Update on Mexican Swine Influenza (30 April)

30 Apr 2009

 The World Health Organisation (WHO) has raised the pandemic alert phase for the Mexican swine flu outbreaks from Phase 4 to Phase 5. The change to a higher phase indicates that there is human-to-human spread of the virus into at least two countries in one region. The declaration of Phase 5 is a strong signal that a pandemic is imminent, though not inevitable. WHO has recommended countries to take steps to heighten surveillance, adopt measures for early detection and treatment of cases, and step up infection control in all healthcare facilities.

2 Even though as of 30th April 2009, there are no human cases of Mexican swine flu in Singapore, MOH will be upgrading our Disease Outbreak Response System Alert status from Yellow to Orange. There is a real possibility that such cases may surface in Singapore and we must be prepared at all fronts to delay its spread to Singapore for as long as possible.

Precautionary Measures Implemented

HEALTHCARE INSTITUTIONS

3 Our hospitals have already enhanced their infection control measures. For example, healthcare workers are already donning full personal protective equipment, especially in high risk areas such as the emergency department and intensive care unit. To reduce risk of exposure triaging of patients have also been introduced at emergency departments, polyclinics and outpatient clinics. Elective admissions have been reduced to increase hospital capacity.

4 Under the ORANGE alert state, infection control measures will be further stepped up. Temperature screening and screening for flu like symptoms for visitors to clinical care areas would be implemented. Hospital staff are required to don PPE in all areas with patient contact. The number of visitors would also be restricted to one visitor per patient.  This will help facilitate contact tracing and reduce unnecessary risk exposure in the hospitals.

ENHANCED SURVEIILLANCE

5 Those with a travel history to Mexico over the past seven days will be quarantined for seven days when they enter Singapore and undergo phone surveillance for symptoms for Mexican swine flu. Those who develop symptoms will be referred to the CDC for a thorough assessment. A dedicated ambulance service (tel 993) has been activated to convey such patients to CDC. Should evidence arise that other countries besides Mexico are exporting cases, MOH will also consider imposing similar conditions for travelers returning from those areas.

6 Members of the public who are returning from other affected areas (ie states of New York, California, Kansas and Texas in the United States and the state of Nova Scotia in Canada) are advised to stay at home for seven days upon return and check themselves for symptoms for Mexican swine flu. They should practice social distancing and refrain from joining mass gatherings, e.g. going to the cinemas, shopping malls, or supermarkets etc. Those who develop respiratory illness with fever (Temperature > 38C) within seven days after their return should put on a surgical mask, call 993 for an ambulance. They should also disclose their travel histories to their doctors.

TEMPERATURE TAKING AND VISITOR DETAILS RECORDING

7 MOH also encourages schools, workplaces and places of mass gathering to conduct temperature checks routinely. Those with a higher-than-normal temperature should be advised to seek treatment immediately. Recording of all information of all visitors, including the date and time of visit, personal particulars and contact number of visitors, is recommended. This will facilitate contact tracing when the need arises.

Situational Update of Cases

GLOBAL SITUATION

8 As of 30 April 2009, there are reportedly 99 confirmed cases of Mexican swine influenza (H1N1) cases in Mexico (with 8 deaths), 91 in the United States (with 1 death), 19 in Canada, 10 in Spain, 5 in United Kingdom, 3 in Germany, 3 in New Zealand, 2 in Israel, 2 in Costa Rica, 1 in Austria, 1 in Switzerland and 1 in Peru.

SITUATION IN SINGAPORE

9 As of 30 April 09, there are no human cases of Mexican swine flu in Singapore.  There have been 22 cases in total referred for further medical assessment. Of the 22 cases, 19 cases have been tested negative for Influenza A. 2 tested positive for usual circulating seasonal strains of Influenza A and 1 is pending laboratory investigations.

10 A review of historical vis-a-vis current seasonal flu trends shows that current incidence rates of acute respiratory illness have not increased from past years. In the past, the incidence rate of influenza A virus infection normally peaks around May/June and the majority were typeable strains. There were no untypeable cases detected last week and this is consistent with the fact that there is no evidence of community spread of the new strain of Mexican swine flu in Singapore. This reinforces the need for strong border controls so that imported cases can be picked up immediately to limit the spread of the virus. MOH will continue to closely monitor the local situation.

Advice from MOH

11 Members of the public are strongly advised to postpone or avoid non-essential travel to Mexico and affected areas. In the event that travel is unavoidable, the public is advised to take precautionary measures such as avoiding crowded areas and maintaining high standards of personal hygiene at all times.

12 MOH advises the public to maintain high standards of personal hygiene, such as washing hands frequently with soap and water, especially after contact with respiratory secretions (e.g. after sneezing and coughing). Those who are unwell with respiratory illness should stay at home and wear a surgical mask if possible.

13 MOH is monitoring the situation closely and will update the public should there be any new developments. For more information on Mexican swine flu, please access MOH’s website at www.moh.gov.sg or call our hotline at 1800-333 9999.

MINISTRY OF HEALTH