26 new confirmed cases of Influenza A (H1N1-2009) as Pandemic Preparedness Clinics gear up

22 Jun 2009

1. Singapore has confirmed another 26 new cases (143rd to 168th cases) of Influenza A (H1N1-2009), comprising 17 local cases and 9 cases with travel history. This brings the total number of confirmed cases in Singapore to 168.

2. As more confirmed Influenza A (H1N1-2009) cases arise from local transmission, it appears that community spread has gathered momentum. In line with this, we are gearing up our polyclinics and a few hundred GPs to treat suspect Influenza A (H1N1-2009) cases. These clinics or Pandemic Preparedness Clinics (PPC) will help to manage patients with influenza-like illness when we move from containment into mitigation mode.

LOCAL CASES

3. The 17 new local cases include two additional cases from the Riverlife Church cluster, one additional case from the cluster at Butter Factory at One Fullerton, nine cases who attended the Fishermen of Christ Church camp together with the 136th case, one case who is linked to two earlier confirmed cases, two cases with transmission from imported cases, and two unlinked cases.

A) Community Clusters 

i) Riverlife Church

Two more students (151th and 164th) who attended the function at Riverlife Church during the 13-14 June weekend have been added to this cluster, bringing the total number of cases to nine.

ii) Butter Factory

One more student (150th) who visited Butter Factory on 17 June together with cases 96th, 117th and 118th cases has been added to this cluster, bringing the number of cases to five.

iii) Fishermen of Christ Church

Nine students who attended the camp together with the 136th case reported on 21 June have now been confirmed positive for Influenza A(H1N1-2009). The camp held at Prince George's Park from 15 to 18 June was organised by the Fishermen of Christ Church and attended by 136 students and adults. The total number of cases stands at ten.

iv) Social

The 154th case is a 17-year-old Singaporean male student who developed a fever on 15 June. He was brought by his father (120th confirmed case reported on 20 June) to seek medical attention at a GP clinic on 17 June. He was given medical leave and prescribed medication. On 19 June, he recovered and attended school. In view that the father was tested positive for influenza A/H1N1-2009, a swab was taken from the 154th case which was tested positive for influenza A/H1N1-2009.

B) Local transmission from imported case

4. The 149th case is a 23-year-old American female working in Singapore. On 15 to 17 June, she had family visiting from USA.  She returned to work from 18 to 20 June. She developed symptoms on 19 June. She sought medical attention on 21 June and later went to TTSH and had her swabs taken and subsequently returned home. Later in the night, she was informed by TTSH that she has tested positive for influenza A/H1N1/2009 and was brought into TTSH via 993 ambulances. Two of her cousins from the USA who had visited her from 15 to 17 June were later confirmed H1N1 cases in Hong Kong.

5. The 156th case is a 23-year-old Singaporean female. On 17 June evening, she had dinner with some friends including the 105th case. She went to work on 18 and 19 June. On 20 June morning, she developed a fever and sought medical attention at a GP clinic who took a swab from her under the MOH influenza surveillance programme. She stayed at home for the rest of the day. Later in the evening, she was informed by MOH that she tested positive for influenza A/H1N1/2009, and was conveyed to NUH for admission via a 993 ambulance.

C) Unlinked cases

6. The 153rd case is a 21-year-old Singaporean national serviceman who returned from overseas national service training from Taiwan in the early morning of 14 June. He was on home leave from 14 - 16 June. He remained home during this period. He reported to Camp on 17 June and stayed there till 19 June. In the late evening of 19 June, he developed a fever and returned home later that night. He walked-in to TTSH on 22 June evening and was subsequently admitted in the early morning of 22 June. 

7. The 157th case is a 19-year-old male foreign student from China. He returned from China to Singapore on 14 June. On 20 June, he developed symptoms and sought medical attention at a GP. On 21 June, he went to NUH A&E and his swabs was taken and subsequently discharged. In the early morning of 22 June, he was informed by NUH that he tested positive for influenza A/H1N1/2009, and was conveyed to NUH for admission via a 993 ambulance.

PANDEMIC PREPAREDNESS CLINIC (PPC) TO HELP MANAGE FLU OUTBREAK

8. Pandemic Preparedness Clinics (PPC), registered under MOH’s Influenza Pandemic Response Framework will be activated when there is evidence of sustained community transmission. They are supported with Personal Protection Equipment (PPE) and Tamiflu from the national stockpile to help manage patients with influenza-like illness. Medical personnel at the PPCs have all been trained in infection control measures, triaging and separating patients with and without fever, mask fitting etc so that they are able to manage both flu and patients with other health conditions safely. To date, there are more than 450 PPCs island-wide.

9. When we eventually move into the mitigation phase, members of the public who develop flu-like symptoms or influenza-like illness (e.g. fever, cough, sore-throat, runny nose) should  go to the nearest PPC or polyclinic for initial assessment and treatment. Depending on the severity of their illness and other risk factors, they may be referred to the hospital for further management.

10. However, people who are pregnant, on active cancer treatment or on kidney dialysis, are advised to contact their regular specialist(s) should they develop flu-like symptoms as the illness may complicate their underlying conditions.

11. The PPCs will be identified with a "H1N1-ready" decal (see Annex A). They are located island-wide to ensure that Singaporeans can get medical assessment and treatment for influenza-like illness promptly. To locate the nearest PPC, the public can go to HPB website (www.street-directory.com/hpb.ppc/) or MOH website (www.moh.gov.sg). 

IMPORTED CASES

12. In addition to the 17 local cases, there are 9 new cases with a history of travel to affected areas.

13. They had travelled to the following countries:

• Australia 

• Philippines 

• UK  

• US

• Canada 

Breakdown of Total Confirmed Cases

14. The breakdown of the 168* cases is as follows:

Country of Origin of Travel of Confirmed Cases (as of 22 June 2009) 

*127 cases were imported while there were 5 community clusters (9 cases in the Riverlife Church cluster, 5 in the Butter Factory cluster, 3 in workplace (CISCO), 2 with social contact), 10 in the Fisherman church camp, 5 household clusters (imported case transmitting to household members), and another 7 were unlinked cases.

# The 68th case is a 33-year-old Singaporean woman who went for a holiday in Europe from 28 May to 17 June. She was on a cruise from 4 June to 16 June. She developed symptoms while on the cruise. She was treated on the ship and returned to Singapore on 17 June.

15. So far, 56 patients have been discharged.  The remaining 112 patients (34th, 37th, 41st, 43rd - 46th, 48th, 52nd, 53rd, 63rd - 68th, 70th - 72nd, 74th - 92nd, 94th - 96th, 98th - 168th) are still in the hospital and their conditions remain stable.

The following is a breakdown of cases by age

Age profile

Advisory to Travellers

16. For those who are planning to travel, they should check the MOH website for the latest update on the list of countries with confirmed cases of H1N1 so that they can make considered decisions on whether to proceed with their travel plans.  For more information on Influenza A (H1N1-2009), please access MOH's website at www.moh.gov.sg, call our hotline at 1800-333 9999, or visit www.flu.gov.sg.

Annex A

Pandemic Preparedness Clinic Decal

MINISTRY OF HEALTH