Tuberculosis in Singapore

In 2010, the number of new TB cases notified to MOH was:

Singaporeans and Permanent Residents - 1,478 cases
Non-Residents (foreigners here for work, study or visit) – 550 cases

The incidence rate for TB in 2010 was 39.2 per 100,000. Among Singaporeans and PRs, 82.4% of the 1,478 cases last year were Singapore-born; 59.7% were 50 years old and above, and 67.4% were males.

There were 126 relapsed cases among Singapore residents of which 104 (82.5%) were Singapore-born.

Definition & Characteristics

Tuberculosis (TB) is an infectious disease caused by a bacterium, Mycobacterium tuberculosis.

It usually affects the lungs (pulmonary tuberculosis), but other parts of the body can also be affected (extrapulmonary tuberculosis), such as the brain, lymph nodes, the kidneys, bones, and joints. If not treated properly, TB can be a fatal disease.

Not everyone who is infected with TB develops TB disease. The body's immune system 'walls off' the TB bacteria, and allows it to lay dormant in the body. This is called latent TB infection. Individuals with latent TB infection do not have symptoms and are not infectious. They cannot spread the TB germs to other people.

TB disease develops in about 10% of those with latent TB infection. Individuals with TB disease may spread the disease to other people. The risk of latent TB infection developing into TB disease is higher in:

Persons with underlying medical conditions such as HIV infection and diabetes;
Persons who have a weakened immune system e.g. due to drugs or sickness;
Persons who have poor nutritional status; and
Drug addicts.

How Tuberculosis Spreads

TB is an air-borne disease transmitted through fine respiratory droplets from an infected person. Persons with TB are most likely to spread it to people who have close and prolonged contact with them, such as family members, friends and co-workers.

You cannot get TB from sharing drinking containers or eating utensils, cigarettes, or saliva shared from kissing. TB is not spread through shaking someone’s hand, sharing food, touching bed linens or toilet seats, or sharing toothbrushes.

Symptoms

Symptoms of TB disease depend on the area affected. Some common symptoms of TB include:

a persistent cough that lasts 3 weeks or longer
low-grade fever
night sweats
fatigue
weight loss
chest pain
coughing up blood or sputum
A persistent cough lasting longer than 3 weeks, and accompanied by any of the other symptoms above, may indicate active TB disease.

If you experience such symptoms, you should consult your doctor right away. Your doctor will ask you to go for a chest X-ray and you may be referred to a specialist for further clinical and laboratory investigations. Early detection is key.

Treatment of Tuberculosis

TB disease can be cured with anti-TB drugs. Treatment usually involves a combination of several different drugs, taken for 6 to 9 months. More than 95% of patients are cured if patients take all the medications prescribed for them.

Incomplete TB treatment means that TB germs in the body that survive continue to grow and multiply, and they may develop resistance to the first-line TB drugs. The mutant TB strains become more deadly and difficult to treat. In such situations, second-line TB drugs must be taken for a longer period in order to clear the infection and the chance of cure is also considerably reduced.

The best way to cure TB and curb its spread is to receive your treatment under MOH’s Directly Observed Treatment (DOT) programme. The World Health Organisation has advocated DOT as the standard of care for TB patients.

DOT is a process during which the TB patient takes each dose of medication under the direct observation of a health care worker to ensure that the correct dosage and combination of TB medications are taken for the entire course of the treatment.
Under DOT, the TB patients’ response and adherence to treatment is closely monitored, so that treatment failure, emergence of drug resistance and spread of the disease can be avoided.

Infection with TB can cause permanent lung damage if not treated early. It can also spread to other parts of the body where it can lead to life-threatening complications.

TB infection may also recur if not properly and completely treated. This results in the possible development of drug-resistant TB strains which are extremely difficult to treat.

Controlling the spread of TB

People with TB should be treated to stop the spread of the disease. You must finish all your medicine until all the germs are killed, even if the symptoms go away and you start to feel better.

If you have active TB, you can help keep your family and friends from getting sick by:

Completing the full course of your TB medications.

Staying at home in the first two weeks of treatment except when attending DOT treatment at polyclinics.earing a face mask in the presence of other people during the first two weeks of treatment.
Covering your mouth with a tissue when you cough or sneeze.

Some measures you can take on your own to help protect yourself and others:

If you have symptoms of TB, go for check up.
If your family members, friends, colleagues or employees have TB, give him or her your full support to adhere faithfully to their treatment until they are cured.
Keep your immune system healthy by adopting healthy eating habits, exercising regularly and having enough sleep.