20/05/2019

First case of Monkeypox in Singapore


Update 6 Jul 2022: Singapore confirms first local case of Monkeypox
Monkeypox contained in Singapore and unlikely to be in community, says expert

The Ministry of Health (MOH) has confirmed the first local case of monkeypox infection in Singapore.

The patient is a 45-year-old male Malaysian national who resides in Singapore. He tested positive for monkeypox on Wednesday (July 6).

He is currently hospitalised at the National Centre for Infectious Diseases (NCID) and his condition is stable. "He is not linked to the imported case announced by MOH on June 21," said the ministry.


Singapore confirms first imported case of Monkeypox

The Ministry of Health (MOH) on Tuesday (21 June) confirmed one imported case of monkeypox infection in Singapore. The patient is a 42-year-old British man who works as a flight attendant and was in Singapore between 15 and 17 June, and again on 19 June as he flew in and out of Singapore.

He tested positive for monkeypox on 20 June and is currently warded in at the National Centre for Infectious Diseases (NCID). His condition is stable while contact tracing is ongoing. The case had onset of headache on 14 June, and fever on 16 June. These symptoms subsequently resolved, and he then developed skin rashes on 19 June. He sought medical attention via teleconsultation on 19 June, and was conveyed to NCID on 20 June.

Contact tracing is ongoing for the affected flights and for the duration of the man’s stay in Singapore. During this period, he had mostly remained in his hotel room, except to visit a massage establishment, and eat at three food establishments on 16 June. The risk of transmission to visitors at these locations is low, as data has shown that monkeypox transmits through close physical or prolonged contact. All four locations visited by the case are undergoing cleaning and disinfection. As of Tuesday, 13 close contacts have been identified, and they will be placed on quarantine for 21 days since their last contact with the case.


WHO: Human Monkeypox (MPX)

On 9 May 2019, the Ministry of Health (MOH) in Singapore notified WHO of one laboratory-confirmed case of monkeypox. The case-patient is a 38 year old Nigerian man who arrived in Singapore on 28 April 2019 and attended a workshop from 29-30 April. Prior to his travel to Singapore, he had worked in the Delta state in Nigeria, and had attended a wedding on 21 April 2019 in a village in Ebonyi State, Nigeria.

The patient developed fever, muscle aches, chills and skin rash on 30 April. He reported that he had remained in his hotel room most of the time between 1 and 7 May. He was transferred to a public hospital by ambulance on 7 May and referred to the National Centre for Infectious Diseases (NCID) on the same day, where he was isolated for further management. Skin lesion samples were taken on 8 May and tested positive for monkeypox virus by the National Public Health Laboratory on the same day. He is currently in a stable condition.

Public health response - Based on investigations thus far, authorities in Singapore have traced and contacted a total of 23 close contacts, including 18 participants and trainers who attended the same workshop, one staff at the workshop venue, and four hotel staff who had close contact with the affected individual. Healthcare workers who were in contact with the patient had used personal protection equipment. MOH’s investigation and contact tracing operations are ongoing.

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Risk of monkeypox spreading in S'pore is low, say experts
The Ministry of Health has confirmed one imported case of monkeypox infection in Singapore, involving a Nigerian national who arrived last month for a workshop.PHOTO: CDC/BRIAN W.J. MAHY

 Singaporeans need not worry too much about monkeypox spreading among the population here, as the risk of human-to-human transmission is low, say infectious disease specialists.

 "I'm not worried about it," said Dr Leong Hoe Nam, an infectious disease specialist at Mount Elizabeth Novena Hospital.

 "Monkeypox has been in other countries like the United Kingdom, and there were no local transmissions subsequently. It didn't happen there, and the chance of it happening in Singapore is low."

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 None of those exposed to virus have caught the infection so far

 The 23 individuals who had close contact with a Nigerian man diagnosed with monkeypox earlier this month are well and have shown no sign so far of having caught the infection, as of Monday evening (May 13).

 They will remain in quarantine up till 21 days from the last time they were in contact with the patient. This is the limit of infection following exposure, although most people who get it would show symptoms between six and 16 days.

 5 of the contacts are Singaporeans, who were quarantined at home, while the 17 foreigners were housed individually at a designated quarantine facility, said a spokesman for the Ministry of Health (MOH) on Tuesday. They have Wi-Fi and meals are delivered to them. The remaining foreigner had left Singapore before the original infection was detected. He is also fine.

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 Singapore Aggressively Confronts 1st Monkeypox Case

 The Singapore Ministry of Health (MOH) reported the 1st laboratory-confirmed case of monkeypox, on May 9, 2019. Additionally, the Singapore MOH released a press statement on May 9th, offering advice for the public, and communicated which measures are being taken to minimize the risk of any potential onward transmission of the monkeypox virus.

 Human-to-human transmission, while possible, is limited. A person is infectious only during the period when he has monkeypox symptoms, particularly a skin rash.

 There have been reported mortality rates up to 10 percent during outbreaks, with most deaths occurring in younger age groups.

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Thermal scanners set up at Indonesia’s checkpoints after Singapore monkeypox case

Thermal scanners have been set up at Indonesia’s airports and seaports, including those in Pekanbaru and Batam, to monitor visitors from Singapore for signs of monkeypox.

This comes after Singapore confirmed its first case of the rare virus last week.

According to a report by Jakarta Post, state-owned airport operator PT Angkasa Pura II (AP II) said it is working with the port health office (KKP) to beef up monitoring at its 13 international airports.

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6 things to know about the virus

A Nigerian national tested positive for monkeypox on Wed (May 8), the first case of the rare viral disease reported here.

