Singapore's Zika Clinical Advisory Group was unanimous about offering free testing to pregnant women islandwide with Zika symptoms, as these experts fear that the virus could have spread beyond the current outbreak area.
Professor Arijit Biswas, who chairs the nine-member group set up in February, said the biggest concern about Zika is its effect on pregnancy.
That is why the group, which advises the Ministry of Health on developing clinical protocols to manage Zika, did not want to restrict the tests to only those in the current outbreak area around Aljunied. "We might miss some (cases)" if this were done, he said. "So we decided to make the net wider."
But these women should have had at least three Zika symptoms within the past two weeks. The symptoms are:
•a fever, usually low-grade;
•a rash that is usually red, flat and itchy and in more than one part of the body;
•any one of the following: joint or muscle ache, red eyes or headache.
Prof Biswas, who is clinical director of Maternal and Fetal Medicine at the National University Hospital, said women who have not exhibited such symptoms in the past fortnight should not go for the tests.
What would happen if Zika becomes endemic here, the way dengue is, and thousands of people get infected every year? "The most important message to pregnant women is, they should take precautions against mosquito bites," he said. And that would apply whether Zika becomes endemic or even now.
"Use mosquito repellents available in Singapore which are safe, wear long sleeves and pants in light colours, stay in air-conditioned rooms and use a mosquito net if possible," said Prof Biswas.
His other piece of advice for pregnant women is: "Either abstain, or practise safe sex throughout your pregnancy." This is to prevent any possible infection from a partner, who might not know he has Zika.
Prof Biswas also answered other questions about Zika. His answers have been paraphrased.
Q: If a pregnant woman has Zika, how accurate are the tests to check if the baby is affected?
A: Microcephaly, the most common birth defect linked to Zika infection, cannot always be picked up early. In some cases, it is spotted only after birth. But some features might be picked up during tests, like structural abnormality. If the baby looks structurally abnormal, a second test of the amniotic fluid can be done, but this carries a 0.5 to 1 per cent risk. Things that can go wrong include leakage from the womb, early contractions and even infection.
Q: If the tests cannot accurately tell if the baby is compromised, what's the point of regular monitoring?
A: The majority of pregnant women who have been infected with Zika give birth to perfectly normal babies. Monitoring the baby's development can give reassurance.
Q: If scans show the baby has a small head, should parents abort?
A: A small head alone is not enough to show the baby has microcephaly. There must be other symptoms such as extra fluid in the brain, or calcification. Also, about 15 per cent of babies born with microcephaly can live normal lives.
If abnormalities are found, you should discuss it with your doctor, as each case is different.
Q: Why can't women whose babies are likely to suffer from microcephaly abort if they have been pregnant for more than 24 weeks?
A: A foetus older than 24 weeks can survive unaided, but one that is less than 24 weeks can't. This is why 24 weeks is the legal limit for abortion.
Q: If the virus stays in the body for only two to four weeks, why do women infected with Zika have to wait two months, and men six months, before trying for a child?
A: This is to be really safe, as there are reports that the virus can stay in the semen for up to six months.
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