Saturday, 3 September 2016

Recurring outbreaks of TB in Singapore

Second case of pre-school teacher diagnosed with TB
RISK? Bridges Montessori Pre-school where the teacher worked.TNP FOTO: 

In the latest incident, a teacher at Bridges Montessori pre-school in Punggol was affected.

The principal of the pre-school, Ms Jen Chng, told TNP that the teacher had gone through training at the Montessori pre-school for two weeks before she started her teaching duties.

Ms Chng said the school hired the 29-year-old teacher from the Philippines sometime in July, and she was only there for a month.

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Punggol pre-schoolers screened for TB; second such reported case in a week

Children and staff at a second pre-school had to undergo screening for tuberculosis (TB), after a foreign trainee teacher was diagnosed with active TB. This is the 2nd report of TB screenings at pre-schools in less than a week.

At least one pre-schooler, a 2-yr-old girl, has been found with latent TB, which means the disease is in its non-infectious, asymptomatic state. The case will be followed up at the Tuberculosis Control Unit (TBCU)

Bridges Montessori Preschool on Punggol 17th Avenue first found out on Aug 12 that a trainee teacher had been diagnosed with active TB, said its director, Ms Irene Toh, 58.

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TB diagnosed in pupil at Punggol preschool after teacher tests positive

At least one student at a preschool in Punggol has been diagnosed with latent tuberculosis (TB), after a trainee teacher tested positive for the disease earlier this month.

The Tuberculosis Control Unit (TBCU) carried out screening at the Bridges Montessori facility at 200 Ponggol 17th Ave last Tue (Aug 23), after the diagnosis was made, according to the preschool's director, Irene Toh. She told Channel NewsAsia that she was informed by some parents that their children had tested positive for the illness after the screening. Ms Toh was unable to provide a specific number, pending further confirmation. There are about 50 students at the centre.

This is the 2nd time in a month that a teacher at a preschool has been diagnosed with TB, after a member of staff at Little Greenhouse in Bukit Batok came down with the illness. Channel NewsAsia has sought comment from the Health Ministry on the latest case. 

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MOH did not make public TB case in Punggol preschool where 2-year-old child was infected

Just 5 days after about 80 preschool children enrolled at a centre in Bukit Batok were screened for tuberculosis (TB), after a teacher there was found to have contracted the infectious disease, it has been revealed that at least one student at a preschool in Punggol has been diagnosed with latent TB, after a trainee teacher tested positive for the disease earlier this month.

In the case of the preschool in Bukit Batok, the teacher diagnosed with TB was a Chinese national who taught at the Little Greenhouse preschool on Bukit Batok Street 31. The teacher did not update the pre-school on her condition after she was diagnosed.

In the case of the two-year-old child from the preschool in Punggol who was diagnosed, the nationality of the teacher was not revealed, but she was a new trainee-teacher who had been working in the preschool before clearing the pre-employment screening here in Singapore. She passed a medical test in her home country. The trainee-teacher will be leaving the school on mutual agreement and returning to her home country.

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Foreigner teacher spread Tuberculous to 2-year-old in Punggol pre-school

A foreigner teacher spread Tuberculous (TB) to a 2-year-old in a pre-school, Bridges Montessori Preschool, at Punggol Seventeenth Avenue. Parents of 50-plus other pre-school children have been informed of the bacteria outbreak but only 29 students and 7 staffs were screened last Tuesday (Aug 23) but the results are not out yet.

The nationality of the teacher with active TB is covered up by Singapore’s mainstream media, and this news is also covered up by the Ministry of Health which has not made any announcement of the TB outbreak so far. The infected teacher passed a pre-employment TB test but was diagnosed positive on Aug 12, but that has been three weeks after she started work.

According to the school director, a pre-employment check done at the Singapore Anti-Tuberculosis Association found a “scar” in the trainee’s lungs, and the doctor referred her for further checks. The Singapore doctor had even advised that she could continue with “normal activities” at the time.

