H7N9

13 May 2013

Question No. 1135

Name of Person: Ms Foo Mee Har

To ask the Minister for Health (a) what possible impacts will the H7N9 strain of bird flu outbreak in China have on Singapore; and (b) what precautions do we have in place to counter and contain any spread of the disease.

Question No. 1147

Name of Person: Dr Lee Bee Wah 

To ask the Minister for Health with the outbreak of the new strain of bird flu and the imminent school holidays in June (a) what is the Ministry's advice for those who are planning trips to China; and (b) how prepared are our hospitals to meet any epidemic outbreak of bird flu.

Question No. 1173

Name of Person: Mr Zainal Sapari

To ask the Minister for Health (a) what is the risk assessment of the H9N7 strain of bird flu spreading to Singapore; (b) what are the measures taken to minimise the potential threat posed by the spread of this strain of bird flu; and (c) what is the worst case scenario that Singapore has to be prepared for.

Question no. 1190

Name of Person: Dr Lam Pin Min

To ask the Minister for Health (a) if he will provide an update on the novel coronavirus and H7N9 influenza outbreak; and (b) what are the surveillance measures and management strategies in place to handle any index case in Singapore

CONSOLIDATED ANSWER

Current disease situation - H7N9 in China

1.       Since the first reports from China on 31^st March this year, there have been a total of 132 confirmed cases of avian influenza A (H7N9) infection, including 33 deaths. Affected areas in China include eight provinces and two municipalities.  Taiwan also reported one confirmed case who was likely to have been infected in Jiangsu, China.

2.       Infected poultry and contaminated live poultry markets are the most likely source of infection. Many of the cases had such exposure, and the virus has been isolated in chickens, ducks, pigeons and environmental samples from live poultry markets. Closure of the poultry markets in Shanghai has significantly reduced the number of cases there.

3.       There is no evidence of sustained person-to-person transmission so far. Despite close monitoring of more than 2000 contacts, only three small family clusters have been identified so far, but these could be due to either common exposure to an animal source or limited person-to-person transmission.

Current disease situation - Novel Coronavirus in Saudi Arabia, Qatar, Jordan and the United Arab Emirates

4.       Besides the threat of H7N9, MOH is also closely monitoring another emerging infectious disease - the novel coronavirus infection first reported by the World Health Organisation (WHO) in September last year.  To date, there are a total of 34 confirmed cases of novel coronavirus worldwide, with 18 deaths. Countries which have reported cases include Jordan, Qatar, Saudi Arabia, the United Arab Emirates, the United Kingdom (UK) and France.  The source of the novel coronavirus remains unclear. There have been several clusters suggestive of limited human-to-human transmission between close contacts, but there is no evidence of sustained human-to-human transmission of the infection so far. However, we are monitoring the progress of investigations into the latest Saudi Arabian cluster closely.

Risk assessment to Singapore and Local control measures

5.       So long as there is no sustained human-to-human transmission for H7N9 or novel coronavirus, the risk of an outbreak in Singapore will remain low.

6.       Singapore does not import live poultry, birds or fresh frozen poultry meat from China. The Agri-Food and Veterinary Authority (AVA) has a comprehensive inspection and testing programme for imported poultry and birds to ensure that they are free from H7N9. The local chicken farms are under strict biosecurity and AVA conducts regular inspections at all pet shops that sell birds. AVA has a surveillance programme in place for chickens and birds in Singapore, including for birds in the wetlands reserves and public parks. The H7 avian influenza virus has not been detected in tests on local and imported birds.

7.       A potential concern is transmission of H7N9 to Singapore via migratory birds carrying the virus.  However, as the current H7N9 virus has not been detected in migratory birds in China, the risk of such transmission is currently low. AVA is vigilant against this possibility, and has stepped up surveillance testing on birds in Singapore, including migratory birds.

8.       We also need to be vigilant against the possibility of cases in travelers coming to Singapore. MOH has alerted all hospitals and doctors to look out for suspect cases with symptoms such as fever, cough and signs of pneumonia, and a travel history to affected areas for H7N9 and novel coronavirus. Suspect cases will be isolated and tested for H7N9 or novel coronavirus infection. To date, MOH has been notified of 11 cases who have been investigated for H7N9, and 24 who were investigated for novel coronavirus. None have been positive.

9.       Our hospitals have put in place procedures to manage suspected cases of H7N9 and novel coronavirus. These include infection control measures for management of respiratory infections, and triaging and separating of suspect cases at emergency departments from non-suspect cases to minimise risk of transmission. 

10.     When a confirmed index case is detected in Singapore, we stand ready to undertake contact tracing and phone surveillance of close contacts as an added precautionary measure, even in the absence of sustained human to human transmission. ICU isolation beds are available to manage severely ill patients.

Travel advisory

11.     WHO currently does not advise special screening at points of entry, nor does it recommend any travel or trade restrictions for both H7N9 and novel coronavirus.

12.     MOH has advised travellers to affected areas on general precautions, such as practicing frequent hand washing with soap and water, avoiding crowded areas and maintaining a high level of personal hygiene. In addition, H7N9-specific precautionary measures include avoiding direct contact with poultry, birds and their droppings, and consuming poultry and eggs that are thoroughly cooked.

13.     We have put up Health Advisory posters and issued Health Advisory notices to travellers at our airports, to remind inbound travellers who have been in the affected areas to seek medical attention if they become unwell with fever and cough, and to inform their doctors of their travel history.  As the June school holidays are approaching, we expect that Singaporeans will be making plans for overseas travel.  We would like to remind them to be alert to the latest global disease situations for H7N9 and novel coronavirus, as well as updates to MOH's travel advisory. 

Worst case scenario and preparedness

14.     We continue to monitor the situation for evidence of community transmission of H7N9 or novel coronavirus.  

15.     MOH has actively engaged other government agencies to coordinate whole-of-government approach to be ready for such a scenario. We have worked with hospitals and clinics to ensure that there is adequate surge capacity in healthcare infrastructure and beds. At the national level, we have sufficient personal protective equipment (PPE) and antiviral stockpiles (for influenza), which can be deployed should the need arises. Possible control measures include isolation of cases, quarantine of close contacts, and social distancing measures to reduce community transmission, if necessary.

16.      We will continue to engage the WHO and our overseas counterparts to keep abreast with the most updated information. We are monitoring the situation closely as it evolves to ensure that public health is safeguarded.