Zika

 

Zika virus infection in humans has been reported since the 1950s. It is transmitted by the Aedes mosquito, identical to dengue. Only about one in five infections are symptomatic. Zika is generally a mild and self-limiting illness. Although rare, serious neurological complications have been reported. There is no vaccine or specific anti-viral drugs.

For the latest updates on global Zika Virus transmissions, please refer to the European Centre for Disease Prevention and Control  website.

FAQs about Zika

Zika in Singapore

On 28 August 2016, MOH confirmed localised community spread of Zika Virus Infection in Singapore. 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. As such, vector control remains the mainstay in reducing the spread of Zika.

For the latest Zika situation in Singapore, please refer to www.nea.gov.sg/zika

For more information on Zika clusters, visit www.nea.gov.sg/zika-clusters.

FAQs on Zika in Singapore

Symptoms

Most people infected with the Zika virus do not develop symptoms. Otherwise, they usually develop within 3 to 12 days after the mosquito bite and are similar to those of dengue and chikungunya. Symptoms include:

  • Fever
  • Rashes
  • Joint pains, muscle pain, headache
  • Conjunctivitis (red eyes)

Symptoms often last between 4 to 7 days.

Zika and Pregnancy 

While there is currently no evidence that pregnant women are more likely to get Zika virus infection, the consequences can be more serious if a pregnant woman is infected, as the Zika virus infection can cause microcephaly in a small number of unborn foetus of pregnant women.

Pregnant women with symptoms of possible Zika virus infection (fever and rash and other symptoms such as red eyes or joint pain) should seek medical attention immediately, and consult their Obstetrics and Gynecology (O&G) doctor.

Pregnant women will remain a special group to whom we will make Zika tests more affordable and accessible. Doctors will continue to make the clinical judgment whether testing of Zika is necessary, and for those who have Zika symptoms or whose male partner is Zika-positive, the 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.

Men who are confirmed positive for Zika should practise safer sex through the correct and consistent use of condoms or abstain from sexual intercourse for at least six months after recovery.

A pregnant patient with confirmed Zika infection will be arranged for admission to a public hospital with a referral to an O&G doctor for further management.

FAQs on Zika and Pregnancy

Health Advisory 

Zika is generally a mild disease. It may cause a viral fever similar to dengue or chikungunya, with fever, skin rashes, body aches, and headache. But many people infected with the Zika virus infection do not even develop symptoms.

Pregnant women with symptoms of possible Zika virus infection (fever and rash and other symptoms such as red eyes or joint pain) should seek medical attention immediately, and consult their Obstetrics and Gynecology (O&G) doctor.

Men who are confirmed positive for Zika should practise safer sex through the correct and consistent use of condoms or abstain from sexual intercourse for at least six months after recovery.

For pregnant women

While there is currently no evidence that pregnant women are more likely to get Zika virus infection, the consequences can be more serious if a pregnant woman is infected, as the Zika virus infection can cause microcephaly in a small number of unborn foetus of pregnant women.

Pregnant women should adopt strict mosquitoes precautions. 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. Pregnant women who have had sexual intercourse with their male partner who tested positive for Zika should consult a doctor and inform him/her of possible exposure to Zika so that he/she can arrange for Zika testing. 

WHO’s May 2016 guidelines do not recommend routine Zika testing for asymptomatic pregnant women. If you are concerned, you should discuss further with your doctor.

For couples planning pregnancy

If both the man and woman are well
They should take strict precautions against mosquito bites, and if they have further questions, consult their doctor. 

If woman is symptomatic
(with fever and rash and other symptoms such as red eyes or joint pain)

She should seek medical attention promptly, and if confirmed positive for Zika, she should practise safer sexual practices or abstain from sexual intercourse for at least 8 weeks after recovery, before trying to conceive. 

If the man is symptomatic
(with fever and rash and other symptoms such as red eyes or joint pain)

He should seek medical attention promptly, and if confirmed positive for Zika, he should practise safer sex through the correct and consistent use of condoms or abstain from sexual intercourse for at least six months after recovery.