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Bukit Batok kindergarten latest to be hit with Tuberculous outbreak

A unidentified kindergarten teacher was diagnosed with latent tuberculous last Friday (Aug 19), putting the Bukit Batok kindergaren the latest to be hit by the infectious disease. The Ministry of Health (MOH) began their screening of 104 pre-school children, aged between two months and six years old, and 20 employees at the Bukit Batok Street 31 kindergarten, Little Green House, only on Wednesday (Aug 24).

According to the kindergarten, the centre was fumigated and sanitized a day after the discovery (Aug 20). Parents were informed of the tuberculous outbreak on the same day. The blood test result is still pending.

This is the third tuberculous outbreak in one year. Last month in July, 47 residents living at Ang Mo Kio Blk 203 were diagnosed with tuberculous. In Dec last year, 5 children caught tuberculous from an infected nurse at the National University Hospital.

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It was reported that preschool children attending Little Green House at Bukit Batok were screened for latent tuberculosis (TB) on Wednesday (Aug 24).

This comes after a teacher was diagnosed with the disease. The teacher had reported sick last Thursday. She was later diagnosed with TB.

On Saturday, parents were informed of the situation. The premises were fumigated and the toys and surfaces were sanitised.

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Children being screened for TB at Little Greenhouse preschool

Preschool children were being screened for latent tuberculosis (TB) on Wed (Aug 24) at Little Greenhouse's Bukit Batok branch, after a teacher was diagnosed with the disease.

Ms Ruth Kua, deputy chief operating officer of Global Eduhub which runs Little Greenhouse, said the teacher called in sick last Thursday and reported that she had been diagnosed with tuberculosis the next afternoon. The teacher has been with the school for more than a year.

She added that the teacher is currently on medical leave for about two weeks, after which her contract will be terminated as she will be on antibiotics for 6 to 9 months. 

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Pre-schoolers screened for TB due to teacher’s contract of the infectious disease

One of the preschool teacher of Little Greenhouse pre-school at Bukit Batok Street 31, was confirmed to have contracted active tuberculosis (TB). As a result, the students and the staffs of the school are obliged to take the screening to make sure that they are not infected.

104 children and 20 staffs of the school all had been screened, the Ministry of Health (MOH) said in its statement on 24 August. The children below 5 years old had a skin test and chest X-ray, while those above 5 years old were given blood tests.

The teacher who was infected with the disease had called school in sick on Thursday (18 August). Ms Ruth Kua, deputy chief operating officer of Global EduHub, the pre-school’s parent company, said she did not show any signs of being infected by the disease before.

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Pre-schoolers screened for TB after teacher gets disease
Ms Ruth Kua left chairs outside the pre-school for parents in case they wanted to be present at the screening

When 1 of her teachers at the pre-school she runs was diagnosed with tuberculosis (TB), she thought parents would flare up at her.

Instead, Ms Ruth Kua saw support from parents during the crisis.

Yesterday, 80 children enrolled at the Little Greenhouse pre-school at Bukit Batok were screened for TB after the teacher was diagnosed with the airborne disease.

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Elderly client of senior day centre diagnosed with TB

The Ministry of Health (MOH) said on Friday (Aug 19) that a case of tuberculosis (TB) was discovered at Peacehaven Bedok Day Centre in late June. MOH and the Tuberculosis Control Unit (TBCU) were notified of the TB case on 26 Jun. The elderly patient who is no longer infectious is now undergoing treatment for TB.

The centre’s executive director, Mdm Low Mui Lang, said that the resident was segregated after she started coughing. She was subsequently admitted to hospital where she was diagnosed with tuberculosis.

MOH added that TBCU said that all who were in close contact with the patient have been screened after it initiated contact tracing.

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TB case found at Peacehaven Bedok Day Centre

A case of tuberculosis (TB) was discovered at Peacehaven Bedok Day Centre in late June, the Ministry of Health (MOH) said on Fri (Aug 19).

In response to queries, MOH said both the ministry and the Tuberculosis Control Unit (TBCU) were notified of the TB case on Jun 26, and that the patient is now undergoing treatment for TB.

The centre's executive director, Mdm Low Mui Lang, said in a statement that the resident was segregated after she started coughing. "She was then admitted to hospital and was diagnosed with tuberculosis," she said, adding that the resident is no longer infectious.

