World Tuberculosis Day

20 Mar 2008

WORLD TUBERCULOSIS DAY

World TB Day – I am stopping TB

1 World TB Day, held annually on 24 March, is a day of world-wide social action to build public awareness about tuberculosis (TB) as well as to call for increased commitment from the government and community to fight the disease.  The theme for this year’s World TB Day is “I AM STOPPING TB”.  It puts across the message that everyone can do something to stop TB and that every individual’s action counts. It calls for personal and community responsibility to stop TB.

What is TB

2 Tuberculosis is an infectious disease that is preventable and curable. It is contagious and spreads through the air by aerosolized respiratory droplets from a person who has the disease. Persons who breathe in the air containing TB bacteria can become infected. In most people who become infected, the body’s immune system is able to fight the TB bacteria and stop them from multiplying. Although dormant, the bacteria are not killed. This is called latent TB infection. Persons with latent TB infection do not have symptoms of TB disease and they cannot spread the disease to others. However the bacteria remain alive in the body and there is about a 10% lifetime risk of developing TB disease in the future. Preventive chemotherapy may be given to a person with latent TB infection to prevent the progression from latent infection to disease. 

3 For persons who progress from infection to the disease state of TB, the symptoms include prolonged cough of more than 3 weeks, blood in the sputum, fever, night sweats, loss of weight and appetite, and fatigue. If left untreated, 50% of TB sufferers will die from the disease.

Global TB Situation

4 Despite concerted efforts taken globally to fight TB, the disease remains a massive global public health problem, especially in the developing world. The World Health Organisation (WHO) reported that there were 9.2 million new cases and 1.7 million deaths from TB in 2006 . 

5 The emergence of resistant strains of TB, [Multi-Drug Resistant TB (MDR TB) and Extensively Drug Resistant TB (XDR TB)] have made the control and management of TB even more challenging.  The WHO estimates that there are nearly half a million new cases of MDR-TB each year and has recently reported the highest rates of drug-resistant TB to date.  This is of great concern as MDR TB and XDR TB are more difficult and many times more expensive to treat.  Furthermore, currently available drugs may fail to provide a cure for persons with XDR TB.

TB Situation in Singapore

6 TB incidence in Singapore decreased rapidly from 1960 to mid 1980s due to better social-economic conditions and the TB control programme which was set up in 1957.  It stagnated for a decade, until the inception of the Singapore Tuberculosis Elimination Programme (STEP) in 1997, where there has been a steady decline in the incidence rate of TB. In 2007, the incidence of TB was 35.1 cases per 100,000 residents (1256 cases) compared to 54.8 per 100,000 residents (1712 cases) in 1997 and 35.6 per 100,000 residents (1256 cases) in 2006.  In 2007, men accounted for 68% (851 cases) of new TB cases in Singapore, and more than half (56%) of the patients were aged 50 years and above. The number of MDR TB cases remains low (4 cases in 2007).

Control of TB in Singapore

7 The key to successful control of TB in Singapore is early diagnosis and complete treatment till cure.  To ensure early diagnosis of TB, persons with symptoms suggestive of TB should consult a doctor without delay.

8 Treatment of TB takes 6 to 9 months. Patients with TB disease must complete the full course of treatment to ensure that they are cured. Failure to complete the full course of treatment may result in a relapse of TB with resistant strains. Directly Observed Therapy (DOT) is an international standard of care for TB treatment, where a trained healthcare professional observes the patient taking his daily medication.  Adherence to DOT ensures successful treatment and cure. Each new diagnosis of TB is notified to the TB Control Unit (TBCU) in Tan Tock Seng Hospital. TBCU carries out contact tracing and evaluation for close contacts of infectious TB cases in order to provide appropriate treatment to prevent the progression of the disease among the infected contacts.

9 MOH has a responsibility to ensure that persons who are irregular with their TB treatment or who do not complete their treatment do not pose a public health risk to the community. Public health enforcement action will be taken against those who persistently default treatment and they will be required under the Infectious Diseases Act to comply with treatment by DOT until completion.  Persons who continue to default their treatment may also be detained at the Communicable Disease Centre at TTSH for the duration of their treatment.

Personal Responsibility

10 The theme for World TB Day calls for patients to play their role in stopping TB. Persons who have symptoms suggestive of TB should consult a doctor promptly. They should adhere to their treatment to ensure that they do not develop drug-resistant strain of TB.  Such resistant forms of TB are man-made as their emergence is a result of non-adherence to treatment or inadequate treatment. By seeking early treatment and adhering to their treatment, they are safeguarding the health of those around them i.e. at home, in school and at work.

Community Responsibility

11 “I am stopping TB” also calls the community to play a part in the control of TB.  There is still significant stigma attached to TB patients, and this works against people coming forward for proper diagnosis and treatment.  Moreover, as the complete treatment for TB takes at least 6 to 9 months, it is crucial that TB patients receive the full support and understanding from their families, friends, employers and co-workers so that they can successfully complete their treatment and prevent disease transmission to the community. For instance, families of patients should encourage the patient to be adherent to his treatment, while employers should allow their workers to take time off so that they could go to the polyclinic for DOT.  Treatment completion will not only benefit the patient but also his family, workplace and the community at large.

12 Let us work together to provide the support and encouragement to TB patients so that they will adhere and complete their entire course of treatment.

13 More information on Tuberculosis is available at the Health Promotion Board website at www.hpb.gov.sg.

MINISTRY OF HEALTH

20 March 2008