The man is currently in an isolation ward at the National Centre for Infectious Diseases and is in stable condition.

22 out of 23 individuals who have been identified as close contacts of the patient are under quarantine as a precautionary measure. Here are 6 things to know about monkeypox:
  • WHAT IS MONKEYPOX?
  • WHY IS IT CALLED MONKEYPOX?
  • WHAT ARE THE SYMPTOMS OF MONKEYPOX?
  • HOW DOES MONKEYPOX SPREAD?
  • HOW IS MONKEYPOX DIAGNOSED AND TREATED?
  • IS AN OUTBREAK LIKELY IN SINGAPORE?

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 What you need to know about the disease

Authorities have confirmed Singapore's first case of monkeypox infection, imported by a 38-year-old Nigerian who arrived on Apr 28. The patient, who may have contracted the rare disease from eating bush meat while in Nigeria, tested positive for the virus on May 8. He is in stable condition in an isolation ward at the National Centre for Infectious Diseases (NCID).

 People who were in close contact with him have been put in quarantine although they have had no symptoms.

 Here are some things you need to know about the disease:
  • How is monkeypox spread, and should we be worried about an outbreak?
  • What are the symptoms?
  • How dangerous is it?
  • How is monkeypox diagnosed and treated?

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 Monkeypox facts
  • Monkeypox is a viral disease that produces pox-like lesions on the skin. It is closely related to smallpox but is not nearly as deadly as smallpox was.
  • The history of monkeypox is new (1958), and medical professionals diagnosed the first human monkeypox cases and differentiated them from smallpox in the early 1970s.
  • Monkeypox virus (MPXV) causes monkeypox. The majority of cases are transmitted from animals (rodents) to humans by direct contact.
  • Monkeypox is contagious. Person-to-person transfer, probably by droplets, can occur infrequently.
  • Risk factors for monkeypox include close association with African animals (usually rodents) that have the disease or caring for a patient who has monkeypox.
  • During the first few days, symptoms are nonspecific and include fever, nausea, and malaise. After about four to seven days, lesions (fluid-filled pustules, papules) develop on the face and trunk that ulcerate, crust over, and begin to clear up after about 14-21 days, and lymph nodes enlarge. There may be some scarring.
  • The diagnosis of monkeypox is often made presumptively in Africa by the patient's history and the exam that shows the pox lesions, however, a definitive diagnosis is made by PCR, ELISA, or Western blotting tests that are usually done by the CDC or some state labs. Definitive diagnosis is important to rule out other possible infectious agents like smallpox.
  • Treatment may consist of immediate vaccination with smallpox vaccine because monkeypox is so closely related to smallpox and thus cross-protective. Treatment with an antiviral drug or human immune globulin has been done.
  • In general, the prognosis for monkeypox is good to excellent as most patients recover. The prognosis may decrease in immunocompromised patients, and patients with other problems such as malnutrition or lung disease may have a poorer prognosis.
  • Monkeypox is preventable as long as people avoid direct contact with infected animals and people. Vaccination against smallpox seems to afford about an 85% chance of avoiding the infection. There is no commercially available vaccine specifically for monkeypox.
  • Research is ongoing to study antivirals, genetics, and rapid tests for monkeypox.

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 THREE OTHER RARE INFECTIOUS DISEASES SPOTTED HERE RECENTLY

 Monkeypox is not the first rare infectious disease here in recent years.

 Here are three more:
  • Candida auris infection - Candida auris is a drug-resistant invasive fungus that kills nearly half of its victims in 90 days. It is not a threat to healthy individuals and has so far been seen mostly in patients with weakened immune systems. At least three cases have been seen in a Singapore hospital since 2012, said a New Paper report.
  • Zika virus infection - The mosquito-borne Zika virus made headlines in 2015 when thousands of people in Brazil were affected and babies were born with Zika-related birth defects. The first locally transmitted case here was seen in August 2016, involving a woman who had no history of travel to countries affected by Zika then. About 450 people here were infected by the end of that year. As of last month, there were four Zika cases this year.
  • Group B Streptococcus (GBS) infection - GBS is a bacterium commonly found in the gut and urinary tract of about 15 per cent to 30 per cent of adults without causing any disease. But it may occasionally cause infections of the skin, joints, heart and brain. A mass outbreak of 360 cases occurred in Singapore in 2015, with two fatalities. About 150 of the more serious cases were linked to the consumption of raw freshwater fish.

Living with COVID-19

It is “possible” to live with the Omicron variant of COVID-19, as the number of cases with severe outcomes remain low despite the surge in cases, said Health Minister Ong Ye Kung on Tuesday (Feb 8). Speaking at the Singapore Health Quality Service Awards 2022, Mr Ong thanked healthcare workers for their efforts amid the COVID-19 pandemic. Adding that the Ministry of Health (MOH) will monitor the trajectory of the transmission wave closely, he noted that “every country will experience and even shape the curve of their transmission wave”.

The wave could rise sharply and come crashing down in a few weeks such as in South Africa and Australia, or it could remain moderately high for slightly longer like in the Netherlands or Denmark, he added. “We are trying to co-exist with a force of nature, with measures that we have put in place such as restrained social behaviours and vaccinations. No one knows exactly what the impact of these measures will be, what the final trend line will look like, and what is on the other side of Omicron,” said the Health Minister.

“But it is however comforting and encouraging is that among patients infected, the number of cases with severe clinical outcomes remains low despite the sharp surge in cases. This means it is possible to live with Omicron.” The current Omicron wave is registering daily cases a few times more than that of the Delta wave “as expected”, and the numbers may go up even more, said Mr Ong.

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