are not known to have travelled to Zika-affected areas recently, and are thus likely to have been infected in Singapore. This confirms that local transmission of Zika virus infection has taken place.  At this point, the community transmission appears to be localised within the Aljunied Crescent/ Sims Drive cluster.

3.    34 have fully recovered. The other 7, who are still symptomatic and potentially infectious, are recovering at Tan Tock Seng Hospital.

4.    The profile of the 41 cases are as follows:

    A 47-year-old female Malaysian had developed fever, rash and conjunctivitis from 25 August. She was referred to the Communicable Diseases Centre (CDC) at Tan Tock Seng Hospital, where she was tested positive for Zika on 27 August. She has since been hospitalised for observation at the CDC.
    A Singaporean father and his son who reside at Block 62 Sims Drive. The former is a 65 year-old retiree, while his son is a 21 year-old full time National Serviceman who is doing his National Service at Khatib Camp. They developed symptoms of fever and rash from 23 August and 21 August respectively and were warded at CDC on 27 August.
    A 30 year-old male Singaporean who works at a construction site at 60 Sims Drive and lives at Sembawang Drive. He developed fever and rash since 22 August and was warded at CDC on 27 August.
    A 44-year-old unemployed male Singaporean who lives at Block 54 Sims Drive. He developed symptoms on 23 August and is currently warded at CDC.
    36 foreign workers were tested positive, of which 7 are warded at the CDC. They were among the 118 persons working at the construction site at 60 Sims Drive who were tested[1]. The other 29 who tested positive have fully recovered.

Other Areas of Concern

5.    Given that the Zika virus is spread by the Aedes mosquito vector, MOH cannot rule out further community transmission in Singapore, since some of those tested positive also live or work in other parts of Singapore. At this point, these other areas of concern include Khatib Camp, Sembawang Drive and places where the construction workers live (Kranji Road, Joo Chiat Place, Senoko South Road, Toh Guan Road East and Lor 101 Changi).

Ongoing Screening and Testing

6.    MOH will continue to screen the close contacts of confirmed cases. MOH is also carrying out Zika testing on others living and working in the Aljunied Crescent/ Sims Drive area and other areas of concern who have symptoms of fever and rash.  In particular, MOH has worked with the contractors at a construction site at Sims Drive to screen the workers there who were recently reported by a general practitioner (GP) to have symptoms of fever, rash and conjunctivitis. We have verified with Khatib Camp that there were no symptomatic cases to date.

7.    MOH has also alerted all GPs, polyclinics and hospitals to be extra vigilant and to immediately report patients with symptoms associated with Zika virus infection to MOH.  

Current Assessment

8.    We expect to identify more positive cases. Given that the majority of Zika cases are asymptomatic or mildly symptomatic, and mosquitoes in the affected areas may already have been infected, isolation of positive cases may have limited effect to managing the spread. We should focus our efforts on vector control.

Vector Control

9.    Since receiving notification from MOH on 27 August, NEA has intensified vector control operations to control the Aedes mosquito population in the vicinity of Aljunied Crescent/ Sims Drive. NEA has deployed more than 200 officers to inspect the area and conduct outreach to residents and other stakeholders in the vicinity. NEA’s intensified vector control operations include:

    Inspecting all premises, ground and congregation areas
    Conducting mandatory treatment such as ultra-low volume (ULV) misting/spraying of premises and thermal fogging of outdoor areas to kill adult mosquitoes
    Increasing frequency of drain flushing and oiling to prevent breeding
    Public education outreach and distribution of insect repellents

10.    On 27 August, NEA accessed more than 1,800 premises out of an estimated 6,000 premises to check for mosquito breeding, and also conducted ground checks in the vicinity. 19 breeding habitats -  comprising 13 in homes and 6 in common areas, were detected and destroyed

11.    On 27 August, NEA also followed up on an earlier inspection on 24 August at the construction site at Sims Drive to re-inspect the site and conduct misting and thermal fogging. A Stop Work Order was issued to the construction site on 27 August, as the housekeeping of the construction site was found to be unsatisfactory with potential breeding habitats favourable to mosquito breeding. The construction site is required to rectify these conditions and step up preventive measures to prevent recurrence of mosquito breeding.

12.    The on-site workers quarters at the construction site and two other dormitories at Senoko South and Kranji were also inspected on 27 August.  One breeding was detected and destroyed at the dormitory at Kranji.  NEA is conducting vector control operations at the remaining dormitories and the vicinity of Sembawang Drive today.

13.    NEA officers and grassroots volunteers also conducted outreach in 14 blocks of flats in the vicinity of Aljunied Crescent and Sims Drive, to distribute Zika information leaflets and insect repellents on 27 August. We completed outreach to the remaining blocks in the vicinity on 28 August. NEA will similarly be conducting outreach in the Sembawang Drive residential area.

14.    As the majority of people infected with the virus do not show symptoms, it is likely that some transmission may already have taken place before these cases of Zika were confirmed. Hence, even as NEA conducts operations to contain the transmission of the Zika virus, residents are urged to cooperate fully with NEA and allow its officers to inspect their premises for mosquito breeding and to spray insecticide to kill any mosquitoes. NEA may need to gain entry into inaccessible premises by force after serving of requisite Notices, to ensure any breeding habitats are destroyed quickly. 

15.    To minimise the risk of further spread of Zika in Singapore, it is critical that all of us as a community take immediate steps to prevent mosquito breeding in our homes by doing the 5-step Mozzie Wipeout   and protect ourselves from mosquito bites by applying insect repellent regularly.

Health Advisory

16.    We advise those living or working in the affected area of Aljunied Crescent/ Sims Drive and the other areas of concern, especially pregnant women, to monitor their health. They should seek medical attention if they are unwell, especially with symptoms of fever and rash. They should also inform their doctors of the location of their residence and workplace.

17.    Zika is generally a mild disease and many people infected with the Zika virus do not even develop symptoms. Like dengue, it is transmitted by the bite of an infected Aedes mosquito.

18.    Zika virus infection can however cause microcephaly in the unborn foetuses of pregnant mkwomen. Pregnant women should adopt strict mosquitoes precaution if travelling to an affected area. Individuals working, studying or living in an affected area who are sexual partners of pregnant women should adopt safe sexual practices (e.g. consistent and correct use of condoms during sex) or consider abstinence throughout the women’s pregnancy.

19.    MOH will provide updates on any further developments and our latest public health risk assessments. Singaporeans should refer to MOH’s webpage on Zika (www.moh.gov.sg/zika) for the latest health advisory.

[1] Of those tested, 78 were negative. 4 results are pending.

Last updated on 28 Aug 2016