A review of Zika viral infections in pregnancy and implications for antenatal care in Singapore

Given the consensus that there is a causal relationship between Zika virus (ZIKV) infection in pregnancy and congenital Zika syndrome (CZS), clinicians must be prepared to manage affected patients despite the numerous gaps in current knowledge. The clinical course in pregnancy appears similar to that in non-pregnant women, although viraemia may be prolonged. ZIKV infection can be diagnosed by serum and urine reverse transcription-polymerase chain reaction, but commercially available serological tests are currently unreliable in dengue-endemic regions. Although vertical transmission can occur at any time during gestation, first- and second-trimester infections have the highest risk of developing central nervous system anomalies. Aberrant fetal growth and pregnancy loss may also occur. Serial ultrasonography should be conducted for infected cases. Without a vaccine, pregnant women should be advised to minimise mosquito bites and reduce sexual transmission risk. Overall, the absolute risk of CZS arising amid a ZIKV outbreak appears relatively low.

Harvard Zhenjia Lin, Paul Anantharajah Tambyah, Eu Leong Yong, Arijit Biswas, Shiao-Yng Chan
Singapore Med J 2017; 58(4): 171-178 doi: 10.11622/smedj.2017026


Infectious diseases in Singapore and Asia: persistent challenges in a new era

Infectious diseases continue to be a major problem in Singapore and Asia, and developments in medical technology have sometimes, paradoxically, contributed to the issue. Although the spotlight has shifted over time from infectious diseases to the chronic, non-infectious diseases that develop in the course of ageing, infectious diseases are still an important cause of illness and death worldwide.(1) In addition to the predictable burden of endemic diseases such as Candida and dengue, the threat of pandemics is ever-present and global, and Singapore and Asia have not been spared from this onslaught.

Lawrence Soon-U Lee
Singapore Med J 2017; 58(4): 169-170 doi: 10.11622/smedj.2017025


Zika in Singapore: insights from One Health and social medicine

The detection of the Zika virus in Singapore in the last week of August 2016 has generated concern in the community, particularly among pregnant women, and prompted the authorities to take swift action to contain the spread of the virus. In addition to public health efforts currently under way, including the lively ethical discourse on dealing with this mild disease and its significant risk of congenital malformations, we believe that important insights can also be found in the One Health (OH) approach. OH is an ethical, ecological approach that takes into consideration justice and respect for human and animal populations as well as the environment.(1-3) This approach considers the wider social and environmental factors that shape disease transmission, and helps us to identify three populations that are particularly vulnerable but may be overlooked in this scenario: transient foreign workers, their sexual partners and local monkey populations.

Tamra Lysaght, Tsung-Ling Lee, Sangeetha Watson, Zohar Lederman, Michele Bailey, Paul Anantharajah Tambyah
Singapore Med J 2016; 57(10): 528-529 doi: 10.11622/smedj.2016161