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Bedok elderly care resident treated for TB

A resident of an elderly daycare centre in Bedok was diagnosed with active tuberculosis (TB) in Jun, but is undergoing treatment and is no longer infectious, a news report said yesterday.

The woman, whose age was not mentioned, is from Peacehaven Bedok Day Centre, reported Channel NewsAsia. She was diagnosed on Jun 26.

A total of 36 residents & staff at the centre, who were in close contact with her, were screened and no cases of active TB were found, the Ministry of Health (MOH) said.

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Three SMRT workers diagnosed with TB

Public transport operator, SMRT, has confirmed that 3 of its staff have been diagnosed with tuberculosis (TB). All three diagnosed were from the Tanah Merah station in the East-West line. Two of the infected are train drivers, while the other is a crew member. SMRT said that they were diagnosed with the disease four to six weeks ago.

The Straits Times which reported the news said that two were found to have latent TB while the other was found to have active TB, which is contagious. The report did not specify if it was any of the the drivers or the crew member who diagnosed with the active strain. But it confirmed that the two latent cases are not linked to the active one.

Latent TB, which in noninfectious, can develop into active TB if left untreated. SMRT said that it has since screened all staff from the Tanah Merah station. It did not say how many people were screened, but results of the screening are expected to be out in the next few weeks.

related: Slow detection of TB by SMRT a public health concern?

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3 SMRT staff found to have tuberculosis

Three SMRT staff members – two train drivers and a crew manager – have been diagnosed with tuberculosis (TB).

The trio, who were from Tanah Merah station, were diagnosed with the disease four to six weeks ago, a Straits Times report on Saturday (6 August) said.

Two were found to have latent TB while the other was found to have active TB, which is contagious. Non-infectious latent TB can develop into active TB if left untreated.

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Another SMRT worker found to have TB

Screening for tuberculosis (TB) among SMRT staff has been stepped up after another SMRT worker was diagnosed with the contagious disease.

Like 3 other recent cases, the fourth SMRT worker, a train driver, is also from Tanah Merah station. He was warded at Tan Tock Seng Hospital (TTSH) early this week but has since been discharged.

He was found to have active TB, like one of the earlier cases. The other 2 workers were found to have latent TB, which is not contagious but can develop into active, contagious TB if untreated. All 4 are receiving medication for the disease.

related: Three SMRT workers diagnosed with TB

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What You Need to Know About Tuberculosis (TB)

Six individuals across four unrelated units in Block 203 Ang Mo Kio Avenue 3 were detected to have the same strand of multi-drug resistant tuberculosis (TB).

Just last year, there were 1,498 new cases of TB among Singapore citizens and permanent residents.

What is TB? How does it spread? Can it be treated?

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MOH unable to provide update for reason of how AMK tuberculosis cluster occurred

Ministry of Health (MOH) in its reply to a parliament question, was not able to provide update to the reason of how the Ang Mo Kio tuberculosis (TB) cluster occurred.

Dr Lily Neo, an MP for Jalan Besar GRC, asked the Minister for Health at the 22nd session of the 13th Parliament on whether the recent occurrence of a cluster of tuberculosis cases is of alarming concern and whether he can provide an update on the reason for such occurrence.

Earlier on June 16, MOH held a press conference and revealed that there were 6 cases of multi-drug-resistant tuberculosis (MDRTB) emerged from Ang Mo Kio Block 203, and the first case were found back in 2012.

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TB cases in Ang Mo Kio: Risk of an epidemic low, no cause for panic, say experts

A "highly unusual" outbreak of six tuberculosis cases within a period of four years at Block 203 in Ang Mo Kio has brought a forgotten disease back into the spotlight.

Even as the block's residents queued up for TB screenings yesterday, the Government and healthcare experts have assured the public that the risk of an epidemic is low.

TB, especially its multi-drug resistant strain, is not that common. According to statistics released by the Ministry of Health (MOH), the incidence of TB among Singaporeans and permanent residents last year was 38.4 per 100,000 - the 2nd lowest in Asia after Japan.

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6 cases of multi-drug resistant TB in Ang Mo Kio block, MOH offers free screening to residents

The detection of an unusual cluster of 6 multi-drug resistant tuberculosis (MDRTB) infections at a block of flats in Ang Mo Kio has prompted health authorities to offer free TB screenings to the block's residents starting Thu (Jun 16) until Sunday (Jun 19).

