Wednesday, 7 October 2015

Hepatitis C cluster @SGH: 22 infected, 4 have died

Updated 26 Oct 2015: SGH hep C outbreak: 2 infected patients part of affected cluster
This brings total to 25 patients infected

The two Singapore General Hospital (SGH) patients who had earlier tested positive for hepatitis C have been found to be part of the affected cluster, bringing the total number of patients infected in the hospital’s hepatitis C outbreak earlier this year to 25.

“Phylogenetic studies done for the two patients who were tested positive as announced on 23 October showed that they are part of the affected cluster,” said SGH’s Chairman of the Medical Board Fong Kok Yong in a statement issued by the hospital today (Oct 26).

The patients were admitted to Wards 64A and 67 from April to June 2015.  “We will provide the patients and their family with our full support and ensure that the patients receive timely and appropriate care,” said Prof Fong.

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WP Queries Delay In Hep C Outbreak Announcement

The Workers’ Party extends its deepest condolences to the affected families and friends of the four patients who passed away since the outbreak of the Hepatitis C virus infections at the renal ward of the Singapore General Hospital (SGH) that affected 22 patients.

It was reported SGH had been aware of the infection cluster since early June 2015, but information surrounding the outbreak was only made public four months later, in October 2015. An outbreak of Hepatitis C is a potential public health risk. The knowledge of such an outbreak is relevant to all citizens as they weigh their treatment options.

The Workers’ Party would therefore like to seek clarifications from the Minister with regard to the standard protocol in releasing information on such outbreaks, whether or not they occur within a treatment facility. These questions are posed with a view to strengthen Singapore’s infection control protocols in the future.
  • Is there a timeframe within which healthcare institutions must report such incidents to the Ministry?
  • What does the Ministry believe is a permissible interval of time before the public is made aware of such incidents?
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SDP slams lack of transparency in handling of hepatitis C outbreak

The Singapore Democratic Party (SDP) yesterday (Oct 8) criticised the lack of transparency in the Ministry of Health’s (MOH) handling of the hepatitis C outbreak at Singapore General Hospital, and was the second Opposition party to voice concern over the incident in as many days.

In a media release yesterday, SDP chief Chee Soon Juan asked why the public had not been informed, even though internal investigations into the outbreak had started as early as May.

“Was the withholding of the information a political consideration?” he said.

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Late disclosure because there “were no signs of acute hep C cases”: MOH

The reason why it took several months for the news of the Hepatitis C outbreak to be made public was because there were no signs that the incidents were of acute viral Hepatitis C.

This was the explanation given by the Ministry of Health (MOH) on Wednesday, when responding to questions which are being raised by the public since the outbreak at the renal ward of the Singapore General Hospital (SGH) was reported in the media.

According to the Infectious Diseases Act (IDA), incidents of acute viral hepatitis C must be reported to the ministry within 72 hours, unlike chronic cases which need not be reported.

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SGH Fiasco A Systemic Failure
The timeline that traces the tragic events in SGH’s Ward 67 makes for
 scary reading

As one Hepatitis C patient after another started popping up at the ward with frightening regularity, the hospital seemed to have been 
more interested in trying to establish a pattern rather than informing the
 Ministry of Health or the public.


Transparency took a hit as the hospital took an awfully long time — six months 
to be exact — to report the outbreak among its kidney patients.


Five cases of infection were spotted in just one month from 17 April to 
14 May. Another two surfaced in two days between 25 May and 27.

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Not just a medical mystery

I HAD to go to the Singapore General Hospital yesterday to pick up some medication for my mother. The first thing she told me was not to go through Block 6. That’s where the Hepatitis C outbreak occurred, in wards 64A and 67. I told her that merely walking through isn’t about to get me infected. This isn’t an airborne disease like Sars. Someone would have to jab me with an infected needle, I told her. Then she said: “But they don’t know how it happened.”

Yup, we have a mystery virus. The hospital has yet to identify the strain of Hepatitis C. The mystery is where it came from. It must come from someone’s blood, and get into something that gets into someone else’s blood, or in this case, at least 22 patients’ blood. But none of the other patients in those wards have this type of virus. And according to the SGH authorities, protocols on needle use had been observed.