For everyone

Vector control remains the mainstay in reducing the spread of Zika. Like dengue fever, to prevent the spread of the virus, we must first prevent the breeding of its vector, the Aedes mosquito. The Aedes mosquito is easily identifiable by the distinctive black and white stripes on its body. It prefers to breed in clean, stagnant water easily found in our homes. To prevent breeding of the Aedes mosquito, we need to frequently check and remove stagnant water in our homes.

Learn more ways to prevent Aedes mosquito breeding on NEA’s Zika website: www.nea.gov.sg/zika

Testing

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. It is however useful in directing vector control efforts. 

However, as more cases are found in other parts of Singapore, testing will no longer be focused on the clusters only, and MOH will provide a subsidy for the test by the public sector laboratories as follows:  

  • For subsidised patients at the public healthcare institutions, they 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 the medical social worker for assistance, such as from Medifund.
  • For private patients in the public healthcare institutions, and patients at private clinics and private hospitals, they will pay the full cost of $150 for the Zika test. 

Doctors will continue to make the clinical judgment on individuals whether testing of Zika is necessary.

Pregnant women will remain a special group to whom we will make Zika tests more affordable and accessible. Doctors will continue to make the clinical judgment whether testing of Zika is necessary, and for those who have Zika symptoms or whose male partner is Zika-positive, the 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.

Vector Control

Vector control remains the mainstay in reducing the spread of Zika. 

Like dengue fever, to prevent the spread of the virus, we must first prevent the breeding of its vector, the Aedes mosquito. The Aedes mosquito is easily identifiable by the distinctive black and white stripes on its body. It prefers to breed in clean, stagnant water easily found in our homes. To prevent breeding of the Aedes mosquito, we need to frequently check and remove stagnant water in our homes.

Learn more ways to prevent Aedes mosquito breeding on NEA’s Zika website: www.nea.gov.sg/zika

FOR MORE INFO

  • MOH Hotline: 1800-225 4122

  • Report potential mosquito breeding sites to NEA: 1800-2255-632 or Contact_NEA@nea.gov.sg

Frequently Asked Questions

On Zika 

Q:      How is the Zika virus spread?
The Zika virus is transmitted to humans by the bite of an infected Aedes mosquito (Aedes aegypti and Aedes albopictus are the common species found locally). A mosquito is infected when it takes a blood meal from a Zika-infected person and later transmits the virus to other people it bites.

Q:      What treatments are available for the virus?
There is no known vaccine or specific treatment against the Zika virus. Treatment is directed at alleviating symptoms.

Q:      Which are the vulnerable groups?
While there is currently no evidence that pregnant women are more likely to get Zika virus infection, the consequences can be more serious if a pregnant woman is infected, as the Zika virus infection can cause microcephaly in a small number of unborn foetus of pregnant women. Hence, pregnant women ought to take added precautions undertaking strict protection against mosquito bites.  Pregnant women who develop symptoms of Zika such as fever and rash should consult their doctors for testing for Zika infection.

Those without these symptoms but who are concerned that they have been infected with the Zika virus should consult and follow the advice of their doctors regarding monitoring of the pregnancy.

Pregnant women should adopt safe sexual practices (e.g. consistent and correct use of condoms during sex) or consider abstinence for at least eight weeks if there is a possibility that their sexual partners may have Zika infection. People diagnosed with Zika should adopt safer sex practices or consider abstinence for at least 6 months.

Q:      Which countries are affected?
Sporadic cases of local Zika virus infection have been detected in several countries in Southeast Asia, including Cambodia, Indonesia, Philippines, Malaysia (Sabah), Vietnam, Lao People’s Democratic Republic and Thailand previously.  As of June 2016, active transmission has been reported in Beung Kan and Phetchabun provinces of Thailand.  

On 28 August 2016, MOH confirmed localised community spread of Zika Virus Infection in Singapore. 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.

