Zika is raising alarm bells in Singapore right now. Like Dengue, Zika spreads like wildfire in this tropic mosquito hotbed we call home, and while the symptoms of the virus are mild for most, there is serious risk involved for unborn babies. As if we didn’t have enough to worry about with the lingering threat of Haze! Many don’t know a great deal about the virus and its effects, but knowledge is power, and what we need is information and practical advice straight from the experts. We sat down with Professor Arijit Biswas (the Head of Obstetrics and Gynaecology at the National University Hospital), and Dr. Michelle Turvey (an Australian postdoctoral associate in infectious diseases at the Singapore-MIT Alliance for Research and Technology (SMART). Want clear and concise information about Zika, practical tips for preventing infection, and what it means for those of you trying for a baby? Read on.
And with mosquito repellent sold out in Singapore, we’re happy to announce a 20% discount for HoneyKids readers on NZ brand Skin Technology’s range of pregnancy and child-safe insect repellent. We might not need to become permanent residents at indoor play centres after all!
What is Zika and how is it transmitted?
Dr. Turvey: Zika belongs to the Flaviviridae family of viruses, which includes the better-known members Dengue, West Nile and Yellow Fever viruses. Zika infection generally results in a mild disease, with many not experiencing any symptoms at all. It’s not a new virus; reported cases date back to the 1950s.
Zika virus is transmitted through the bite of the female Aedes mosquito where the virus is present in the blood carried by the mosquito from an infected individual to another human host. Aedes mosquito species are found in Singapore and bite during the day.
What are the symptoms of Zika that we should look out for? Do all people bitten by a Zika infected mosquito fall ill?
Dr. Turvey: Some people infected with Zika will not even know. The majority of Zika infections are asymptomatic or mildly symptomatic with complaints such as slight fever, skin rashes, muscle and joint pains, headaches and redness of the eyes. Sickness lasts between four to seven days and may start three to 12 days after the mosquito bite. The consequences can be more serious for pregnant women infected with Zika, with evidence linking Zika to microcephaly of the unborn foetus. Refer to the Ministry for Health’s webpage (www.moh.gov.sg/zika) for the latest health advisory and seek medical attention if you are feeling unwell.
If you suspect you’re infected with Zika where should you go and what tests are available? What is the treatment?
Professor Biswas: If you think you have symptoms of Zika, go straight to a GP clinic. After assessment the doctor may send a sample of your urine for a RT-PCR test for Zika RNA (reverse-transcription polymerase chain reaction). While the test can be positive in blood samples for the first few days, it remains positive in urine samples for up to two weeks. Unlike countries where related mosquito-borne viral infections like Dengue are not common (such as the US), Zika antibody testing is not useful and not done in Singapore. Such antibody tests may be falsely positive in patients who have previously had Dengue or Chikungunya.
Zika is a very mild viral infection for most adults and children and so doesn’t require treatment. Like Dengue, no specific anti-Zika viral medicine is currently available.
What are the effects on babies born to mothers infected with Zika during pregnancy? Is there any evidence to suggest children and adults may also be affected (brain function or otherwise)?
Professor Biswas: There’s now reasonably good evidence that Zika infection, particularly during the earlier part of pregnancy, may infect the unborn baby. The virus might affect developing brain cells and lead to development of microcephaly (small head). It can also cause a host of derangements in the formation of the developing brain such as muscle and joint problems like clubfeet and stiffened joints in the baby. The exact risk of abnormality is not known but is somewhere between one and 10 percent of all cases of pregnancy with Zika infection. When infection occurs in the third trimester, it is very unlikely to cause fetal abnormalities. But in some cases, it may cause impaired placental function and restriction of fetal growth.
Currently there’s no evidence that Zika infection has any significant harmful effects on children. I liken it to German measles (Rubella), where infection in early pregnancy can lead to serious fetal abnormalities in babies, but it is a minor illness in children. In adults, Zika, like many other viral illnesses, can very rarely cause a condition of temporary paralysis called Guillain-Barre syndrome (in one in every few thousand cases).
Australia and the US have issued a warning against pregnant women travelling to Singapore. Do you have any practical advice for pregnant women living in Singapore to prevent contracting Zika?
- Cover up and wear loose, light coloured clothing with long sleeves and full-length trousers.
- Use mosquito repellents –15-20% DEET products have the best safety record. Repellents containing 10% Picaridin are also safe but slightly less effective. Patches and clip-ons containing natural oils have variable and unreliable efficacy.
- Avoid green areas and gardens during dawn and dusk hours.
- Stay mostly in air-conditioned rooms and use mosquito nets at night.
- Follow NEA guidelines to make sure there are no mosquitoes breeding in your home and backyard.
Many women are concerned about the effect of Zika on future pregnancies. How long should couples wait after contracting Zika before trying for a baby?
Professor Biswas: Zika infection does not affect future pregnancies provided you do not conceive too soon. Women who have had Zika infection should avoid falling pregnant for eight weeks, while infected men should avoid getting their partners pregnant for six months. The difference is because the virus might remain in the semen for a longer period of time. During this time, practise safe sex with proper use of condoms.
Is work underway on a Zika vaccine?
Dr. Turvey: Researchers at SMART Infectious Diseases and many other research institutes and universities worldwide, are working very hard to develop a vaccine and against the Zika virus. Human clinical trials are underway globally as we speak. Other promising treatments in development include therapeutic antibodies, which bind to the Zika virus and help our immune system to clear the infection before it can take hold.
Research is also underway to better understand the Zika virus and how it infects and replicates within the host, so we are better equipped to design smarter and more effective preventative and therapeutic drugs against the disease.
Where to buy your insect repellent (it’s sold out in Singapore!)
Can’t get your hands on insect repellant? Neither can we! It’s sold out island-wide in response to the Zika outbreak (even at market giants FairPrice and Guardian). We’ve witnessed some heartwarming gestures – one woman travelling abroad made a generous offer on Facebook to bring pregnant women mosquito spray. For the rest of you, check out Skin Technology’s range of eco-friendly insect repellents made in New Zealand. They have a pregnancy safe product and a new generation repellent containing Picaridin – a breakthrough substitute to DEET recommended by the World Health Organisation and suitable for kids from two years. Not only will you score 20% off the retail price, you’ll also get free shipping for orders of 12 items (do a group order!). Just use the discount code SING20. Phew!