Reports from Malaysia and Singapore today describe more details about local Zika infections, while a new study from Europe shows that cohesive surveillance for microcephaly is lacking in most countries.
Malaysia: 2 Zika strains
The Malaysian Ministry of Health (MOH) said today there are six cases of Zika in the country, and all patients are hospitalized for monitoring. Two of the new cases are in sisters, one of whom is pregnant.
The MOH said the sisters are infected with two different strains of Zika that are circulating in the country, according to a translated press release posted by Avian Flu Diary, an infectious disease blog. Genomic sequencing has identified one strain as a local strain (Micronesia), and another strain (Polynesian) that officials say was likely imported from Singapore and more closely resembles the strain that's behind the current outbreak in the Americas.
In a press conference held today, Malaysia's minister of health, Datuk Seri Dr S. Subramaniam, said, "This goes to show that there are two types of virus strains lurking among us," according to Astro Awani, a Malaysian news outlet. Subramaniam said he presumed both strains posed similar risks to the public.
Also today, the Malaysian MOH said it will be meeting with the National Fatwa Council to discuss pregnancy and Zika. Abortion is legal in Malaysia, a mostly Muslim country, only if the mother's life is in danger.
Only clusters, not single cases, to be noted in Singapore
The discovery of two strains of Zika in Malaysia further complicates the picture of how and why Zika is triggering acute illnesses across southern Asia.
On Sep 8, Singapore's Ministry of Health reported that the strain that's led to most of the 341 cases in the city-state is of the Asian lineage, unlike the current strain found in the Americas.
A new cluster of eight Zika cases was reported by Singapore health officials today. According to Avian Flu Diary, Singapore will no longer be reporting individual cases of Zika virus, only clusters.
Microcephaly not reported uniformly
Finally today, a new study in BMJ showed that European countries have varying ways of classifying and reporting microcephaly. Though Zika virus is not currently a concern in Europe, the study suggests a worldwide problem in surveying congenital disorders.
Researchers looked at EUROCAT data to determine that the prevalence of microcephaly in Europe is currently 1.53 per 10,000 live births. But they noted that the 24 national registries surveyed used different measurements and definitions for microcephaly, varied in size, and did not include microcephaly cases that were diagnosed after hospital discharge.
In a commentary on the study, Russell S. Kirby, PhD, an epidemiology professor at the University of South Florida, said the EUROCAT data show the challenges of capturing an accurate picture of birth defects, and notes that the United States suffers from its own challenges when it comes to documenting Zika's most feared outcome.
"Ironically, the National Birth Defects Prevention Network (NBDPN) in the US made the decision to discontinue annual reporting of microcephaly by state … because of extreme variability in state level prevalence reports, and microcephaly was not included among the conditions in the most recent report of US national prevalence estimates," Kirby said.
See also
Sep 14 Avian Flu Diary Malaysia post
Sep 14 Astro Awani story
Sep 14 Avian Flu Diary Singapore post
Sep 14 Singapore National Environment Agency update
Sep 14 BMJ study
Sep 14 BMJ commentary
