The Ministry of Health (MOH) Singapore has confirmed 41 locally transmitted Zika cases. Due to the potential risk of Zika transmission in Singapore, the Taiwan Centers for Disease Control (Taiwan CDC) thus raised the travel notice level for the country to Level 2: Alert for Zika virus on August 29, 2016. Pregnant women and women planning pregnancy are advised to postpone their trips to areas where Zika virus is active, travelers visiting areas with ongoing Zika transmission are advised to avoid mosquito bites, and people returning from Zika-affected areas are advised to follow the “2226 Principle”.

Following the first case of locally transmitted Zika virus infection in Singapore that was announced on August 27, 2016, MOH Singapore immediately updated the latest development of the local outbreak situation the next day, confirming 41 locally transmitted Zika cases. All the cases are residents or workers in the Aljunied Crescent/ Sims Drive area. Among the cases, 36 were identified through active testing of potentially infected individuals. As of now, 34 have fully recovered, while the other 7 are still hospitalized for treatment. The 41 cases include the first case in 47-year-old female Malaysian, a Singaporean father and his son, a Singaporean construction worker, an unemployed male Singaporean, and 36 foreign workers at a construction site. None of them have recently traveled to Zika-affected areas. MOH Singapore said that the community transmission appears to be localized within the Aljunied Crescent/Sims Drive cluster for the time being. However, since some cases have visited Khatib Camp and Sembawang Drive, more cases are expected to occur.

Although the disease is usually mild in adults, it can cause congenital microcephaly and even deaths in fetuses of mothers who were infected with Zika virus while pregnant. Taiwan CDC advises pregnant women and women planning pregnancy to postpone all unnecessary travels to Zika-affected areas. In addition, travelers are advised to follow the “2226 Principle” after leaving the affected areas to prevent Zika transmission, which specifies that female travelers are urged to postpone pregnancy 2 months after their return regardless whether they develop suspected Zika symptoms, and male travelers, if they do not develop suspected Zika symptoms, are urged to avoid sex or use condoms correctly for 2 months after their return from an affected-area, and if they develop suspected Zika symptoms, they are urged to avoid sex or use condoms correctly for 6 months after their return. Travelers visiting affected areas are urged to take precautions against mosquito bites such as wearing light-colored clothing, long sleeves and long pants, applying officially approved mosquito repellent to exposed parts of the body, staying at accommodations installed with window screens, screen doors or air conditioners. Taiwan CDC urges travelers returning from affected areas to proactively contact the quarantine officer at the fever screening station at the airport when suspected symptoms develop. If symptoms develop within two weeks of their return, please seek immediate medical attention and inform the physician of their travel history.

The World Health Organization (WHO) announced on August 25, 2016 that since 2007, at least 67 countries, areas and/or territories worldwide, primarily in Latin America and the Caribbean region, have reported local outbreaks of Zika virus infection. Although some countries have reported a gradual decline in the number of Zika virus infection cases, Zika outbreaks continue to persist worldwide. Hence, the public is urged to remain vigilant for Zika virus. Taiwan CDC has issued a travel notice of Level 2: Alert for Zika virus for 58 countries and territories with ongoing outbreaks or possible local transmission of Zika virus, including 5 countries in Asia: Thailand, the Philippines, Vietnam, Indonesia and Singapore. For more information, please visit the Taiwan CDC website at http://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Consultation Hotline, 1922 (or 0800-001922).