MOH concludes investigations into keratoconjunctivitis cases in rugby players

1. MOH has completed investigations into the outbreak of microsporidial keratoconjunctivitis involving attendees of an international rugby tournament held at Turf City between 21 and 22 Apr 2012.

2. The tournament involved around 1,600 youth players from 16 rugby clubs from Singapore, Hong Kong, Malaysia, Australia and the United Arab Emirates (UAE). A total of 159 attendees from participating countries reported symptoms related to eye infection (such as redness and itchiness). The breakdown is as follows:

  • Singapore – 89 cases
  • Hong Kong – 33 cases
  • Malaysia – 15 cases
  • Australia – 13 cases
  • UAE – 9 cases

3. MOH has contacted 72 of the players reported by local clubs. Their ages ranged between 6 and 17 years. Clinical symptoms experienced by these cases included eye redness, pain and itchiness, blurred vision, photosensitivity and eye discharge. The majority of these cases (~ 90%) sought outpatient treatment. None of them were hospitalised. All these cases have fully recovered or are recovering.

4. Microsporidia are spore-forming organisms that are present in the environment and soil. Infection can occur when mud enters the eye during sporting activities in muddy fields. This can cause keratoconjunctivitis, which may result in eye pain, redness or blurry vision between 2 and 30 days after exposure. Cases of eye infection with microsporidia have been known to occur in Singapore. Two studies of microsporidial keratoconjunctivitis cases by ophthalmologists in Singapore identified prior soil or mud contamination in the eye as important risk factors. Microsporidia keratoconjunctivitis is generally mild and can be treated with antibiotic eyedrops. The infection has not been documented to be transmitted from person to person.

5. MOH’s investigations revealed that microspordial spores are likely to be ubiquitous in soil here and are not limited to the Turf City pitches. To reduce the risk of microsporidia eye infection during sporting activities on grass pitches in Singapore, members of the public are advised to avoid playing on very muddy or waterlogged pitches for sports involving contact with soil or mud. If playing in such conditions cannot be avoided, one should ensure that one’s hands and face are thoroughly washed after the event.

6. Members of the public are also advised to seek early medical consultation if they experience symptoms such as red, itchy, painful red eyes with blurring of vision after engaging in sports that involve contact with soil or mud.

7. MOH will also work with the appropriate authorities to provide advice to sports clubs and pitch operators on measures to minimise the risk of such infections at their grounds (e.g. ensuring proper drainage of pitches and installing adequate washing facilities).


29 JUNE 2012

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