Additional Measure for Early Detection of MERS-CoV

Temperature screening at air checkpoints from 18 May

1. The Ministry of Health (MOH) is closely monitoring the latest global developments on Middle East respiratory syndrome coronavirus (MERS-CoV) infections, including the situation in Saudi Arabia which continues to see more confirmed cases in recent weeks. A statement issued by the World Health Organization (WHO) on the Fifth Meeting of the International Health Regulations (IHR) Emergency Committee concerning MERS-CoV had also strongly urged Member States to take immediate steps to improve national policies for infection prevention and control. In line with the Committee’s assessment that the seriousness of the situation had increased in terms of public health impact, we intend to commence temperature screening at air checkpoints for passengers arriving from affected countries in the Middle East from 18 May 2014 (Sun) [See Factsheet for more information]. This is an additional measure for the early detection of MERS-CoV.

2. No cases of MERS-CoV have been detected in Singapore thus far [see Background]. The risk of an outbreak in our community also remains low as sustained human-to-human transmission of the virus has not been reported. Nonetheless, the possibility of an imported case here cannot be ruled out given today’s globalised travel patterns. As the global MERS-CoV situation is still unfolding, our ongoing surveillance efforts and assessment of the public health impact here will guide the calibration of existing as well as future public health measures.

3. While it is a pre-emptive measure, temperature screening may not pick up all imported cases due to the long incubation period (up to 14 days) of MERS-CoV and the presence of mild and asymptomatic cases. MOH and healthcare institutions therefore remain vigilant to test for MERS-CoV where clinically indicated, such as in patients with serious respiratory illness and a compatible travel history. All suspected and confirmed cases will be isolated and managed under strict airborne infection control precautions. If a case is detected, MOH will conduct contact tracing when appropriate, and all close contacts will be placed under quarantine. Guidance to healthcare workers on the management of any suspected cases of MERS-CoV infection has also been provided.

4. Health Advisories are in place at our border checkpoints for incoming travellers from areas affected by MERS-CoV, as well as for outgoing travellers to these affected areas. MOH’s Health Advisory is also distributed to both passengers flying to and from affected areas. The Islamic Religious Council of Singapore (MUIS) will continue to work with the relevant travel agents to ensure that MOH’s Health Advisory is provided to Umrah and Haj pilgrims. There is currently no advisory against travel to countries of the Arabian Peninsula, or to countries reporting imported cases of MERS-CoV. Prior to overseas travel, members of the public are also encouraged to refer to the MOH web page on MERS-CoV for the latest Health Advisory.

Health Advisory 

5. To reduce the risk of exposure to MERS-CoV, we would like to advise Singaporeans travelling to affected areas to maintain vigilance and adopt the following health precautions when overseas:

- Observe good personal hygiene at all times;

- Practise frequent hand washing (e.g. before handling food or eating, after going to toilet, or when hands are soiled);

- Avoid close contact with persons suffering from acute respiratory infections (e.g. someone who is coughing);

- Avoid contact with camels and other live farm or wild animals, including not visiting camel farms. If contact has been made, thoroughly wash hands with soap.

- Adopt good food safety and hygiene practices and avoid consuming unpasteurised milk, undercooked meats, raw fruits and vegetables (unless they have been peeled), or unsafe water.

6. MOH would also like to advise frequent travellers to the Middle East and Umrah/Haj pilgrims to:

- Be vaccinated against influenza and meningitis. Persons aged 65 years and above or with chronic medical conditions should also get vaccinated against pneumococcal infections. While there is NO vaccination against MERS-CoV, vaccinations against influenza and pneumococcal infection will help prevent these common infections which have similar symptoms as MERS-CoV.

- Pilgrims with pre-existing chronic medical conditions (e.g. diabetes, chronic heart and lung conditions) should consult a doctor before travelling to assess whether making the pilgrimage is medically advisable.

7. Individuals should wear a surgical mask and seek medical attention promptly if they become unwell with fever and cough while travelling in or if they had recent travel history (within 2 weeks) to any areas reporting human cases of MERS-CoV. They should inform the doctor of the areas that they have travelled to.

Background

8. In 2014 as of 14 May, a total of 48 suspected cases investigated locally for MERS-CoV had all tested negative. They reported a travel history to the Middle East for business (4 cases) or social purposes (4 cases), as well as for Umrah (40 cases).

9. MERS-CoV is a novel coronavirus which causes acute respiratory illness in infected patients. The virus was first reported by the WHO on 22 September 2012, and thus far all cases worldwide remained associated with the Arabian Peninsula.

10. Coronaviruses are a large family of viruses which are known to cause illness in humans and animals. Human coronaviruses usually cause mild respiratory illnesses like the common cold, with the exception of the MERS-CoV and the SARS coronavirus which can cause severe illness.

MINISTRY OF HEALTH

15 MAY 2014

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FACTSHEET

Procedure for handling passengers with fever identified through temperature screening

1 Passengers with fever detected at the temperature screening stations will be referred to a designated area for further clinical assessment. A medical practitioner will then recheck the passenger’s temperature manually, ask about his/her travel history or any history of contact with a confirmed case of MERS-CoV, and look for evidence of lung infection or severe respiratory infection with breathlessness. These are the criteria for suspected cases of MERS-CoV.

2 If the passenger fulfils these criteria, he/she will be referred to Tan Tock Seng Hospital (or KK Women’s and Children’s Hospital in the case of children under 16 years of age) for further evaluation, testing and clinical follow up.

3 If the passenger does not fulfil the criteria for suspected cases of MERS-CoV, he/she will be given a surgical mask and health advisory, and will be placed on phone surveillance until his/her symptoms resolve. If his/her condition worsens while he/she is on phone surveillance, he/she will be advised to seek medical attention promptly.