For the latest updates on global Zika Virus transmissions, please refer to the European Centre for Disease Prevention and Control website.

Zika in Singapore

Q: What are the measures taken to keep Singapore safe from Zika?

On 28 August 2016, MOH confirmed localised community spread of Zika Virus Infection in Singapore. 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. As such, vector control remains the mainstay in reducing the spread of Zika.

HSA has since June 2016 been working with the National Public Health Laboratory (NPHL) to provide Zika-tested red cells to pregnant women who require non-emergency red cell transfusions.

It is critical that the community join in the fight by taking immediate actions to prevent mosquito breeding by doing the 5-step Mozzie Wipeout weekly.

Zika and Pregnancy 

Q:    If a woman who is not pregnant is bitten by a mosquito and infected with Zika virus, will her future pregnancies be at risk?
Zika virus infection does not pose a risk of birth defects for future pregnancies.

Q:    Are there any tests which can be done to determine if a pregnant woman is infected with Zika? 
Currently, the only reliable test available for Zika is the reverse transcriptase-polymerase chain reaction (RT-PCR) test which looks for genetic material of the virus in blood or urine. However, RT-PCR test is only able to detect Zika infection in blood within 5-7 days of onset of symptoms and in urine within 14 days of onset. Therefore, the time window in which a pregnant woman can be tested using RT-PCR is very short. 

At present, there is no reliable serological test (which looks for antibodies in the blood) for Zika.

Q:    If I am pregnant and my male partner is tested positive for Zika, do I need to get tested if I do not have any symptoms?
If you have had sexual intercourse with your partner, you should consult a doctor and inform him/her of possible exposure to Zika so that he/she can arrange for Zika testing. 

Q:    If I am pregnant and asymptomatic, but worried about possible exposure to Zika, where should I go to get tested?
WHO’s May 2016 guidelines do not recommend routine Zika testing for asymptomatic pregnant women. If you are concerned, you should discuss further with your doctor. 

Q:   Should a woman who is pregnant get regular blood/ urine tests for Zika, to make sure that she is not infected? 
No, unless she has symptoms of possible Zika Virus Infection (fever and rash and other symptoms such as red eyes or joint pain). 

Q:   Is it safe for pregnant women to use insect repellent? 
Yes, insect repellents sold in Singapore are safe for use for pregnant women. 

You can also prevent mosquito bites by wearing long, covered clothing, and sleeping under mosquito nets or in rooms with wire-mesh screens or air-conditioned rooms to keep out mosquitoes.

Q:   If I am pregnant and have recently visited a Zika affected area in Singapore, what should I do?
There is no need to see your doctor, if you are well. You should continue to take strict precautions against mosquito bites. If you have symptoms of possible Zika virus infection (fever and rash and other symptoms such as red eyes or joint pain), you should seek medical attention immediately, and consult your Obstetrics and Gynecology (O&G) doctor.

Q:    If my female partner is pregnant and I am tested positive for Zika, what should I do?
You should practise safe sex through the correct and consistent use of condoms, or abstinence, for at least the whole duration of your female partner’s pregnancy. 

Q:    If I am pregnant and live, work or study in a Zika affected area in Singapore, what should I do?
You should take steps to prevent mosquito bites and consult a doctor if you develop a fever and rash and other symptoms such as red eyes or joint pain after possible exposure to Zika. You should tell the doctor where you live, work or study.

Q:    If I am pregnant and asymptomatic, but worried about possible exposure to Zika, where should I go to get tested? 
WHO’s May 2016 guidelines do not recommend routine Zika testing for asymptomatic pregnant women. If you are concerned, you should discuss further with your doctor. 

Q:    If I am pregnant and my blood tests positive for Zika, will I need to be hospitalised and for how long?
You will be referred to a public hospital for management and followed up by an O&G doctor.

