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Source:
www.moh.gov.sg |
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Enhancing Public Health
Measures Against Tuberculosis |
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Gazetting TB under the Sixth Schedule
of the Infectious Diseases Act (IDA) |
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The Ministry of Health (MOH) will place
tuberculosis (TB) under the Sixth Schedule of the Infectious
Diseases Act (IDA) with effect from 1 December 2008, This will
further strengthen public health measures against the spread of the
disease, especially amongst air travellers. |
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Placing TB under the Sixth Schedule of
the IDA enables MOH to disclose particulars of the TB patient to the
relevant authorities in a timely manner. Preventive measures can
then be implemented without delay. These include: |
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Contact tracing for infectious TB
patients who have travelled on long-haul flights, |
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Prohibition of infectious TB
patients from travelling on commercial flights, and |
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Management of recalcitrant TB
patients to undergo treatment |
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A person with TB is infectious until he
has completed at least 2 weeks of effective treatment and tests show
that his sputum no longer contains any TB bacteria. Persons with
Multi-Drug Resistant TB (MDR TB) however require longer treatment
for a few months before they become non-infectious. However,
transmission of infection to another person requires close prolonged
contact e.g sitting close to a person with TB on an airplane.
Persons with TB therefore must not travel until they have been
cleared by their doctors for travel. |
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Currently under the IDA, information
which identifies a patient or suspected patient of an infectious
disease cannot be disclosed unless it is for the purpose of carrying
out public health measures to prevent the spread of the disease and
(i) either the disease is listed on the Sixth Schedule or (ii) the
Minister for Health has given special approval, or the disclosure is
made to the World Health Organisation to comply with international
health regulations[1]. |
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Severe Acute Respiratory Syndrome (SARS)
is the only disease listed on the Sixth Schedule. SARS was gazetted
under the Sixth Schedule back in 2003 for contact tracing of
possible SARS cases and the management of persons on Home Quarantine
Orders. |
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Update on the Tuberculosis Situation
in Singapore |
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There were 700[2]new cases of TB
notified among Singapore residents in the first 6 months of 2008, as
compared to 1,256 cases last year. The projected incidence of TB in
2008 is 38.4 per 100,000, which is higher than the 35.1 per 100,000
in 2007. |
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Most (86%) of the increase in TB cases
in 2008 compared to 2007 (56%) was among persons aged 50 years and
above. These older adults went through periods when TB was highly
prevalent. They would have acquired latent infection in those early
years and are manifesting TB disease now. This suggests that the
increase in TB incidence in 2008 was probably due to increased
reactivation of latent TB infection. |
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Males accounted for 71.1% (498 cases) of
new TB cases and more than half (59.7%) of the male cases were aged
50 years and above. There were 82 relapsed cases among residents for
the first half of 2008, with 2 of the relapsed cases being notified
as MDR TB. There were no new cases of MDR TB for the same period.
Please refer to Annex for the detailed statistics. |
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Control of TB in Singapore |
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Early diagnosis and complete treatment
till cure is the key to successful control of TB in Singapore.
Patients with symptoms suggestive of TB should consult a doctor
promptly and complete the full course of treatment (6 – 9 months). |
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Non-adherence to treatment may result in
a relapse of TB with resistant strains i.e. multi-drug resistant TB
(MDR TB) and Extensively Drug Resistant TB (XDR TB), which are more
difficult and expensive to treat. Directly Observed Therapy (DOT) is
the international standard of care for TB treatment, where a trained
healthcare professional observes the patient taking his medication
and checks whether the patient has any side-effects from taking the
TB medication. |
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MOH will take public health enforcement
action against those who persistently default treatment as they pose
a public health risk to the community. Such persons will be required
under the IDA to comply with treatment by DOT until completion.
Persons who continue to default their treatment may be also be
detained at the Communicable Diseases Centre at Tan Tock Seng
Hospital till they are cured. |
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How individuals and the community can
help control TB |
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People with TB can be treated and cured
earlier if they seek medical help promptly and adhere to their
treatment. This can safeguard the patients’ health as well as the
people around them. There is still stigma attached to TB patients
and this acts as a hurdle for people coming forward for diagnosis
and treatment. |
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The community can hence also play its
part by providing support and encouragement to TB patients. For
instance, families of patients should encourage patient to be
adherent to treatment and employers should be understanding and
allow their workers to take time off to go to the polyclinic for
DOT. |
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More information on TB is available at
the MOH FAQs at
http://www.pqms.moh.gov.sg/apps/fcd_faqmain.aspx
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MINISTRY OF HEALTH
28 November 2008 |
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[1] Informing the Airlines is one of the
requirements laid down by WHO in the latest guidelines on TB and
travel. Extract from the 3rd Edition of WHO's "TB and Air Travel":
“Airline companies are obliged to comply with the applicable
requirements in the IHR and the laws of the countries in which they
operate. It is the responsibility of airlines to be familiar with
the specific laws and regulations concerning communicable diseases
applying to passengers and goods at points of entry for each
destination country. Similarly, when transporting infectious agents
or passengers with communicable diseases, airline companies need to
comply with the laws on safety procedures and on the release of
passenger information of each country to which they fly, as well as
the IHR regarding such information and other issues." |
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[2]Preliminary data |
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Source:
www.moh.gov.sg Press Release 28
Nov 2008 |
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FrontPage Edition: Sat 29 Nov 2008
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