In a statement, the Health Ministry assured the public that the 6 pose no ongoing public health risk, as they have either completed or are receiving treatment.

The 6 individuals with MDRTB come from four separate units at Block 203 Ang Mo Kio Avenue 3. The first 3 cases come from the same household, with the first individual in that unit diagnosed in Feb 2012. The rest of the household was subsequently monitored for the infection. 2 were later diagnosed with active MDRTB in May 2012 and Oct last year.


'High alert’ after 3rd case in same HDB block: Doctor who flagged TB cases
MOH to review list of notifiable diseases
5 child patients found with latent TB after screening: NUH
178 children to be tested after NUH nurse found to have TB
About 70 residents from affected Ang Mo Kio block screened for TB so far
'High alert’ after 3rd case in same HDB block: Doctor who flagged TB cases
Residents of affected Ang Mo Kio block undergo tuberculosis screening

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Screening for residents of Ang Mo Kio block after 6 TB cases found

The residents of a block of flats in Ang Mo Kio Avenue 3 are being urged to undergo screening for tuberculosis (TB), after 6 of their neighbours were diagnosed with the same drug-resistant strain of the disease over a four-year period.

Last night, grassroots volunteers, officers from the Ministry of Health (MOH) and Ang Mo Kio GRC MP Koh Poh Koon knocked on the doors of the 160 units of Block 203 to inform residents of the situation, which MOH described as "highly unusual".

3 of the 6 TB patients lived in the same unit but the other 3 were from different households. All 4 households said they did not know and had not interacted with one another.

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Drug-resistant TB ‘takes longer to cure, poses more risk’

Compared with patients diagnosed with tuberculosis (TB), those infected with the multi-drug-resistant strain of the disease will have to take more medicines a day, & the types of medication they consume also put them at risk of side effects such as kidney, liver or psychiatric problems.

Doctors TODAY spoke to also noted that patients diagnosed with such multi-drug-resistant strains will take more time to be completely cured. The doctors were commenting after the Ministry of Health (MOH) said on Wednesday that there was an unusual cluster of 6 multi-drug resistant TB cases at a public housing block on Ang Mo Kio Ave 3.

The inappropriate treatment of TB and patients’ poor adherence to the treatment increases the likelihood that drug-resistant strains will develop. The use of antibiotics has also led to the rise of such strains 
of the disease.


Doctor who helped connect dots praised for her ‘astute observation’
Lack of symptoms, patients’ reticence hinder TB detection
6 TB cases found at Ang Mo Kio block
AMK TB cluster: Man who caught disease from friend ‘angry’ at his ‘negligence’
S’poreans at higher risk of heart failure
Ang Mo Kio TB cases: Residents surprised, but not overly alarmed

TB cases in AMK could stem from 2012 Parklane cluster

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Mystery over how 6 patients ended up with same TB strain

How 6 people from 4 different households managed to pick up the same strain of multi-drug resistant tuberculosis (TB) is a mystery.

The 6 patients told Health Ministry officials that apart from the 3 from the same household, they did not know or interact with one another and had not congregated at common areas. They ranged in age from early 20s to 70.

The index case was a man who was first diagnosed with drug-resistant TB in Feb 2012. Another member of his household was diagnosed with the same strain 3 months later. That year, a woman living in the same unit was also diagnosed with a latent form of TB. This meant she would have shown no symptoms of the disease. However, in Oct last year, she too developed an active infection.

related: TB cases in Ang Mo Kio: What you need to know about TB

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Cluster of multi-drug resistant TB cases discovered in a single block in Ang Mo Kio

The Ministry of Health (MOH) is investigating a cluster of drug resistant tuberculosis (TB) cases residing at Blk 203 Ang Mo Kio Ave 3.

TB can be spread through fine respiratory droplets containing the TB bacteria when a person with infectious TB coughs or sneezes. Persons with close or prolonged contact with persons with TB may be at risk of becoming infected. Drug resistant TB takes longer to treat.

