Measles Cases at MINDSville@Napiri Home and S11 Dormitory @ Punggol

     The Ministry of Health (MOH) has noted an increase in the number of measles cases in Singapore in recent weeks. In the past week, there were confirmed cases of measles infection at the following locations:

1. 14 cases at the MINDSville @ Napiri, a residential home for persons with intellectual disability located at 7 Lorong Napiri.

2. Three cases at S11 Dormitory @ Punggol, a foreign worker dormitory located at 2 Seletar North Link.

2.     There is currently no evidence of community spread from these cases. Nonetheless, MOH has taken precautionary measures to prevent further spread. These include vaccination of close contacts who do not have proof of vaccination or immunity, and close monitoring of the health of close contacts. All suspected measles cases will be isolated.     Cases at MINDSville@Napiri 3.     MOH was notified of a suspected case on 7 July, and subsequently a cluster of measles infection amongst residents and staff of the MINDSville@Napiri home on 19 July 2019. As of 22 July, there were 14 confirmed cases involving 12 residents and two staff. Six of the residents were hospitalised, of whom one has been discharged and is no longer infectious. The remaining five patients in hospital are in stable condition.

4.     The first case was a resident who developed symptoms on 29 June and received outpatient treatment on 1 and 5 July. She was subsequently hospitalised and was tested positive for measles on 9 July. She has since been discharged and is no longer infectious. Nine more cases were reported from 19 July to 20 July and the remaining four cases were reported on 22 July. The cases were promptly isolated and treated.

5.     Following the notification of the first suspected case on 7 July, MOH had advised the home on vaccination recommendations for close contacts, as well as enhanced infection prevention and control measures. Staff and residents were reminded to maintain a high standard of personal hygiene and staff were asked to wear gloves and protective equipment when tending to symptomatic residents. The home was also advised to closely monitor residents and staff for symptoms and to seek medical treatment for them if they are unwell.

6.     As an added precaution, in view of shared facilities in the home, all residents and staff who do not have proof of immunity to measles have been given the Measles, Mumps, Rubella (MMR) vaccination on 22 July. Residents will be screened for symptoms prior to leaving the home for essential medical appointments and other activities.

 Cases at S11 Dormitory @ Punggol 7.     On 15 July 2019, MOH was notified of the first case of measles infection in S11 Dormitory @ Punggol involving one Indian worker. Two other measles cases involving a Bangladeshi and another Indian worker from the same dormitory were notified to MOH on 16 July and 19 July respectively. All three cases were hospitalised and have since been discharged. They are no longer infectious.

8.     The Bangladeshi worker had recently arrived from Bangladesh on 27 June 2019, while the other two cases had no recent travel history. Vaccination history of the three cases is unclear. The three cases reside at different blocks in the dormitory and are from different companies, working at different sites. They reported no contact with sick people. Thus far, there have been no links identified amongst the three cases. Investigations are ongoing.

9.     MOH is working with the companies to conduct screening and vaccination of all close contacts of the three cases who do not have proof of vaccination or immunity. As of 22 July, 50 close contacts (including roommates and co-workers) have been identified and vaccinated. MOH has also advised the companies to closely monitor the health of the identified close contacts and to seek medical treatment promptly if they are unwell.

10.     As an added precaution, in view of shared facilities within each floor of the dormitory, MOH is working with NCID to offer MMR vaccination to all residents who do not have proof of vaccination or immunity and are staying on the same floor as the cases, so as to reduce the risk of further transmission. The vaccination of all contacts identified is expected to be completed by the end of this week.

 Update on previous cases at Toh Guan Dormitory and Sungei Tengah Lodge11.     MOH announced earlier on 27 June 2019 that a total of eight measles cases were identified in Toh Guan Dormitory and Sungei Tengah Lodge in June 2019, with two from Toh Guan and six from Sungei Tengah. MOH has since completed vaccination of all close contacts of the eight measles cases.There have not been further cases reported from either dormitory.

 Vaccination and Vigilance Key to Measles Prevention 12.     As of 22 July, 116 measles cases have been notified to MOH in 2019. 88 of these cases were local and 28 were imported from Bangladesh, Dubai, Malaysia, New Zealand, Philippines, Thailand and Vietnam. No deaths were reported in 2019 arising from the notified cases of measles.

13.     Measles is a highly transmissible viral disease among unvaccinated individuals, with an infectious period of as early as four days before onset of rash to four days after. The most effective way of preventing measles infection is to be vaccinated. High vaccination coverage at the population level would ensure high herd immunity, which reduces the risk of widespread transmission and large outbreaks.

14.     Measles vaccination is compulsory by law for all children residing in Singapore as children are at high risk of developing complications. MOH would like to remind parents to ensure that their children’s measles vaccinations are up to date so as to protect themselves, maintain the high vaccination coverage and prevent community outbreaks locally. Adults are also recommended to be vaccinated against measles if they have not been previously vaccinated or lack evidence of immunity.

15.     The MMR vaccination is available at polyclinics, private general practitioner clinics and private paediatric clinics. It is fully subsidised for children (Singapore Citizens) at polyclinics. MediSave can also be used at the private general practitioner and private paediatric clinics for both adults and children.

16.     We urge Singaporeans to be vigilant, as measles cases around the world have increased substantially. As a travel hub, Singapore is likely to see increased cases from importation. MOH investigates all notified cases of measles under our surveillance programme, and will continue to monitor the situation closely. MOH has alerted general practitioners to be on the look-out for cases of measles, particularly in patients who have recently travelled overseas or who have not been vaccinated, and to notify MOH promptly.

17.     The public should also remain vigilant and adopt the following precautions where relevant:

• If travelling to areas with measles outbreaks, please check that you are immune to measles, which can be ascertained with a blood test or by receiving a vaccine that protects against measles, such as the measles, mumps, rubella (MMR) vaccine;

• Observe good personal hygiene at all times; 

• Practise frequent hand washing with soap (e.g. before handling food or eating, after going to toilet, or when hands are dirtied by respiratory secretion after coughing or sneezing); 

• Avoid close contact with people who are unwell or showing symptoms of illness;

• Wear a mask if having respiratory symptoms such as a cough or running nose;

• Cover your mouth with a tissue paper when coughing or sneezing, and dispose the soiled tissue paper in the rubbish bin immediately; and

• Seek medical attention promptly if feeling unwell.