Singapore health authorities remain vigilant about TB

3 November 2011, TODAY

PARENTS whose children study in Bedok Town Secondary School may understandably be angry to learn recently of three pupils being diagnosed with tuberculosis (TB) from a newspaper report and not through an official Ministry of Health announcement.

The performance of both the infected pupils and other anxious pupils at their O-Level examinations may be adversely affected.

This is just the tip of the iceberg for a disease once thought eradicated. Multidrug-Resistant TB and Extensively Drug-Resistant TB are worryingly on the rise worldwide. Both are difficult to treat.

The World Health Organization has indicated that China, India, Indonesia, the Philippines and Vietnam are hotbeds of TB infection.

Many of our immigrants, migrant workers and domestic maids come from these countries.

Over the past 20 years, an annual average of 1,500 new cases of TB have been detected among Singaporeans and permanent residents. Foreigners accounted for 550 cases last year.

Even more worrying is the increase in the number of TB patients here who fail to complete their treatment, reported in 2009. This could lead to a further spread of TB and the rise of drug-resistant strains.

TB is a highly contagious, airborne disease that can be easily contracted in crowded places. While the bacteria infects mostly the lungs, it can spread to other organs. TB has now afflicted younger Singaporeans and not just the elderly.

MOH statistics last year showed that there were 153 Singapore-born TB victims under the age of 30, of which 12 were under the age of 10. The writing is on the wall.

In 2005, the public were mostly unaware of two TB incidents in schools. In one case, a primary school teacher with a persistent cough was diagnosed with TB. Of the 38 pupils and 12 teachers sent for screening, five pupils and three teachers were found to have picked up the TB bacteria.

In the other case, a Chinese national secondary student was found to have TB. Of the 70 students and 10 teachers screened, five were found to be infected.

Singapore, as a tiny, densely-populated island with a hot, humid climate, is particularly vulnerable to the spread of infectious diseases, such as TB, SARS, H1N1 and avian flu.

Our fight against public health threats must lie in constant vigilance, pro-active preventive measures and a fully transparent approach to pre-empt panic in any outbreak.

Concerned Singaporeans expect the MOH to issue an overdue and credible public assurance, backed by full facts and figures, on the latest school incidents.

See Leong Kit

Reply from MOH

MR SEE Leong Kit in "No room for complacency in fight against tuberculosis" (Nov 3) noted the recent TB cases in schools and the spread of TB among young Singaporeans. We share his concern and are working closely with the Tuberculosis Control Unit (TBCU), the Ministry of Education (MOE) and schools to manage such cases.

When a TB case is detected in a school, the TBCU will work with the school to inform teachers, students and parents of students who were in close contact with the affected student to carry out contact investigations.

This process identifies close contacts who might have been exposed to TB and offers them preventive treatment. It is important to note that TB is spread via close and prolonged contact.

We would like to assure Mr See and parents that the health authorities and schools have established effective procedures to manage TB cases. An affected school would work closely with TBCU and MOH on the contact tracing and screening procedures, as well as preventive measures. The school would also step up its vigilance and encourage students to seek medical attention if they are unwell.

Despite our proximity and open borders with countries with high incidence of TB, Singapore has one of the lowest TB incidence rates in Asia. However, as TB is in the community, TB cases will surface in schools and other institutions from time to time. Incidentally, only a very small proportion of TB cases occur in children - the incidence rate of TB among children in schools (aged 15 and below) is also much lower than the overall incidence rate. Last year, the TB incidence rate for children aged 5 to 9 years was 2.3 per 100,000 and for children aged 10 to 14 years was 2.0 per 100,000 compared to the overall rate of 39.2 per 100,000 population.

TB is a curable disease. Early detection and full compliance to treatment remain the key to a successful TB control programme. Patients generally become non-infectious after the first two weeks of treatment and there is thus no risk to the community when they return to work/school after this period. However, for complete cure, patients will need to adhere to the full treatment course, which involves taking several anti-TB drugs for at least six months. The support and encouragement from family members and employers will go a long way in ensuring that patients adhere to treatment.

The national TB control programme was strengthened in 1997 with the launch of the Singapore TB Elimination Programme to better control and manage the disease. The MOH regularly reviews the effectiveness of our TB control programme and will implement enhancements from time to time.

Dr Jeffery Cutter
Director, Communicable Diseases Division
Ministry of Health

Wong Siew Hoong
Director of Schools
Ministry of Education