It’s true that multi-vials were used, but this still meant using fresh needles and syringes each time plus other “protocols” that the World Health Organisation says must be in place because there is still a “risk” of contamination. Nothing’s been said about the blood bank where the patients might have recourse to, but media reports seem to have given it the all clear because not all the victims had received blood transfusions. So maybe in the operating theatre? Most of the 22 are renal transplant patients apparently and because of this procedure, it makes them vulnerable to infections which is a reason for their being screened for Hep C in the first place.

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SGH Paid No Heed to the Well-Documented Dangers of Multi-Dosing

SGH is still hiding behind its stance that multi-dosing is a “long established and accepted practice in healthcare institutions”. Is that true?

Healthcare experts in Canada had already warned the public not to engage in such a practice in the wake of, yes, a Hepatitis C outbreak at colonoscopy clinics.

When did this outbreak take place? September 2014 – almost a year before Singapore’s outbreak.

related:
Hepatitis C Timeline Reveals SGH’s Shocking Lack of Regard for Patients Lives
SGH Accused of Hiding the Truth about Hepatitis C Infection Cases Last Year

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WHY DID THE GOVERNMENT DELAY ANNOUNCEMENT OF HEP C OUTBREAK?

The WP has taken the Singapore government to task for its decision to reveal information about the Hepatitis C outbreak at the Singapore General Hospital (SGH) 4 months after it was first discovered in June 2015.

In a statement on the WP website issued today (7th Oct), the WP said that since SGH had been aware of the infection cluster since early June 2015, it should have made the information public earlier because a Hepatitis C outbreak is a potential public health risk to all citizens, especially those who wish to seek treatment at the hospital.

The WP is also seeking "clarifications" from the Health Minister Gan Kim Yong on the standard protocols taken when it comes to releasing information on such outbreaks, such as whether there is a time frame within which healthcare institutions must report such incidents to the Ministry and what is the permissible interval of time before the ministry must make such information public.

related:
SDP'S DR TAMBYAH WARNED ABOUT INFECTIOUS DISEASE OUTBREAK
RELATIVE OF HEP C PATIENT INFECTED AT SGH REVEALS HER SIDE OF STORY
BLOGGER: STOP HIDING TRUTH, HEP C OUTBREAK MAY DATE BACK TO 2014!

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10 questions we still have for SGH

STUNNING news emerged yesterday: at least 22 patients have been infected with hepatitis C at Singapore General Hospital (SGH). Of the 22 infected, eight have died, and four of those deaths are related to hep C.

While there were apologies and promises of support all round, no one from the media has gotten in touch with the patients, or their next-of-kin. (ST even appeared confused about how many known patients there were: 21, at least 21, or 22?)

Like you, we have a lot of questions. What happened, and how? What now? Unfortunately, after reading the papers this morning, we’re still puzzling over some important ones. Here they are:

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Timeline on outbreak of hepatitis C infections at SGH

The Singapore General Hospital (SGH) today (Oct 6) revealed that 22 people had been infected with Hepatitis C at its renal ward earlier this year. The 22 people were infected between April and June, but some of the cases were only detected recently.

Here is a timeline of how events unfolded:
  • April 17 to May 14: Five cases of Hepatitis C infections detected
  • May 15: SGH conducted internal investigations on dialysis centre
  • May 25 to 27: 6th and 7th cases detected
  • May 29: Dialysis centre cleared as potential source of infection
  • May 30: 8th case detected
  • June 2: Infection control team activated; 9th case detected
  • June 10: Renal ward stop using multi-dose vials
  • June 11 to 16: 10th, 11th, 12th, 13th and 14th cases detected
  • June 23: Use of multi-dose vials stopped hospital-wide; 15th case detected
  • June 25 to 26: 16th, 17th and 18th cases detected
  • July 7 to 15: 19th and 20th cases detected
  • Aug 11: 21st case detected
  • Late August: SGH informs Ministry of Health (MOH) of “unusually large cluster” of Hepatitis C patients
  • Sept 18: 22nd case detected
  • Late September: SGH submits final report to MOH
  • Oct 6: SGH makes public the infections, says it will start contacting staff and more than 400 patients who had gone to the ward, to ask them to go for screening. The MOH announces setting up of independent review committee.
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Hepatitis C Infection Timeline Reveals SGH’s Shocking Lack of Regard for Patients Lives

RONALD LEE: Why did both SGH and the MOH shroud this Hepatitis C outbreak in secrecy until now?

Could more have been spared the infection if quicker and more steadfast action was taken?

Thousands celebrated National Day on August 9th, ignorant that in SGH, a storm was brewing.