The cluster of infections in Ang Mo Kio was detected by a vigilant doctor from the Tuberculosis Control Unit at Tan Tock Seng Hospital.  The doctor reported his findings to MOH in May 2016, leading to an investigation that established in June 2016 that the six individuals were infected with the same MDRTB strain, with the last case confirmed on 10 June.

related: TB Experts: FT influx from 3rd world increases reported cases in Singapore

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6 drug resistant TB cases in AMK

6 residents of Block 203, Ang Mo Kio Avenue 3 have contracted multidrug-resistant tuberculosis (MDR TB).

While 3 of them, including Patient Zero, live in the same flat, the other 3 are from different units.

Announcing this at a press conference last evening, Associate Professor Benjamin Ong, director of medical services at the Ministry of Health (MOH), said this makes it "highly unusual to find cases of the same strain of the MDR TB who do not share common activities with one another".


What is TB, how it spreads, how it is treated
I'll make kids wear masks, says mum at TB affected block
AMK resident recounts tough battle with TB

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TB cases in Ang Mo Kio: Astute of Tan Tock Seng Hospital doctor to identify cluster, says MP Koh Poh Koon

'Astute' ? where are the prevention measures?

Why is Singapore seeing an increase in cases of tuberculosis (TB)? Is Singapore regressing into a 'developing country'?

Is there screening for foreigners coming to Singapore to work screened? especially from the countries that have high incidence of TB?

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MDR-TB Cluster in AMK, Singapore

There are many criticisms made of our local press, but it is clear that we have good journalists. Ms Kelly Ng from Today has figured out what MOH appeared to have left out from its press release, which is that the Ang Mo Kio MDR-TB cluster ultimately has its roots in the 2012 Parklane cybercafe outbreak. The index case of the Ang Mo Kio cluster was also one of the Parklane cybercafe patrons who developed MDR-TB 4 years ago.

It appears that he had been living with his friend and his friend’s mother then, and had  – according to this friend – infected both of them due to “negligence in taking medicine”. While he appeared to have been diagnosed with active MDR-TB during the original contact investigations in 2012, his mother had latent MDR-TB that only progressed onto active MDR-TB 3 years later.

Should this person’s mother (and others diagnosed with latent MDR-TB during the original contact investigations in 2012) receive treatment for latent MDR-TB? Experts are split on this issue currently, because there is not enough high-quality evidence to favour one approach over the other. So some would advocate preventive treatment – usually using a fluoroquinolone-based regimen – while others would recommend close follow-up for at least 2 years.

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5 children found to have latent TB

5 of the children screened at the National University Hospital (NUH) after one of its paediatric nurses was found to have pulmonary tuberculosis (TB) have tested positive for a latent infection of the disease.

"Treatment has been offered to these patients as a precautionary measure," an NUH spokesman said late last night.

The hospital said it had contacted more than 160 patients, and more than 130 of them had been brought in by their parents for screening.

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5 child patients found with latent TB after screening: NUH

The National University Hospital has screened more than 130 child patients after it was discovered that one of its paediatric nurses had pulmonary tuberculosis (TB).

The hospital said in an update on Tue (Dec 22) that it has contacted more than 160 patients in total for screening. Out of these, none has active TB, but five have positive Mantoux reading, which is indicative of latent TB infection, said NUH, adding that they have been offered treatment as a precautionary measure.

An NUH spokesperson said in a statement that latent TB infection can be effectively treated to prevent progression to active TB, with current treatment options reducing the risk of developing active TB by more than 90%.

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Tuberculous disease outbreak in National University Hospital, 178 children recalled for test
Photo of NUH from reuelwrites

There has been a tuberculous disease outbreak in Singapore’s National University Hospital (NUH) and 178 children have been recalled for testing.

The hospital found out the outbreak when a nurse was tested positive for tuberculous (TB), with a TB patch the size of a 50-cent coin last Friday (Nov 27). The nurse first experienced persistent coughing in July. One of the wards affected was ward 47. 131 of the children are under two years old and 34 are especially vulnerable as they had just received a transplanted organ and were under immune system suppressant drugs.

Professor Paul Tambyah, an infectious disease expert at NUH, said there is a 10% chances of people getting the bacteria if a person coughs at them for two hours, and that the risk of infection depends on the exposure, the bacterial load of the infected and the immune system of the exposed.

