Enhancing Public Health Measures Against Tuberculosis

28 Nov 2008

Gazetting TB under the Sixth Schedule of the Infectious Diseases Act (IDA)

1          The Ministry of Health (MOH) will place tuberculosis (TB) under the Sixth Schedule of the Infectious Diseases Act (IDA) with effect from 1 December 2008, This will further strengthen public health measures against the spread of the disease, especially amongst air travellers.  

2          Placing TB under the Sixth Schedule of the IDA enables MOH to disclose particulars of the TB patient to the relevant authorities in a timely manner. Preventive measures can then be implemented without delay. These include:

Contact tracing for infectious TB patients who have travelled on long-haul flights,

Prohibition of infectious TB patients from travelling on commercial flights, and

Management of recalcitrant TB patients to undergo treatment

3          A person with TB is infectious until he has completed at least 2 weeks of effective treatment and tests show that his sputum no longer contains any TB bacteria. Persons with Multi-Drug Resistant TB (MDR TB) however require longer treatment for a few months before they become non-infectious. However, transmission of infection to another person requires close prolonged contact e.g sitting close to a person with TB on an airplane. Persons with TB therefore must not travel until they have been cleared by their doctors for travel.  

4         Currently under the IDA, information which identifies a patient or suspected patient of an infectious disease cannot be disclosed unless it is for the purpose of carrying out public health measures to prevent the spread of the disease and (i) either the disease is listed on the Sixth Schedule or (ii) the Minister for Health has given special approval, or the disclosure is made to the World Health Organisation to comply with international health regulations[1].

5          Severe Acute Respiratory Syndrome (SARS) is the only disease listed on the Sixth Schedule. SARS was gazetted under the Sixth Schedule back in 2003 for contact tracing of possible SARS cases and the management of persons on Home Quarantine Orders.

Update on the Tuberculosis Situation in Singapore

6          There were 700[2] new cases of TB notified among Singapore residents in the first 6 months of 2008, as compared to 1,256 cases last year. The projected incidence of TB in 2008 is 38.4 per 100,000, which is higher than the 35.1 per 100,000 in 2007.

7          Most (86%) of the increase in TB cases in 2008 compared to 2007 (56%) was among persons aged 50 years and above. These older adults went through periods when TB was highly prevalent. They would have acquired latent infection in those early years and are manifesting TB disease now. This suggests that the increase in TB incidence in 2008 was probably due to increased reactivation of latent TB infection.

8          Males accounted for 71.1% (498 cases) of new TB cases and more than half (59.7%) of the male cases were aged 50 years and above. There were 82 relapsed cases among residents for the first half of 2008, with 2 of the relapsed cases being notified as MDR TB. There were no new cases of MDR TB for the same period. Please refer to Annex for the detailed statistics.

Control of TB in Singapore

9          Early diagnosis and complete treatment till cure is the key to successful control of TB in Singapore. Patients with symptoms suggestive of TB should consult a doctor promptly and complete the full course of treatment (6 – 9 months).

10        Non-adherence to treatment may result in a relapse of TB with resistant strains i.e. multi-drug resistant TB (MDR TB) and Extensively Drug Resistant TB (XDR TB), which are more difficult and expensive to treat.  Directly Observed Therapy (DOT) is the international standard of care for TB treatment, where a trained healthcare professional observes the patient taking his medication and checks whether the patient has any side-effects from taking the TB medication.  

11        MOH will take public health enforcement action against those who persistently default treatment as they pose a public health risk to the community.  Such persons will be required under the IDA to comply with treatment by DOT until completion.  Persons who continue to default their treatment may be also be detained at the Communicable Diseases Centre at Tan Tock Seng Hospital till they are cured.

How individuals and the community can help control TB

12        People with TB can be treated and cured earlier if they seek medical help promptly and adhere to their treatment. This can safeguard the patients’ health as well as the people around them. There is still stigma attached to TB patients and this acts as a hurdle for people coming forward for diagnosis and treatment. The community can hence also play its part by providing support and encouragement to TB patients. For instance, families of patients should encourage patient to be adherent to treatment and employers should be understanding and allow their workers to take time off to go to the polyclinic for DOT.

13        More information on TB is available at the MOH FAQs at http://www.pqms.moh.gov.sg/apps/fcd_faqmain.aspx

MINISTRY OF HEALTH

28 November 2008

[1] Informing the Airlines is one of the requirements laid down by WHO in the latest guidelines on TB and travel.

Extract from the 3rd Edition of WHO's "TB and Air Travel":

“Airline companies are obliged to comply with the applicable requirements in the IHR and the laws of the countries in which they operate. It is the responsibility of airlines to be familiar with the specific laws and regulations concerning communicable diseases applying to passengers and goods at points of entry for each destination country. Similarly, when transporting infectious agents or passengers with communicable diseases, airline companies need to comply with the laws on safety procedures and on the release of passenger information of each country to which they fly, as well as the IHR regarding such information and other issues."

[2]Preliminary data

• Annex (0.55 MB)