Tuberculosis

Tuberculosis, better known as TB is an air-borne disease transmitted through fine respiratory droplets from an infected person.

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.

Tuberculosis in Singapore

The incidence of tuberculosis (TB) declined from 307 cases per 100,000 population in 1960 to 56 cases per 100,000 in 1987.  From 1987 to 1998, the rate of TB among residents was fairly static ranging from 49 - 57 per 100,000 resident population. Following the launch of the Singapore Tuberculosis Elimination Programme (STEP) in 1997, the incidence of TB has declined and fluctuates within a stable range of 35 to around 45 cases per 100,000 population among Singapore residents.

For more information, please refer to the latest annual “Communicable Diseases Surveillance in Singapore” here.

Definition & Characteristics

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

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

Most persons exposed casually do not become infected. For those who do become infected, most develop latent TB (LTBI). Persons with LTBI do not have symptoms of TB (e.g. cough) and do not spread TB to others.

In most healthy persons with LTBI (90%), the TB bacteria remains inactive in their body throughout their life.  Among persons with latent TB infection, about 5% develop active TB disease within the first two years. Another 5% may develop active TB sometime after two years and within their lifetime. 

The risk of progression to active TB 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
  • Substance abusers/Drug addicts.

How Tuberculosis Spreads

TB is typically spread through close and prolonged contact with an infectious individual, and not by contact with items or surfaces touched by a person with TB. A person cannot get TB from sharing cups, eating utensils, food or cigarettes. TB is not spread by shaking someone’s hand, kissing, touching bed linens or toilet seats.

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

Early detection is key. Persons who have persistent cough that lasts 3 weeks or longer should consult a doctor immediately. Their doctor may ask them to go for a chest X-ray and they may be referred to a specialist for further clinical and laboratory investigations.

Treatment of Tuberculosis

TB can be cured with anti-TB drugs. Treatment of active TB, which is sensitive to first-line anti-TB drugs, usually involves a combination of several different drugs, taken for 6 to 9 months. More than 95% of persons with active TB are cured if they take all the medications as prescribed.

Adherence to treatment until completion is important to ensure effectiveness. Otherwise, TB may recur or become resistant to first-line anti-TB drugs. Drug-resistant TB is extremely difficult to treat as less effective drugs will have to be used. 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 is to be treated under MOH’s Directly Observed Therapy (DOT) programme. The World Health Organization has advocated DOT as the standard of care for all 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 are closely monitored, so that treatment failure, emergence of drug resistance and spread of the disease can be avoided.

Health Advisory

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: You must finish all your medicine even if the symptoms go away and you start to feel better.
  • Staying at home in the first two weeks of treatment except when attending DOT treatment at polyclinics
  • Wearing 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 to help protect yourself and others:

  • If you have symptoms of TB, consult your doctor.
  • 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.

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