A Whole of Nation Approach to Prevent The Spread of TB

1        On World Tuberculosis (TB) Day on 24 March, Singapore joins the global community in reiterating its commitment to continue the fight against TB. The World Health Organization’s (WHO) theme for this year’s World TB Day is “Wanted: Leaders for a TB-free World” as it calls for commitment to lead efforts to end TB from not only governments, but also at all levels – from community leaders to TB patients, civil society advocates, healthcare workers and other partners. 

Update on TB Situation in Singapore

2        TB remains a global public health threat. In 2016, there were more than 10 million cases of active TB globally, with 1.8 million deaths. In addition, there were almost half a million cases of multi-drug resistant TB (MDRTB). MDRTB is more difficult to treat and has lower cure rates, with death rates as high as 30 to 40%.

3        TB is endemic in Singapore and latent TB infection is not uncommon in our population, with rates of up to 30% in the older age groups, as TB had been prevalent in Singapore until the 1970s. In 2017, there were 1,536 new cases of active TB among Singapore residents. This is lower than the 1,617 cases in 2016. The incidence rate was 38.7 cases per 100,000 population in 2017, compared to 41.2 cases per 100,000 in 2016. Older age groups and males continue to make up a significant proportion of the new active TB cases. Please refer to Annex A for details. 

TB Screening and Treatment in Singapore

4        TB is an air-borne disease, and is transmitted through close and prolonged exposure to an infectious individual with untreated, active pulmonary (lung) TB. Not all individuals who are exposed to an infectious individual will get TB.

5        TB is curable and the spread of TB is preventable. To ensure early detection and treatment, and to curtail the spread of TB, the Tuberculosis Control Unit (TBCU) carries out contact tracing and screening of close contacts to ensure that those at risk of infection are tested and receive appropriate treatment.

6        Persons diagnosed with active TB will be started on treatment immediately and placed on medical leave. Once treatment starts, the person will rapidly become non-infectious. There is no further risk of exposure in the workplace or school, and there is therefore no need for workplaces or places where a recently diagnosed active TB case has visited to be closed. Close contacts found to have latent TB infection are not infectious and can continue their activities as usual.

7        While there are national control measures in place to reduce the risk of TB transmission in Singapore, everyone plays an important role in preventing the spread of TB. Individuals who display symptoms of active TB, such as unexplained prolonged cough of three weeks or more, should seek medical attention early to ensure prompt diagnosis and treatment.

Importance of Treatment Adherence

8        The full course of active TB treatment takes six to nine months (up to 24 months for drug-resistant TB). If patients do not adhere strictly to the treatment program (e.g. taking their medication on time), there is a higher chance of disease relapse and developing MDRTB.

9        Directly Observed Treatment (DOT) remains a pillar of the Singapore TB Elimination Programme (STEP). DOT is the best way of monitoring patients’ response and adherence to treatment for the sake of their health, and minimises the spread of TB in the community. DOT comprises the administration of TB medicines by a trained healthcare worker to the patient, and is available at all the polyclinics. STEP manages an outreach DOT programme for patients who are unable to commute to clinics for their medications due to age or infirmity.

10       Support and encouragement from patients’ family members, friends and co-workers are vital in ensuring that TB patients successfully complete their treatment. Employers can also play their part, by granting their employees flexibility during the day to access DOT. Treatment adherence and completion will benefit not only the patient, but also protect his family, workplace and community from infection.

11      With everyone playing their part, we can ensure TB patients are treated effectively and reduce the community transmission of TB in Singapore. More information on TB is available at the MOH website or the HealthHub website.

ANNEX A
UPDATE ON THE TUBERCULOSIS SITUATION IN SINGAPORE

MOH was notified of 1,536 new cases of tuberculosis (TB) among Singapore residents[1] in 2017, which is lower than the 1,617 cases in 2016. Correspondingly, the incidence rate was 38.7 cases per 100,000 population in 2017, compared to 41.2 cases per 100,000 in 2016. 

Most of the cases (78.3%) among Singapore residents were Singapore-born. Older age groups and males continue to make up a significant proportion of the new cases. Of the 1,536 new cases notified in 2017, 1,026 (66.7%) were 50 years old and above, and 1,048 (68.2%) were males. 

There were 124 relapsed cases among Singapore residents of which 109 (87.9%) were Singapore-born. 

The emergence of multi-drug-resistant TB (MDRTB) remains a serious public health challenge. In 2017, Singapore had six new cases of MDR-TB (two Singapore-born and four foreign-born residents). The number of such cases must be kept low despite a higher regional prevalence of MDRTB, through strong emphasis on treatment compliance under the national TB control programme.  

Please refer to Tables 1, 2 and 3 for the detailed statistics.

Table 1
Number of cases and distribution of tuberculosis infection by site, Singapore residents¹ 2008 – 2017

Table 2
Distribution of TB cases by age group and country of birth, Singapore residents, 2017

Table 3
Ethnic-gender distribution of reported tuberculosis (new case) among Singapore residents, 2017

[1] Residents refer to Singaporeans and Permanent Residents