Update on Tuberculosis Situation in Singapore

           On World Tuberculosis (TB) Day on 24 March, Singapore joins the global community in reiterating its commitment to continue the fight against TB. The World Health Organization’s (WHO) theme for 2021’s World TB Day is “The Clock is Ticking”, which appeals for global action on the commitments made by global leaders to end TB.

2.        TB remains a global public health threat. In 2019, there were more than 10 million cases of active TB globally, with 1.4 million deaths. In addition, there were almost half a million cases of multi-drug resistant TB (MDRTB). MDRTB is more difficult to treat and has lower cure rates, with death rates as high as 30 to 40 percent.

3.         TB is endemic in Singapore and latent TB infection is not uncommon in our population, with rates of up to 30 per cent in the older age groups. In 2020, there were 1,370 new cases of active TB among Singapore residents. This is lower than the 1,398 cases in 2019. The incidence rate was 33.9 cases per 100,000 population in 2020, compared to 34.7 cases per 100,000 in 2019. Older age groups and males continue to make up a significant proportion of the new active TB cases. Please refer to the Annex for details.

TB Screening and Treatment in Singapore 4.          TB is an air-borne disease, and is transmitted through close and prolonged exposure to an infectious individual with untreated, active pulmonary (lung) TB. Not all individuals who are exposed to an infectious individual will get TB.

5.            TB is curable and the spread of TB is preventable. To ensure early detection and treatment, and to curtail the spread of TB, the National TB Programme (STEP) carries out contact tracing and screening of close contacts to ensure that those at risk of infection are tested and receive appropriate treatment.

6.            Persons diagnosed with active TB will be started on treatment immediately and placed on medical leave. Once treatment starts, the person will rapidly become non-infectious and no longer pose as a source for infection. There is no further risk of exposure in the workplace or school, and there is therefore no need to for workplaces or places where a recently diagnosed active TB case has visited to be closed. Close contacts found to have latent TB infection are not infectious and can continue their activities as usual.

7.           While there are national control measures in place to reduce the risk of TB transmission in Singapore, everyone plays an important role in preventing the spread of TB. Individuals who are unwell and display symptoms, such as cough, should seek medical attention early to ensure prompt diagnosis and treatment.

Importance of Treatment Adherence8.            The full course of active TB treatment takes six to nine months (up to 24 months for drug-resistant TB). If patients do not adhere strictly to the treatment programme (e.g. taking their medication on time), there is a higher chance of disease relapse and developing MDRTB.

9.             Directly Observed Treatment (DOT) remains a pillar of STEP. It comprises the administration of TB medicines by a trained healthcare worker to the patient, and is available at all the polyclinics. STEP manages an outreach DOT programme for patients who are unable to commute to clinics for their medications due to age or infirmity.

10.           Support and encouragement from patients’ family members, friends and co-workers are vital in ensuring that TB patients successfully complete their treatment. Employers can also play their part, by granting their employees flexibility during the day to access DOT. Treatment adherence and completion will not only benefit the patient, but also protect his family, workplace and community from infection.

11.           With everyone playing their part, we can ensure TB patients are treated effectively and reduce community transmission of TB in Singapore. More information on TB is available at the MOH website or the HealthHub website.