MOH Launches Clinical Practice Guidelines In Fight Against Tuberculosis

1.    To mark World Tuberculosis Day which falls on 24 March every year, the Ministry of Health (MOH) will be launching a set of clinical practice guidelines (CPG) for tuberculosis (TB) to aid medical practitioners in the diagnosis and management of TB.

2.     The CPG serves as a reference for all doctors and stresses the importance of early diagnosis and treatment for TB patients. Developed by a clinical workgroup appointed by MOH, the guidelines aim to facilitate the early detection of active TB, provide guidance on the use of TB diagnostic tools and treatment regiments, and provide information on the public health measures for TB control. It will be made available to doctors from next month.

3.     The World Health Organization’s theme for this year’s World TB Day is “Unite to End TB”. It stresses the importance of close collaboration across disciplines and sectors, as well as personal responsibility to end the global TB epidemic.

Update on the Tuberculosis Situation in Singapore

4.     TB is a global public health threat. Globally, there are more than 9 million cases of TB every year, with 1.5 million deaths. In addition, there are almost half a million cases of multi-drug resistant TB (MDRTB). MDRTB is more difficult to treat and has lower cure rates, with death rate as high as 30% to 40%.

5.     In 2015, there were 1,498 new cases of TB among Singapore residents locally. This is higher than the 1,454 cases in 2014. Older age groups and males continue to make up a significant proportion of the new cases. Please refer to Annex A for details.

6.     TB is curable and the spread of TB is preventable. While there are currently national control measures in place to reduce the risk of ongoing transmission in Singapore, each of us plays an important role in keeping our community safe and free of TB. Individuals who display symptoms such as unexplained prolonged cough of 3 weeks or more should seek medical attention early to ensure prompt diagnosis and treatment.

Importance of Treatment Adherence

7.     The full course of TB treatment takes six to nine months. If patients do not adhere to their medications, there is a higher chance of them developing drug resistance, treatment failure, and future disease relapse. Directly Observed Treatment (DOT) therefore remains a pillar of the Singapore TB Elimination Programme (STEP) as it is the best way of assuring patients’ adherence for the sake of their health and others around them. DOT consists of daily administration of TB medicines by a trained nurse to the patient, and is available in polyclinics. STEP also manages an outreach DOT programme for patients who are unable to commute to clinics for their medications due to age or infirmity.

8.     To prevent disruption to TB treatment, patients are counselled on the importance of adhering to DOT for the entire duration of their treatment regimen. It is in the best interest of the patient and the community that TB patients adhere to the recommended treatment protocol. Intermittent treatment can result in patients becoming infectious again, or needing to extend their treatment beyond the usual treatment period of 6-9 months. If patients are not treated promptly, or if they are not strictly adherent to treatment, the danger to the community is greater. Contact investigations reveal community transmission remains a problem and result in a significant number of newly infected cases locally.

Support from the community

9.     Support and encouragement from patients’ family members, friends and the community are vital in ensuring TB patients successfully complete their treatment. Employers should also be supportive of TB treatment for their workers, by granting them the flexibility to go to polyclinics for DOT. Treatment adherence and completion will benefit not only the patient, but also his family, his workplace and the community.

10.     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

(https://www.moh.gov.sg/content/moh_web/home/diseases_and_conditions/t/tuberculosis.html) or the HPB website (http://www.hpb.gov.sg/diseases/article.aspx?id=586).

MINISTRY OF HEALTH

24 MARCH 2016

ANNEX A

Update on the Tuberculosis Situation in Singapore

MOH was notified of 1,498 new cases of tuberculosis (TB) among Singapore residents[1] in 2015, which is higher than the 1,454 cases in 2014. Correspondingly, the incidence rate was 38.4 cases per 100,000 population in 2015, compared to 37.4 cases per 100,000 in 2014. The number of non-residents[2] notified with TB was 1,206 in 2015 compared to 1,287 in 2014.

Older age groups and males continue to make up a significant proportion of the new cases. Of the 1,498 new cases notified, 1018 (68.0%) were 50 years of age and above, and 1,009 (67.4%) are male. There were 144 relapsed cases among Singapore residents.

The emergence of multi-drug-resistant TB (MDR-TB) remains a serious public health challenge. In 2015, Singapore had five new cases of MDR-TB who were Singapore-born residents. The number of such cases must be kept low despite a higher regional prevalence of MDR-TB, 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 residents* 1960 – 2015

* Singapore citizens and permanent residents

Table 2

Distribution of TB cases by age group and country of birth,

Singapore residents, 2015

Table 3

Ethnic-gender distribution of reported tuberculosis (new case)

 Singapore residents, 2015

[1] Residents refer to Singaporeans and Permanent Residents

[2] Non-residents refer to foreigners on long term stay here for work, study or visit