TUBERCULOSIS SCREENING FOR BLOCKS 1 AND 3 JALAN BUKIT MERAH AND ABC BRICKWORKS MARKET AND FOOD CENTRE

         The Ministry of Health (MOH) will conduct mandatory Tuberculosis (TB) screening from 11 to 15 January 2024 for residents and workers of Blocks 1 and 3 Jalan Bukit Merah, ABC Brickworks Market and Food Centre and Thong Kheng Seniors Activity Centre @ Queenstown at Block 3 Jalan Bukit Merah.

2        Following the detection of a cluster of seven TB cases linked to Block 2 Jalan Bukit Merah in 2022, MOH had conducted an onsite screening for current and former residents, shop owners and employees of Block 2 Jalan Bukit Merah from May to August 2022. All the detected cases of active TB disease were treated under the National TB Programme. Between February 2022 and July 2023, 10 additional active TB disease cases were detected by the National TB Programme. As these cases have been started on treatment since diagnosis, they do not currently pose any public health risk, because active TB disease rapidly becomes non-infectious once treatment starts.

3        Genetic analysis conducted by the National TB Programme in September 2023 revealed that all 10 cases have similar genetic make-up as the cases in Block 2 Jalan Bukit Merah. This suggests that there had possibly been spread beyond Block 2 Jalan Bukit Merah to the immediate vicinity. The extended on-site TB screening is offered by MOH as a precautionary measure, to protect residents living in the area by identifying any undetected active TB disease cases, and prevent further transmission as far as possible.

4        An estimated 3,000 individuals will be screened for this screening exercise. From 11 to 15 January 2024, the following groups are required to undergo mandatory screening:

1. Current residents, stallholders and shop owners (including employees) at Blocks 1 and 3 Jalan Bukit Merah;

2. Stallholders and employees at the ABC Brickworks Market and Food Centre; and

3. Clients and staff who attend the Thong Kheng Seniors Activity Centre @ Queenstown at Block 3.

5        In addition, voluntary screening will be offered to these groups:

1. Frequent visitors to Blocks 1, 2 and 3 Jalan Bukit Merah and ABC Brickworks Market and Food Centre between November 2021 and January 2024. These persons must have spent a cumulative total of more than 12 hours per month at the location(s);

2. Persons living or working at Block 2 who did not undergo TB screening during the previous mass screening exercise from May to August 2022;

3. Former residents and tenants of Blocks 1 and 3 Jalan Bukit Merah; and

4. Teachers and students of PCF Sparkletots @ Queenstown in Block 3 Jalan Bukit Merah.

6        The risk of transmission to persons who are not close contacts of a TB case is very low. Screening is thus not necessary for individuals who had only occasionally visited the blocks, market and food centre, or the vicinity.

7        Both mandatory and voluntary screening are offered free of charge, with priority given to those for whom screening is mandatory.

8        The screening process for TB involves administering a blood test to detect latent TB infection. From 11 to 13 January, staff from MOH and the National Centre for Infectious Diseases (NCID) will be going door-to-door to conduct mandatory screening in the homes of residents of Blocks 1 and 3 Jalan Bukit Merah. In addition, screening stations will be set up at the open-air carpark adjacent to Block 2 Jalan Bukit Merah from 11 to 15 January, to cater to persons working at the blocks or ABC Brickworks Market and Food Centre. Residents who are unable to undergo screening in their homes can request to be screened at the screening stations instead.

9        Persons who are offered voluntary screening can make an appointment at https://go.gov.sg/tbs for screening at the carpark of Block 2 Jalan Bukit Merah from 14 to 15 January 2024. Screening is strictly by appointment only.

10       Staff from MOH and NCID, with support from the People’s Association, will be visiting all units at the affected blocks and stalls at the ABC Brickworks Market and Food Centre from 6 to 9 January 2024, to engage residents and stallholders and to address any questions they may have. Residents and stallholders should be ready with their personal identification details to facilitate verification of household members and appointment scheduling.

11       Persons who test positive for latent TB infection will be required to undergo additional evaluation, which includes chest X-ray, clinic review and other tests (e.g. sputum testing). Persons with latent TB infection do not exhibit symptoms of TB, are not infectious and therefore do not pose a public health risk. Those diagnosed with latent TB infection will be offered preventive treatment to reduce their risk of developing active TB disease in the future. Persons with an abnormal chest x-ray will be further evaluated at the TB Control Unit and if diagnosed with active TB disease, treatment will commence promptly. Contact tracing for each active TB disease case will be conducted in accordance with current contact tracing protocols to identify and evaluate close contacts.

Identification of TB Cluster

12       In March 2022, MOH was notified of seven TB cases involving residents of Block 2 Jalan Bukit Merah, who were diagnosed between February 2021 and March 2022. Voluntary TB screening was offered in May 2022 to current and former residents of Block 2 Jalan Bukit Merah, as well as stallholders, shop owners and their employees at that location. As the number of latent TB infections detected in the screening exercise was higher compared to the rates expected for the general population, the screening exercise was made mandatory in June 2022 to detect TB cases and provide them with appropriate treatment. In total, the screening detected 197 cases of latent TB infection and 15 cases of active TB disease. All the detected cases of active TB disease were treated under the National TB Programme.

13       Between February 2022 and July 2023, 10 additional active TB disease cases were diagnosed by the National TB Programme. Of these, six of them were frequent patrons of the ABC Brickworks Market and Food centre, one worked at the market, two are residents of Block 1 Jalan Bukit Merah, and one is a resident of Block 2 Jalan Bukit Merah.

14       In accordance with the World Health Organization’s recommendations, the National TB Programme initiated contact investigations and screening of contacts for each of the cases, involving their family members, close workplace colleagues and acquaintances from common social activities. Investigations for each of the cases at the time of their diagnosis did not identify each other as close contacts.

15       Genetic analysis conducted by the National TB Programme in September 2023 revealed that all 10 cases have similar genetic make-up as the cases in Block 2 Jalan Bukit Merah. This suggests that there had possibly been spread beyond Block 2 Jalan Bukit Merah to the immediate vicinity. Further detailed epidemiological investigations into the cases did not reveal any common links, other than that many of the cases frequented ABC Brickworks Market and Food Centre or lived in the vicinity. They did not know or interact with one another, or congregate at the same common areas, and had also not identified each other as close contacts. MOH was notified of the cases in November 2023.

Health Advisory

16       MOH strongly encourages residents and persons working in Blocks 1 and 3 Jalan Bukit Merah, and ABC Brickworks Market and Food Centre to be screened to determine if they have active TB disease or latent TB infection (which is non-infectious).

17       Transmission of the TB bacteria from active cases usually requires prolonged exposure (days to weeks, rather than minutes to hours). A person cannot get TB from sharing cups, utensils or food. TB is also not spread through shaking hands, kissing, touching bed linens or toilet seats.

18       Active TB disease is curable, and the spread of TB is preventable. Early detection and prompt treatment of cases remain important in helping those infected and rendering them non-infectious. For individuals diagnosed with active TB disease, adherence to treatment is important. More information on TB can be found in the Annex. 

MINISTRY OF HEALTH
5 JANUARY 2024