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NUH recalling 178 children cared for by nurse with TB

Photo: The Straits Times

The 1st of the 178 patients were at NUH (above) for screening on Tue. The children will have a chest X-ray to check for TB, and blood tests if aged five or older, and/or skin tests to see if they have the bug latent in them.

The National University Hospital (NUH) is recalling 178 paediatric patients - including 131 under the age of 2 years - who had been cared for by a nurse now confirmed to have tuberculosis (TB).

They include 34 children who have received a transplanted organ, so are on immunosuppression drugs and therefore at higher risk than normal children.

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1 baby found to have latent tuberculosis after NUH recalled patients for screening

The boy was found to have latent TB, which means he has the bacteria in his system, but does not have the disease. FOTO: ST FILE

One of the children exposed to the nurse at the National University Hospital (NUH) who has tuberculosis (TB) has been found to have the bug.

The boy, who is 4 months old now, was in Ward 47 where the nurse worked, from Aug 23 to Sept 5.

The hospital is recalling 178 paediatric patients who had been cared for by the nurse before she discovered she had the disease.

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NUH recalls 178 children suspected of TB

The National University Hospital (NUH) has recalled 178 paediatric patients for TB tests which include chest X-rays, blood tests, and skin tests. All of them have been cared for by a nurse who has been confirmed to have contracted TB.

After the SGH hepatitis C saga which affected 23 patients and saw 4 deaths, we would have thought that other public hospitals such as NUH would have taken a leaf out of SGH’s book and learnt how to practise preventive measures. Well, apparently not….

Out of the 178 patients recalled, 34 have taken immunosuppression drugs after receiving an organ transplant, which puts them at a higher risk of contracting the disease. Further, children have a weaker immune system compared to adults.

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Rise in TB incidence due to ageing population, more foreigners: Study

A greying population and a rise in the number of foreigners have contributed to an increase in the incidence of tuberculosis (TB) in Singapore since 2008, a study led by researchers from the National University of S'pore (NUS) has found.

The incidence rate of TB — the number of new cases per population at risk, at a given time — had been on a downward trend in Singapore since 1998, even hitting a historic low of 35.1 cases per 100,000 people in 2007. But the number began to climb to around 39 cases per 100,000 people from 2008.

In their study, which was published in BioMed Central Public Health journal in October, the NUS researchers looked at more than 40,000 TB cases reported to the S'pore Tuberculosis Elimination Programme (STEP) registry between 1995 & 2011. They found that the higher incidence of the infectious respiratory disease among the elderly partly accounted for the increase in incidence of TB among Singapore residents; the resident elderly population here in 2011 was almost double its population in 1995.

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Tuberculosis Situation in Singapore

TB is a global public health threat. Globally, there are more than 9 million cases of TB every year, with 1.5 million deaths. In addition, there are almost half a million cases of multi-drug resistant TB (MDRTB). MDRTB is more difficult to treat and has lower cure rates, with death rate as high as 30% to 40%.

In 2015, there were 1,498 new cases of TB among Singapore residents locally. This is higher than the 1,454 cases in 2014. Older age groups and males continue to make up a significant proportion of the new cases. Please refer to Annex A for details.

TB is curable and the spread of TB is preventable. While there are currently national control measures in place to reduce the risk of ongoing transmission in Singapore, each of us plays an important role in keeping our community safe and free of TB. Individuals who display symptoms such as unexplained prolonged cough of 3 weeks or more should seek medical attention early to ensure prompt diagnosis and treatment.

related: Tuberculosis in Singapore

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TB in Singapore

The incidence of tuberculosis in Singapore is the lowest in Southeast Asia. However, the incidence rate, at just below 40 cases per 100,000 resident population, is several times higher than that in the United States, Western Europe, and Australia.

Moreover, the TB incidence in Singapore rose in 2008, after a decade of continuous decline. Many Singaporeans, including healthcare workers are surprised when they are told that more than a thousand new cases of TB are reported among Singapore citizens and permanent residents each year. The new cases actually numbered more than 1400 in each of the past 2 years.

