Update on Ebola

3 November 2014

Question No. 308

Name and Constituency of Member of Parliament

Dr Lily Neo

MP for Tanjong Pagar GRC

Question:

To ask the Minister for Health with more Ebola cases spreading and the first case of human-to-human transmission of the Ebola virus outside of Africa, whether the Ministry has further plans to step up efforts to counter and contain any spread of the virus within the country.

Question No. 314

Name and Constituency of Member of Parliament

Dr Chia Shi-Lu

MP for Tanjong Pagar GRC

Question:

To ask the Minister for Health in view of the worsening Ebola outbreak in West Africa and its spread to other countries, whether the Ministry will consider imposing a travel ban on the affected nations in Africa until the epidemic is brought under better control.

Question No. 320 & 321

Name and Constituency of Member of Parliament

Mr Gerald Giam Yean Song

Non-Constituency MP

Question:

To ask the Minister for Health (a) whether the current Ebola screening measures at Changi Airport are effective in detecting the virus given that its symptoms may appear up to 21 days after exposure to Ebola and that it is difficult to verify travellers' self-declarations of their exposure to Ebola; (b) whether there are plans to use rapid diagnostic test kits to diagnose Ebola; and (c) what lessons have been learned from the cases of Ebola transmission in Texas, USA and Spain to prevent the same mistakes from occurring in Singapore should an Ebola-infected traveller get through our border checkpoints.

To ask the Minister for Health (a) what is the quantum and nature of assistance that Singapore has provided to countries in West and Central Africa to combat the spread of Ebola and treat patients infected with the virus; and (b) what further assistance Singapore plans to provide to the affected countries should the Ebola situation worsen.

 Answer

1        As of 31 October 2014, the World Health Organization (WHO) reported a total of 13,567 cases of Ebola, including 4,951 deaths. There continues to be widespread and intense transmission of Ebola in Guinea, Liberia and Sierra Leone.  Nigeria, Senegal, Spain, the United States (US) and Mali have reported imported cases, some with limited transmission.  WHO has since declared Nigeria and Senegal to be free of Ebola. In addition, a separate Ebola outbreak is ongoing in the remote areas of Democratic Republic of the Congo (DRC) (involving 66 cases and 49 deaths). No new cases of Ebola have been reported in DRC since 4 October. WHO has stated that DRC will be declared free of Ebola on 21 November if there are no further cases.

Mitigating the Risk of Imported Cases of Ebola

I.                   Border Control Measures for Ebola Virus Disease

2        Since 7 August 2014, the Ministry of Health has instituted several border control measures. Travellers are provided with a Health Advisory on Ebola through the deployment of Health Advisory Posters and the distribution of Health Advisory Notices (HANs) to nationals from Ebola-affected African countries at all air, land and sea checkpoints, as well as other travellers who self-declare their history of travel to Ebola-affected countries. The Advisory tells them about Ebola symptoms and advises them to seek medical attention immediately and inform the medical staff of their travel history if they develop such symptoms.

3        The Ministry of Health (MOH) has stepped-up screening measures against Ebola at our checkpoints. Nationals and travellers from countries with significant or potentially significant Ebola transmission (currently Guinea, Liberia, Sierra Leone and DRC, Mali) arriving at our air-checkpoints will be directed to a screening station, where they will be screened for fever, requested to complete a Health Declaration Card, which will include their contact details in Singapore, and assessed for the risk of exposure to Ebola through a questionnaire.

4        Travellers who are found to have a fever will be sent to Tan Tock Seng Hospital (TTSH) for further assessment and testing.  Those who are well but assessed to have a risk of exposure to Ebola will be kept under phone surveillance or quarantined for up to 21 days, depending on the nature of their potential exposure. Screening of travellers from countries with significant Ebola transmission is also conducted at land and sea checkpoints using Health Declaration Cards and questionnaire assessment.

5        The border health measures are part of a multi-layer defence against Ebola.  While they alone will not be able to identify persons who are still in the incubation period and are not symptomatic, or are not truthful in answering the screening questionnaire, they complement our overall efforts in looking out for travellers who may have Ebola infection. 

II.                Travel Restrictions

6        MOH is concerned by the widespread and intense community transmission of Ebola in West Africa. As such, MOH is working with the Ministry of Foreign Affairs (MFA), Ministry of Home Affairs (MHA), the Immigration & Checkpoints Authority (ICA), and the Civil Aviation Authority of Singapore (CAAS) to impose temporary visa requirements for nationals from Guinea, Liberia and Sierra Leone for entry into Singapore, starting from 5 November. This move will allow for better oversight, and control of entry of nationals from these countries, and facilitate possible contact tracing. MOH will continue to monitor the Ebola situation closely and calibrate our preparedness measures.

Managing an Imported Case of Ebola

I.                   Preparedness of the Healthcare Community

7        To keep our healthcare institutions at a high state of vigilance, we have given regular updates to all hospitals, polyclinics and primary care doctors on the Ebola situation. We have also provided them with guidance and protocols on the criteria for identifying suspect Ebola cases, how to refer such cases for further assessment and the subsequent management of suspect and confirmed cases of Ebola. MOH has also conducted preparedness exercises and visited our public hospitals to ensure that they are well-prepared, and adequately resourced to manage cases of Ebola.

II.                Clinical Management

8        Suspect and confirmed cases of Ebola will be centrally managed in TTSH, which has been designated as the national disease outbreak centre. Meanwhile, Ebola virus testing will be centrally conducted by the National Public Health Laboratory’s designated testing facilities at the DSO National Laboratories (DSO).

9        Currently, testing for the Ebola virus is done using the polymerase chain reaction (PCR) method.  This is the most sensitive method and the mainstay of diagnosis in all reference laboratories. Rapid diagnostic test kits to diagnose Ebola are being developed and tested but none has yet been approved for use. MOH will evaluate the performance of such rapid kits to determine their suitability for use in our environment when they become available. 

10      The standard treatment for Ebola is supportive therapy. While there are experimental treatments and vaccines being developed and tested, none have been proven to be clinically safe or effective. MOH will continue to monitor developments in these areas.

Preventing a Local Outbreak

I.                   Lessons Learnt from Spain and the U.S.

11      Of the five Ebola cases that were diagnosed in Spain (1) and the U.S. (4), three involved healthcare workers who had provided care to patients who were infected with Ebola in West Africa. Investigations of these cases suggested possible breaches in infection control measures such as improper removal of Personal Protective Equipment (PPE). 

12      Although our hospitals and healthcare workers have been trained on the proper use of PPE, we have not been complacent. Our hospitals have been reminded on the need for strict infection control measures and adherence to stringent protocols when managing suspect and confirmed cases of Ebola. Even with proper equipment, protocols and training, human error can occur, as was observed in the cases of secondary transmission in Spain and the U.S. MOH will continue to work with the National Infection Prevention and Control Committee (NIPC) and other experts to review our guidances and protocols to ensure a high degree of competency and preparedness in our hospitals. 

Ebola Aid Contribution

13      In response to appeals for aid, Singapore has contributed an aid package consisting of medicines, medical supplies and personal protective equipment to the World Health Organisation (WHO).  In addition, Singapore also contributed US$150,000 in cash to the WHO, to support the WHO Ebola Response Roadmap. Singapore will continue to work with the WHO on how to further assist in the global effort against the Ebola outbreak in Africa based on our capability and available resources including the possibility of seconding one of our experts to assist WHO Headquarters (WHO HQ) in Geneva in their relief effort.