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Title: Correlation of clinical illness with viremia in Zika virus disease during an outbreak in Singapore
Authors: Ng, Deborah H. L.
Ho, Hanley J.
Chow, Angela
Wong, Joshua
Kyaw, Win Mar
Tan, Adriana
Chia, Po Ying
Choy, Chiaw Yee
Tan, Glorijoy
Yeo, Tsin Wen
Leo, Yee Sin
Keywords: Viremia
Issue Date: 2018
Source: Ng, D. H. L., Ho, H. J., Chow, A., Wong, J., Kyaw, W. M., Tan, A., et al. (2018). Correlation of clinical illness with viremia in Zika virus disease during an outbreak in Singapore. BMC Infectious Diseases, 18(1), 301-.
Series/Report no.: BMC Infectious Diseases
Abstract: Background: The first autochthonous Zika virus (ZIKV) outbreak in Singapore was detected in August 2016. We report an analysis of the correlation of clinical illness with viremia and laboratory parameters in this Asian cohort. Methods: We conducted a prospective longitudinal cohort study of patients with a positive blood ZIKV polymerase chain reaction (PCR) result who were admitted to Tan Tock Seng Hospital, Singapore, for isolation and management. Results: We included 40 patients in our study. Rash was present in all patients, while 80% (32/40) had fever, 62.5% (25/40) myalgia, 60% (24/40) conjunctivitis and 38% (15/40) arthralgia. The median duration of viremia was 3.5 days (IQR: 3–5 days). Patients with viremia of ≥4 days were more likely to have prolonged fever compared to those with viremia of less than 4 days (95% versus 63%, p=0.01), but had no significant correlation with other clinical signs and symptoms, or laboratory investigations. However, 21 patients (53%) had hypokalemia despite the absence of gastrointestinal symptoms. Conclusion: Although fever correlated with duration of viremia, 30% of patients remained viremic despite defervescence. Laboratory abnormalities such as leukopenia or thrombocytopenia were not prominent in this cohort but about half the patients were noted to have hypokalemia.
DOI: 10.1186/s12879-018-3211-9
Rights: © 2018 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Fulltext Permission: open
Fulltext Availability: With Fulltext
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