A common perception is that TB belongs in the less developed countries in Asia and Africa, or to Singapore in times past. It is diffi cult to appreciate that TB continues to be common in Singapore today.

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TB Experts: FT influx from 3rd world increases reported cases in Singapore

Several years ago, TB experts have already noticed the increase in proportion of foreign-born persons with TB in Singapore.

The authors of the paper noted the increase in proportion of foreign-born persons with TB in Singapore. They wrote, “Unskilled workers from countries with high incidences of TB accounted for the highest number of and greatest increase in foreign-born TB case-patients.”

They noted that after the economic recovery and liberalization of the immigration policy in Singapore in 2005, there was an influx of migrant workers and immigrants from countries with high incidences of TB and a corresponding increase in TB notifications among this population.

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Tuberculosis among Foreign-born Persons

Singapore, an island city-state (area 710 km2) in Southeast Asia, liberalized its immigration policy and underwent rapid economic growth during 2005–2010. This policy resulted in a marked increase in its population from 4.17 million in 2004 to 5.08 million in 2010, which was largely caused by an increase in foreign-born persons comprising long-term pass holders (LTPHs) (permission to stay in Singapore >6 months), permanent residents (PRs), and naturalized citizens (1).

In recent decades, mass immigration and influx of nonimmigrants from countries with high incidences of tuberculosis (TB) to industrialized countries have contributed to the epidemiology and incidence of TB in host countries (2–9).

We report the epidemiology of TB in foreign-born case-patients in Singapore during 2000–2009.

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Multi-drug-resistant tuberculosis

Multi-drug-resistant tuberculosis (MDR-TB, also known as Vank's disease) is defined as a form of TB infection caused by bacteria that are resistant to treatment with at least two of the most powerful first-line anti-TB drugs, isoniazid (INH) and rifampicin (RMP).

Five percent (5%) of all TB cases across the globe in 2013 were estimated to be MDR-TB cases, including 3.5% of newly diagnosed TB cases, and 20.5% of previously treated TB cases. While rates of MDR-TB infections are relatively low in North America and Western Europe, they are an increasingly serious problem worldwide, in particular in areas of the Russian Federation, the former Soviet Union and other parts of Asia.

MDR-TB infection may be classified as either primary or acquired.[5] Primary MDR-TB occurs in patients who have not previously been infected with TB but who become infected with a strain that is resistant to treatment. Acquired MDR-TB occurs in patients during treatment with a drug regimen that is not effective at killing the particular strain of TB with which they have been infected. Rates of primary MDR-TB are low in North America and Western Europe: in the US in 2000, the rate of primary MDR-TB was 1% of all cases of TB nationally.

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WHO: What is multidrug-resistant tuberculosis (MDR-TB) and how do we control it?

The bacteria that cause TB can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the two most powerful anti-TB drugs.

The reasons why multidrug resistance continues to emerge and spread are mismanagement of TB treatment and person-to-person transmission. Most people with TB are cured by a strictly followed, six-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs (e.g. use of single drugs, poor quality medicines or bad storage conditions), and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings such as prisons and hospitals.

In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and expensive, recommended medicines are not always available, and patients experience many adverse effects from the drugs. In some cases even more severe drug-resistant TB may develop. Extensively drug-resistant TB, XDR-TB, is a form of multidrug-resistant TB with additional resistance to more anti-TB drugs that therefore responds to even fewer available medicines. It has been reported in 105 countries worldwide.

Drug resistance can be detected using special laboratory tests which test the bacteria for sensitivity to the drugs or detect resistance patterns. These tests can be molecular in type (eg, Xpert MTB/RIF) or else culture-based. Molecular techniques can provide results within hours and have been successfully implemented even in low resource settings.

Solutions to control drug-resistant TB are to:

  • cure the TB patient the first time around;
  • provide access to diagnosis;
  • ensure adequate infection control in facilities where patients are treated;
  • ensure the appropriate use of recommended second-line drugs.
In 2014, an estimated 480 000 people worldwide developed MDR-TB. It is estimated that about 9.7% of these cases were XDR-TB.

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6 drug resistant TB cases in AMK
Three recent healthcare outbreaks in Singapore