TB vigilance in schools: Full range of steps in place from detection to treatment

29 Jul 2005, Today

Question

TB vigilance in schools: Full range of steps in place from detection to treatment

Are School Heads Viligant Against TB? 

Your report, "State hospitals make staff sick" (July 13), indicated 25 Malaysian doctors, nurses and other staff were infected with tuberculosis (TB). Once thought to have been eradicated, TB has recently made a worldwide comeback. The World Health Organization has predicted China, India and Indonesia to be hotbeds of Aids and TB infections. In 2002, it also said that TB rates in Singapore, Malaysia, Brunei, Hong Kong and Japan were very high relative to their level of development, and warned that numbers could soar. TB is a highly-contagious, air-borne disease that can be easily contracted in crowded places such as schools, army camps, offices, buses and trains. While TB mostly affects the lungs, it can spread to other organs, such as the brain, heart, bones and womb. In Singapore, TB previously affected mostly elderly people. But now, TB is afflicting younger Singaporeans. A 21-year-old NSman, a 30-year-old teacher and a 40-year-old managing director have been reported to be victims. This year, there were two TB incidents in our schools which the public were largely unaware of. In the first case, a primary school teacher had a persistent cough and was diagnosed with TB. The principal then sent 38 students and 12 teachers for TB screening. It was found that the TB bacteria had been passed on to five students and three teachers. In the second case, a Chinese national secondary student was found to have TB. Seventy students and 10 teachers were screened and five were found to be infected with TB. As in fighting terrorism, our fight against diseases must lie in constant vigilance as well as a transparent approach. Our Health and Education Ministries should clear the air on matters such as: Is there a standard operating procedure laid down for principals on what to do to quickly break the chain of disease transmission in schools? What is being done to "ensure" TB-infected teachers or students complete the full course of medication to completely kill off the TB bacteria, so as not to pose any further risk to other students and teachers?

Reply

Name of the Person: Karen Tan (Ms)

Director, Corporate Communications

Ministry of Health 

Name of the Person: Wong Siew Hoog (Mr)

Director of Schools

Ministry of Education 

Mr See Leong Kit ("Are school heads vigilant against TB?", Today, 18 Jul) had raised concerns about the incidence of Tuberculosis (TB) in Singapore, including schools. 

The incidence of TB has declined in Singapore, from 307 cases per 100,000 population in 1960 to 39 cases per 100,000 in 2004. TB is still very much a disease of the older age group. Of the new cases notified among Singapore residents in 2004, more than half were aged 50 years and above. The incidence among children aged below 15 years remained low at less than 5 cases per 100,000 population. 

Early treatment is important for the prevention of further transmission of TB. Upon diagnosis, the patient is started on treatment and once regular treatment is commenced, the risk of infecting others is very much reduced. Thus the risk of such persons spreading TB to others will be minimised. Active contact tracing is also carried out to identify close contacts of infectious TB cases, who will then be screened and given preventive treatment, where necessary. 

Schools handle all cases of contagious diseases very seriously and they have clear guidelines on what to do in the event of such occurrences. They are guided by advice from the medical agencies. For TB cases, schools will refer to the TB Control Unit of Tan Tock Seng Hospital for advice, and undertake the necessary measures to prevent the spread of the disease to the rest of the school community, including contact tracing and sending close contacts for medical screening. Schools will arrange for the disinfecting of school premises, where necessary. Besides these, communicating with students and parents are also important measures to create awareness and understanding of the disease and preventive actions. 

Mr See had also enquired about ensuring that TB patients complete their full course of medication. Compliance with treatment by TB patients is enhanced by the use of Directly Observed Treatment (DOT). Under DOT, all doses of the TB medication are administered and observed to be taken by healthcare workers in the Polyclinics. To further facilitate monitoring, a computerised system has been put in place to track every case of TB. This ensures that patients who miss their treatments are identified and closely followed up. 

The Ministries of Health and Education remain vigilant on all cases of contagious diseases, including in schools, and will continue to work closely to address them. 

Please publish this letter in full. Thank you.