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Shocking News: Outbreak of Hepatitis C in Singapore General Hospital

The above outbreak infected 22 people and resulted in 4 deaths. This is not good for our premier hospital as it affects the confidence of patients in our medical health care.

The control of infectious disease is always the prime concern of any hospital. So this outbreak has brought into question the effectiveness of the operational protocol of disease prevention at all levels of the hospital. From the time the patient is admitted to the time he is discharged - what are the preventive measures?

One question in the minds of Singaporeans is why was the announcement delayed till 6th October when between April and May there were already 5 cases?

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Mainstream Media Can’t Decide What To Report On SGH’s Hep C Deaths
Yesterday (6 Oct), the mainstream media (MSM) has made public the outbreak of the hepatitis C virus in the Singapore General Hospital (SGH)

In an article published yesterday (6 Oct), The Straits Times said that there are 22 cases of infected patients and 4 deaths.

In a separate article that ran today, The Straits Times seems to be downplaying the situation, and said that the hepatitis C virus “infected at least 21 kidney patients at Singapore General Hospital”.

This morning, former Associate Editor of The Straits Times (ST) Bertha Henson called out her former employers, saying that she “seriously dislike(s) the ST page 1 story”.

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22 Patients Infected With Hepatitis C In SGH, 4 Dead

An outbreak of the hepatitis C virus in one of Singapore General Hospital’s (SGH) renal wards has led to 22 patients being infected with the virus, according to media reports. Of the 22, the youngest is 24-years-old and the remaining are between 50 to 60-years-old. Four have died.

SGH has apologised for the lapse. The hospital said in a media briefing on Tuesday that there was an increase in hepatitis C virus infections in early June 2015 in the renal ward. This prompted urgent checks for the virus by SGH on patients who were staying in the same ward and had abnormal liver function test results.

Investigations into the cause of the infections are ongoing but initial investigations have pointed the source to “intravenous (IV) injectable agents”.

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HEALTH MINISTER GAN: I AM GRAVELY DISAPPOINTED WITH CLUSTER OF HEPATITIS C CASES IN SGH

The Ministry of Health (MOH) has been informed of a cluster of 22 cases of acute Hepatitis C Virus (HCV) amongst patients with kidney disease who had been admitted to Ward 64A or Ward 67 at the Singapore General Hospital (SGH) during the period from April to June 2015. The initial identification of an unusual increase in the number of HCV infections (from 2 to 4 per year on average in SGH’s prevalent pool of renal transplant patients in previous years to 5 within the space of a few weeks) was made by SGH in early June. SGH began its internal investigations in June, and took precautionary measures. SGH made an initial presentation to MOH in late August 2015 and informed MOH of the unusually large cluster of Hepatitis C patients who had been admitted to Ward 64A or Ward 67 during a period from April to June 2015. They submitted their final report to MOH late last month.

MOH has convened an independent Review Committee to provide an objective and critical review of SGH’s investigation and findings, to provide added assurance and to glean learning points for the wider healthcare system. In particular, the Review Committee has been tasked to ascertain if all possible measures had been taken to identify the possible points of infection control breach, and remedy any weak point in the overall workflow with regard to infection control.

Minister for Health Mr Gan Kim Yong said, “I am gravely concerned and disappointed with the occurrence of the cluster of Hepatitis C cases in SGH. My thoughts are with the affected patients and families.

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22 patients diagnosed with Hepatitis C virus, four died: SGH
(Update with comments by the Ministry of Health and Health Minister Gan Kim Yong)

Singapore General Hospital is investigating whether a cluster of hepatitis C virus infections at its renal ward contributed to the deaths of at least four patients, the hospital said in a press statement on Tuesday.

The four had “multiple co-morbidites and severe sepsis” along with other serious conditions when they passed away, and they were among 22 patients who were hospitalised from April to June this year and diagnosed with hepatitis C virus infections.

The hospital, however, was unable to rule out whether hepatitis C, which is a type of liver disease, was a contributing factor to their deaths.

related: Four die as Singapore hospital suffers wave of hepatitis C infections

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22 patients diagnosed with Hepatitis C virus, four died: SGH

Singapore General Hospital is investigating whether a cluster of hepatitis C virus infections at its renal ward contributed to the deaths of at least four patients, the hospital said in a press statement on Tuesday.

