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41 confirmed cases of Zika in Aljunied

SINGAPORE — 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.

NEA teams seen conducting thermal fogging operations in the Aljunied Crescent area on Aug 28, 2016. Photo: Ooi Boon Keong/TODAY

NEA teams seen conducting thermal fogging operations in the Aljunied Crescent area on Aug 28, 2016. Photo: Ooi Boon Keong/TODAY

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SINGAPORE — 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. 

And more cases could emerge, given that the majority of Zika cases have no symptoms or only mild ones, and mosquitoes in affected areas may already have been infected, the ministry said on Sunday (Aug 28), at a press conference held by MOH and the National Environment Agency (NEA). 

The MOH, warning of further community transmission, said other areas of concern at this point include Khatib Camp, Sembawang Drive and places where the construction workers live, including Kranji Road, Joo Chiat Place, Senoko South Road, Toh Guan Road East and Lorong 101 Changi. 

Of the 41 Zika cases, 34 patients have fully recovered. Seven still have symptoms and are recovering at Tan Tock Seng Hospital, the MOH said. Isolation of positive cases may have limited effect in managing the spread, the authorities said, as it announced intensified operations to clamp down on mosquito breeding. 

The Zika virus is spread by the Aedes mosquito, which also transmits dengue. The virus has been linked to serious birth defects in children whose mothers were infected during the pregnancy. 

On Saturday, the ministry disclosed that a 47-year-old Malaysian woman living in Block 102 on Aljunied Crescent had become the first to contract the disease locally. The woman, referred to as Patient A, was diagnosed on August 25. 

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But even before that, a clinic in the Aljunied area — Sims Drive Medical Clinic — had informed MOH of an “unusual increase” in cases with fever, rash and joint pain on Aug 22. The next day, MOH officials had visited the clinic and discussed the cases with the general practitioner. The “initial hypothesis”, it said, was that it was a cluster of mild viral illness transmitted from person to person.

It then made arrangements for the clinic to refer new cases to the Communicable Diseases Centre (CDC) for further testing, and started tracing past cases for further review and if needed, testing. 

On Aug 25, the MOH had gone to the contractor of a nearby construction site for records of workers with fever. That day same, Patient A had gone to the doctor after she developed a fever, rash and conjunctivitis, and was referred to the CDC.

Explaining the developments on Sunday, the MOH said so far the earliest case dates back to July 31. Among the patients, 36 are foreign workers working at a construction site on 60 Sims Drive, four are Singaporeans and one – Patient A - is Malaysian.

Unlike the first case of Zika to emerge in Singapore in May, these 41 patients had not travelled to Zika-infected areas recently so they were likely to have been infected in Singapore.

Asked why the MOH only announced the case of Patient A two days after she was diagnosed - when testing only takes about three to four hours - Health Minister Gan Kim Yong said that the ministry was only alerted to the possibility of more cases when Patient A was confirmed.

“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 thats why we have discovered more cases...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,” said Mr Gan, speaking to reporters after the press conference on Sunday.

Pressed further, he added that some cases required “double confirmation”.

Dr Derrick Heng, the MOH’s group director for public health, pointed out during the press conference that test results of the other cases only came back late Saturday night.  

Infectious diseases expert Leong Hoe Nam, who diagnosed Singapore’s first Zika case at Mount Elizabeth Novena Hospital earlier this year, called the MOH out on not starting investigations earlier.

“Every single mild case of fever, they should have investigated, it was a chance to break the cycle. Kudos to the GP who picked up the trend. We must remember that Zika is very mild, compared to dengue. Patients may not be sick enough to go to hospital but to the GP instead. So the GP now is the gatekeeper,” Dr Leong said.

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MacPherson Member of Parliament Tin Pei Ling, who oversees the ward that Patient A lives in, said that it would have been ideal if the MOH had acted on any suspicion earlier.

“It would have been most ideal to take a more conservative approach at that point in time, if there had been early suspicion, to check if there were any positive cases. But I suppose MOH would have taken the balanced approach between alarming everyone, and doing proper checks,”said Ms Tin.

But Member of Parliament Chia Shi-Lu (Tanjong Pagar GRC), head of the Government Parliamentary Committee for Healthcare, pointed out that none of the cases had a travel history, which “significantly” reduced the likelihood that they were infected.

“It depends on the risk profile, we have to remember that the problem with Zika is that most cases have no symptoms. It’s not like Sars or Mers, or dengue, which are easier to detect,” said Dr Chia, an orthopaedic surgeon. 

He added: “It was very good that the GP detected the cases, all credit to this GP who was alert enough.”

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