Measures to Protect Singaporeans from Zika Virus

18 Dr Lily Neo asked the Minister for Health now that the World Health Organization has declared Zika as an international public health emergency (a) what are the additional measures implemented to better protect Singaporeans against Zika; and (b) whether there are inter-Ministry collaborations to prevent and control the spread of Zika here.

19 Ms Joan Pereira asked the Minister for Health whether the Ministry will consider (a) testing blood samples from travellers coming in from areas with ongoing Zika outbreaks and (b) requiring blood donors who have travelled to affected countries to wait at least 28 days before allowing them to donate blood, as advised by the World Health Organization and implemented in Hong Kong, Canada and Britain.

The Senior Minister of State for Health (Dr Amy Khor Lean Suan) (for the Minister for Health): Madam, with your permission, may I take Question Nos 18 and 19 together?

Mdm Speaker: Yes, please.

Dr Amy Khor Lean Suan: Thank you. On 1 February 2016, the World Health Organization (WHO) declared the recent cluster of microcephaly cases and other neurological disorders reported in Brazil a Public Health Emergency of International Concern (PHEIC). WHO further noted that there was strong association of the PHEIC with Zika virus transmission in the affected areas.

The National Environment Agency (NEA) has an on-going surveillance programme for Zika virus since 2014. Prior to the WHO's declaration, the Ministry of Health (MOH) and NEA had already enhanced the surveillance, as well as stepped up measures, to reduce the risk of the Zika virus taking root in Singapore. Since 26 January this year, Zika virus infection has been added to the List of Notifiable Infectious Diseases under the Infectious Diseases Act. All doctors have been advised to stay vigilant against possible cases of Zika virus infection and on the protocols for testing and managing of suspect and confirmed cases. So far, there has not been any reported case of Zika virus infection in Singapore.

To reduce the risk of Zika becoming entrenched in Singapore, all confirmed cases will be admitted to Tan Tock Seng Hospital until they recover and test negative for the virus. MOH will also screen people in the vicinity of the home and workplace of confirmed cases for Zika virus infection.

In addition, we have issued advisories to travellers to and from Zika-affected countries on how to protect themselves against mosquito bites. We have also reminded travellers who have returned to Singapore from affected areas to monitor their health and consult a doctor if they have symptoms of Zika, such as fever, skin rashes, joint and muscle pains, headaches and red eyes, and to reveal their travel history to their doctor. If they have such symptoms after coming back from areas with Zika transmission, blood samples will be taken for Zika testing.

In the light of WHO's declaration, MOH and NEA have worked together to introduce additional measures. MOH is expanding Zika virus testing capability to more public hospital laboratories. NEA has also stepped up the testing of blood samples from patients with fever and rash and suspected dengue for Zika, as part of its Zika virus surveillance efforts. Given the suspected link between Zika virus infection during pregnancy and microcephaly in newborns, MOH has also set up a Clinical Advisory Group on Zika virus infection and pregnancy to provide expert advice on the management of pregnant women with Zika virus infection. In addition, the Health Sciences Authority (HSA) has also required that donors with a history of travel to outbreak areas be deferred from donating blood for 28 days upon return.

As recommended by WHO, surveillance for microcephaly and Guillain-Barre Syndrome (GBS) has been enhanced, to pick up any unusual trends. MOH is also looking at potential areas for collaboration and research with the relevant institutions on Zika virus diagnostics, transmission and the association with microcephaly and GBS.

In addition, if a case is detected here, NEA and other agencies under the Inter-Agency Dengue Task Force, such as the Ministry of Manpower (MOM) and the Public Utilities Board (PUB), will intensify search and destroy efforts to control the Aedes mosquito population at the implicated sites to contain any potential spread.

As Zika is transmitted through the same Aedes mosquito that transmits dengue, vector control remains the mainstay to prevent transmission of the Zika virus. NEA has stepped up its vector control efforts, in partnership with the community, agencies and stakeholders, to control the mosquito population. NEA has also brought forward the annual "Do the Mozzie Wipeout" campaign this year − in fact, it was held yesterday − as part of its community outreach efforts to raise awareness of the 5-Step Mozzie Wipeout and urge the community to take immediate action to prevent mosquito breeding. All of us can do our part by taking the appropriate precautions to prevent mosquito breeding.

Mdm Speaker: Dr Lily Neo.

Dr Lily Neo (Jalan Besar): Mdm Speaker, may I ask the Senior Minister of State what is the stand of MOH on Zika-affected microcephaly? What sort of directive will MOH give to practising doctors looking after Zika-affected pregnant patients with microcephaly foetuses with regard to termination of pregnancy? Lastly, should circumstances arise, would MOH provide multiple free ultra-sound screening follow-up for Zika-affected pregnant patients to ascertain microcephaly?

Dr Amy Khor Lean Suan: MOH has set up a clinical advisory group to provide assessment and advice on the clinical management of pregnant women with confirmed or suspected Zika virus infection. The clinical advisory group has just met and is still discussing their recommendations on the clinical management of pregnant women with confirmed or suspected Zika virus infection. MOH will issue guidelines and recommendations to doctors based on the recommendations of the advisory group.

Notwithstanding this, it is noted that in Singapore, in fact, all pregnant women are already recommended to undergo routine ultra-sound scans as part of ante-natal check-ups. Any abnormal foetal development, including microcephaly, that is picked up during these scans will be followed up by their doctors. The doctor is in the best place to provide advice to the individual cases. Termination of pregnancy is a personal choice made by the parents in consultation with their doctor.

With regard to ultra-sound scans and whether they will be given free, just let me say that, currently, subsidised patients in public hospitals will be able to receive subsidised ultra-sound screening. In fact, if patients have any financial difficulties, they will be referred to the medical social worker proactively and financial assistance will be given after means testing. MediFund also covers obstetrics care to ensure good ante-natal care for all pregnancies and to optimise pregnancy outcomes.

We will consider this and other issues after the clinical advisory group has made its recommendations.

Mdm Speaker: Ms Joan Pereira.

Ms Joan Pereira (Tanjong Pagar): Mdm Speaker, I thank the Senior Minister of State for the very detailed reply. In the event of a Zika virus outbreak, are there lessons from the severe acute respiratory syndrome (SARS) virus outbreak that MOH could apply?

Dr Amy Khor Lean Suan: SARS and Zika viruses are spread through different modes of transmission. SARS is spread from person to person, while Zika is spread by mosquitoes. Containment measures like isolation of cases, contact tracing and quarantine of close contacts are important for SARS. For Zika, vector control remains paramount. MOH will isolate confirmed cases of Zika infection to reduce the risk of transmission in the community. But once there is community spread – that is, if the Zika virus takes root and infection takes root in the community – then we will move from containment to mitigation measures. Measures to admit a confirmed case, isolate him until he recovers and the history of the virus will not work anymore. So, we will move to containment and mitigation measures and this means that we will take measures similar to dengue prevention and control – that is, source reduction.