The four had “multiple co-morbidites and severe sepsis” along with other serious conditions when they passed away, and they were among 22 patients who were hospitalised from April to June this year and diagnosed with hepatitis C virus infections.

The hospital, however, was unable to rule out whether hepatitis C, which is a type of liver disease, was a contributing factor to their deaths.

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Virus outbreak at SGH: 22 infected and 8 dead

A Hepatitis C virus outbreak happened at a renal ward in Singapore General Hospital with 22 patients infected and among them, 8 dead, possibly from the infection. All 22 patients were staying at the newly-renovated Ward 67 between April and June this year. The news have been covered up until an official press release made by SGH today (Oct 6).

Among the 8 dead, 4 had “multiple co-morbidities and severe sepsis” with Hepatitis C infection possibly being the cause. The other 3 deaths, according to SGH, has been “thoroughly evaluated and have no link to Hepatitis C virus infection has been established”. The last death is still “pending review”.

The youngest infected is a 24 year old, while the rest are between 50 and 60 years old. All names and profiles have been censored by the Singapore government.

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4 Dead After Hepatitis C Outbreak at Singapore General Hospital, Drug Injections Blamed for Infections

Singapore General Hospital has announced that 4 patients from its renal ward have died from infections linked to Hepatitis C. A total of 22 patients were infected with the virus after entering the ward.

SGH says its initial investigation suggest “intravenous (IV) injectable agents”, or drugs administered by means of injection, were the cause of the infection.

The outbreak was discovered in early June, and details were just released today in a press conference.

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4 patients died at S’pore General Hospital, possibly due to Hepatitis C infection
This following article is based on reports from Channel News Asia, Today and The Straits Times

The Singapore General Hospital (SGH) on Tuesday afternoon apologised after four patients in the same ward, who suffered from the Hepatitis C virus, passed away earlier this year.

The four were also ill with other serious co-existing conditions, such as pneumonia and severe sepsis — an immune response to an infection — but were among 22 patients in the hospital’s renal wards (64a and 67) who were infected with the Hepatitis C virus.

In a media briefing, the hospital said it had noted an increased frequency of hepatitis C virus infections in early June in the two wards where the 22 were staying, between April and June this year. Ward 67, in particular, was newly-renovated.

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4 deaths at renal ward could be linked to Hepatitis C: SGH

Twenty-two patients at a renal ward in the Singapore General Hospital (SGH) have been diagnosed with the Hepatitis C virus. Among them, four have died, possibly from the virus.

In a media conference on Tuesday (Oct 6), SGH said that in early June, the hospital discovered an increased frequency of Hepatitis C virus infections in a renal ward. The hospital subsequently stepped up checks for the virus in patients with abnormal liver function tests in the same ward, and found 22 patients infected.

All 22 patients were admitted and stayed in the newly-renovated Ward 67 between April to June 2015. Among them, eight have died, including four who had “multiple co-morbidities and severe sepsis", and the possibility that the Hepatitis C virus could have been a contributing factor has not been ruled out.

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22 patients in SGH renal ward infected with hepatitis C; 4 patients have died
(From left) SGH medical board chairman Fong Kok Yong, SGH CEO Ang Chong Lye and chief nurse Tracy Carol Ayre speaking during a press conference at SGH on Oct 6, 2015. ST PHOTO: AZIZ HUSSIN

The Singapore General Hospital (SGH) has apologised for an outbreak of the hepatitis C virus in one of its renal wards, which has led to 22 patients being infected with the virus.

Of the 22, four - who were also ill with other serious conditions - have since died.

At a media briefing on Tuesday (Oct 6) afternoon, the hospital said it had noted an increased frequency of hepatitis C virus infections (from an average of two to four infections per year to five in a few weeks) in early June in the ward.

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What’s really going on in our nursing homes?

IF YOU have a family member staying in a nursing home, you might have been startled by a report in ST today. The article, “Many in Singapore nursing homes take wrong medication, dosage”, offers a pretty damning report card for nursing homes in Singapore, where “three in five nursing home patients have been getting the wrong dosage, or the wrong medication altogether”.

This is not the case. Read further and you’ll realise that the authors of the report in the article surveyed only three nursing homes. There are about 70 in Singapore. Also, although the report was published last month in the Singapore Medical Journal, the reviews of the nursing homes were actually conducted four years ago – in 2011. Why is the report being published only now?

