Singapore has confirmed its 10th and 11th cases of Influenza A (H1N1-2009). Both patients were on the same flight - Singapore Airlines SQ25 from New York via Frankfurt on 1 Jun - as the 7th confirmed case, a 30-year-old Australian male tourist who was seated at Row 54. The flight arrived in Singapore at 0618 hours on 1 June.

The 10th confirmed case

2 The patient is a 33-year-old Singaporean female who was in New York from 23 - 30 May. She was seated at row 19 on SQ25. She went home by taxi from the airport and developed symptoms later in the same morning.  She remained home for the rest of the day. On 2 June, she stayed at home the whole day and in the evening, took a taxi to TTSH. She was admitted to CDC2, TTSH before midnight on 2 June.
 
The 11th confirmed case

3 The patient is an 18-year old American female visitor.  She was seated at row 57.  She was met by her relative at the airport and they took a taxi to the relative's residence. She developed symptoms in the afternoon of 2 June, took a taxi with her relative to seek medical attention at Raffles Hospital’s Emergency Department in the evening and was sent to CDC, TTSH via a 993 ambulance. She was admitted to CDC2 in the early hours on 3 June.
 
4 Laboratory results confirmed their infection at 1500 hours on 3 June.

Contact tracing

5 Contact tracing has been initiated for the 10th and 11th confirmed cases. Based on MOH’s risk assessment, passengers within rows 17 to 21 and rows 57 to 59 (passengers in rows 55-56 have already been contacted in relation to the 7th confirmed case) on SQ 25 on 1 June who have not been contacted by MOH yet should call the MOH hotline at 1800-333 9999 to enable us to check on their health condition expeditiously.

6 For the 9th case involving a 19-year-old Singaporean female who arrived in Singapore from New York on 28 May, MOH has identified 2 household contacts for HQOs. They are currently well.  Contact tracing is still on-going for any other close contacts.

Changes to the list of affected areas

7 MOH has been monitoring the influenza A (H1N1-2009) situation in a number of countries.  Based on our analysis, we are expanding the list of “affected areas” to include Melbourne and the State of Victoria in Australia, Kobe and Osaka in Japan and Chile, besides USA, Canada and Mexico.

8 Affected areas are defined as areas with clear evidence of widespread community transmission. The number of cases in the State of Victoria, particularly in its capital, Melbourne has been rising rapidly, with the number of cases doubling to reach almost 400 over the last 2 days. For Japan, more than 90% of its cases are found in the two cities of Kobe and Osaka.  For Chile, the government has announced that H1N1 is entrenched in the community and mitigation measures have replaced containment efforts.  Indications are that there is widespread infection throughout the country, although a large majority of cases are found in the capital city, Santiago.

Advice from MOH

9 MOH advises the public to avoid non-essential travel to these affected areas. Should they become unwell within 7 days of their return from affected areas, they should seek medical attention promptly and call 993 for an ambulance. They should avoid taking public transport or taxi to minimise exposure to others.  For people who are unable to avoid travelling to affected areas, they should:

• Avoid crowded areas and contact with anyone who appears unwell.

• Maintain high standards of personal hygiene at all times.
- Wash hands regularly and thoroughly with soap and water, especially before touching the eyes, nose or mouth.
-  Turn quickly away from anyone near if they are about to cough or sneeze. 
- Cover the nose and mouth with a piece of tissue when coughing or sneezing. Dispose of the tissue paper properly in the dust bin after use.

• MOH also advises travellers to see a doctor as soon as possible if they feel unwell overseas and refrain from travelling until certified fit by the doctor.

10 So far in Singapore, all the 11 cases are imported and have a travel history. There is currently no evidence of community spread. MOH is monitoring the situation closely and will update the public on any new developments. For more information on Influenza A (H1N1-2009), please access MOH’s website at www.moh.gov.sg, call our hotline at 1800-333 9999, or visit www.flu.gov.sg.

MINISTRY OF HEALTH
3 June 09