Q:    If I am pregnant and positive for Zika Virus Infection, will my baby have microcephaly?
Currently, even if a pregnant woman is confirmed to be infected with Zika virus, there is no test that will predict the future occurrence of microcephaly. We advise that you follow-up closely with your doctor.

Q:    If a pregnant woman is positive for Zika virus Infection, should she consider termination of pregnancy?
A pregnant patient with confirmed Zika infection will be arranged for admission to a public hospital with a referral to an O&G doctor for further management. Serial ultrasounds and amniotic fluid testing may be considered after the potential risks and interpretation of results are discussed. The termination of pregnancy is a personal choice which should be carefully made by the parents in consultation with their doctor. 

Q:    Can mothers with Zika infection breastfeed their baby? 
Zika virus has been detected in breast milk but there is currently no evidence that the virus is transmitted to babies through breastfeeding.

Zika and Microcephaly

Q:    What is Microcephaly?
Microcephaly is a congenital condition in which the head size is very much smaller than usual for a baby of the same age, race, and sex. 

Microcephaly can be caused by a variety of genetic and environmental factors, such as Down Syndrome, exposure to drugs, alcohol or other toxins in the womb; rubella and a few other infections during pregnancy. 

There is no specific treatment for this condition. Infants with microcephaly showing developmental delay might benefit from early intervention programs or developmental, physical, and occupational therapy, as well as interdisciplinary programmes.

Q:    Does Zika cause microcephaly?
There is evidence that Zika can cause microcephaly. 

Q:    What is the impact of microcephaly on an infant?
Microcephaly can be an isolated condition, meaning that it can occur with no other major birth defects, or it can occur in combination with other birth defects. Infants with microcephaly may have concurrent disabilities. Different  symptoms  and signals associated  with  microcephaly  (very  small  head,  difficulty feeding, high  pitched crying, fits, stiffness of arms and legs, developmental delays and disabilities, among others) have been  described. 

Infants with suspected microcephaly should be evaluated by a healthcare professional. In addition to clinical evaluation, neuroimaging tests to evaluate possible structural deformities may be required.

Q:    What exactly does the risk of microcephaly (from Zika virus) entail?
As studies are still on-going, the risk of microcephaly from Zika virus infection is still not clear. Currently, even if a pregnant mother is confirmed to be infected with Zika virus, there is no test that will predict the future occurrence of microcephaly. Close follow-up by healthcare professionals will be required.

Q:   Can microcephaly be picked up through pre-natal screening? If so, what options are available to pregnant women if it is detected?
Microcephaly may be picked up during pre-natal screening, such as through ultrasound of the fetus. However, not all cases may be picked up in the early stages of pregnancy (i.e. within the first trimester). Some may not be diagnosed until after late in the pregnancy or after the birth of the child. This is similar to other congenital conditions, such as Down Syndrome. Similarly, a small head measured on ultrasound does not necessarily confirm the diagnosis of microcephaly. A significant proportion of fetuses with small heads on ultrasound turn out to be neuro-developmentally normal. 

If this condition is picked up through pre-natal screening, the parents should consult with their healthcare professional on their options. 

Q:    Can amniocentesis tests be used to detect Zika Virus Infection in the fetus? 
If the woman is not known to be infected with Zika virus, amniocentesis is not recommended for detecting Zika virus infection in the fetus. If the woman is confirmed to be positive for Zika, the O&G doctor will assess and counsel her on the pros and cons of doing such a test.

Q:    I think my child’s head is smaller than usual. Does s/he have microcephaly?
Having a seemingly smaller head may not mean that your child has microcephaly. Just as importantly, having a small head does not automatically mean that the child will have developmental concerns. The child should be evaluated by a healthcare professional. More tests may be needed to determine if there are any issues of concern.

Q:    Can microcephaly be treated? What support can be provided to a child born with microcephaly?
Treatment and support depend on whether the child has any disabilities and if so, the type and degree of disability. Treatment and support will include rehabilitative measures which may include environmental stimulation, physiotherapy, speech therapy and occupational therapy.

 

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