The ST article doesn’t say, and in fact the writing was so all over the place that we decided to take a look at the actual document itself. We contacted the main author of the document but she declined to be interviewed. We also looked at the new set of Enhanced Nursing Home Standards that was announced last year by the Health Ministry; these new standards were not mentioned in the ST report.

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Many in Singapore nursing homes take wrong medication, dosage
Jurong Polyclinic senior pharmacist Chia Hui Shan (left) discussing patients' medicine with staff nurse Dolores Anuber at St Joseph's Home.ST PHOTO: MARK CHEONG

Three in five nursing home patients could be taking medication in the wrong dosage or, sometimes, wrong medication altogether.

Not only is this putting them at higher risk of falls and heart problems, but it could also be costing them more.

A review of patients in three nursing homes by pharmacists from the National Healthcare Group (NHG) found that the 480 patients had 392 medication issues between them.

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Enhanced Nursing Home Standards


By 2030, the number of seniors above 65 will nearly triple to over 900,000. One in five residents will be over 65, compared to fewer than one in ten today. Hence, we need to put in place a comprehensive effort to continually enhance aged care standards, including nursing home (NH) care, to make sure that our seniors continue to be provided with good quality care.

A Workgroup comprising of NH representatives and supporting clinical and policy experts was appointed by the Minister for Health in May 2012, to review existing NH standards and identify gaps, and redefine baseline standards and outcomes for good NH care.

The Workgroup’s vision of a good standard of care for seniors in our NHs is for Singapore’s NHs to be homes away from homes where our seniors can be cared for safely and with dignity, and where they can still have a good quality of life despite their high care needs.

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In the News:
MOH appoints independent committee to look into Hep C outbreak
MOH sets up Review Committee to look into Hepatitis C cases in SGH
MOH outlines events leading to SGH announcement of Hepatitis C
Public hospitals cease multi-dosing practice in light of Hepatitis C
Hepatitis C cluster at SGH: What you need to know
Late disclosure because there “were no signs of acute hep C cases”: MOH
Getting hepatitis C from blood transfusion 'extremely rare' today
More news for chronic viral hepatitis c
MOH notified of Hep C outbreak in Aug; says asymptomatic cases
Workers' Party seeks clarification from MOH after Hepatitis C cluster
Public hospitals cease multi-dosing practice in light of Hepatitis C cluster
Public not told earlier 'as there were no signs of acute hepatitis C cases'
More news for acute viral hepatitis C

Hepatitis C: Chronic & Acute infections

Hepatitis C virus (HCV) causes both acute and chronic infection. Acute HCV infection is usually asymptomatic, and is only very rarely associated with life-threatening disease. About 15–45% of infected persons spontaneously clear the virus within 6 months of infection without any treatment.

The remaining 55–85% of persons will develop chronic HCV infection. Of those with chronic HCV infection, the risk of cirrhosis of the liver is 15–30% within 20 years.

Key Facts:
  • Hepatitis C is a liver disease caused by the hepatitis C virus: the virus can cause both acute and chronic hepatitis infection, ranging in severity from a mild illness lasting a few weeks to a serious, lifelong illness.
  • The hepatitis C virus is a bloodborne virus and the most common modes of infection are through unsafe injection practices; inadequate sterilization of medical equipment; and the transfusion of unscreened blood and blood products.
  • 130–150 million people globally have chronic hepatitis C infection.
  • A significant number of those who are chronically infected will develop liver cirrhosis or liver cancer.
  • Approximately 500 000 people die each year from hepatitis C-related liver diseases1.
  • Antiviral medicines can cure approximately 90% of persons with hepatitis C infection, thereby reducing the risk of death from liver cancer and cirrhosis, but access to diagnosis and treatment is low.
  • There is currently no vaccine for hepatitis C; however research in this area is ongoing.
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SGH hep C outbreak: 2 infected patients part of affected cluster

The two Singapore General Hospital (SGH) patients who had earlier tested positive for hepatitis C have been found to be part of the affected cluster, bringing the total number of patients infected in the hospital’s hepatitis C outbreak earlier this year to 25.

“Phylogenetic studies done for the two patients who were tested positive as announced on 23 October showed that they are part of the affected cluster,” said SGH’s Chairman of the Medical Board Fong Kok Yong in a statement issued by the hospital today (Oct 26).

The patients were admitted to Wards 64A and 67 from April to June 2015.  “We will provide the patients and their family with our full support and ensure that the patients receive timely and appropriate care,” said Prof Fong.

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