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1 24 March is World Tuberculosis (TB) Day. The World Health Organisation’s theme for this year’s World TB Day, “Stop TB in my lifetime”, aims for a world free of TB and reminds us that everyone has a part to play in this. On this day, MOH joins the global community to raise public awareness in the effort to stop TB.
2 This year also marks the 15th anniversary of the Singapore Tuberculosis Elimination Programme (STEP). Established in 1997, STEP has been continuously spearheading efforts to promote early diagnosis and effective treatment of patients with TB.
Update on the Tuberculosis Situation in Singapore
3 MOH was notified of 1533 new cases of TB among Singapore residents1 in 2011, which is slightly higher than the 1,478 cases in 2010. Correspondingly, the incidence rate was 40.5 cases per 100,000 population in 2011, compared to 39.2 cases per 100,000 in 2010. The number of non-residents2 notified with TB was 593 in 2011 compared to 550 in 2010.
4 Most of the cases (84.0%) among Singapore residents were Singapore-born. Older age groups and males continue to make up a significant proportion of the new cases. Of the 1533 new cases notified, 892 (58.2%) were 50 years old and above, and 1067 (69.6%) were males.
5 There were 158 relapsed cases among Singapore residents of which 132 (83.5%) were Singapore-born.
6 The emergence of multi-drug-resistant TB (MDR-TB) remains a serious public health challenge. In 2011, Singapore had 6 new cases of MDR-TB, comprising three Singapore-born and three foreign-born residents. The numbers of such cases must be kept low despite a higher regional prevalence of MDR-TB, through strong emphasis on treatment compliance under the national TB control programme. Please refer to Annex for the detailed statistics.
Importance of Early Diagnosis and Complete Treatment in controlling TB
7 To successfully control TB, it is important to ensure that all patients with TB are diagnosed early and undergo treatment of 6 to 9 months until fully cured, so as to curb community transmission. Those who fail to comply with treatment may continue to be infectious and may suffer a relapse of TB some time later as not all the TB bacteria have been killed. Ineffective or incomplete treatment of TB can also result in the development of drug-resistance. Drug-resistant TB is more difficult to treat and will take at least 18 months for treatment to be completed, compared with 6 months for drug-sensitive TB.
8 Persons with symptoms suggestive of TB (such as prolonged cough, fever, night sweats, unexplained loss of weight and appetite, tiredness) should seek medical attention as soon as possible. Family members should also bring their loved ones to the doctor if they notice these symptoms.
9 Directly Observed Treatment (DOT) is the international standard of care for TB treatment. Under DOT, a trained healthcare professional supervises the patient taking each dose of anti-TB medication and ensures that the patient complies with treatment. At the same time, the healthcare professional can monitor the patient for any side-effects. DOT is therefore the ideal mode of TB treatment, and is available at all polyclinics.
10 For those who default treatment and thus pose a public health risk to the community, MOH will take enforcement action by requiring them to comply with treatment by DOT under the Infectious Diseases Act. Persons who continue to default their treatment may also be detained for treatment until they are cured.
Everyone can play a part in reducing the transmission of TB in the community
11 TB is curable and the spread of TB is preventable. All of us play an important role in controlling TB in Singapore and keeping our community safe and free of TB.
12 MOH is currently reviewing the Singapore TB Elimination Programme (STEP), in light of the increase in the number of TB cases in recent years. There are multiple factors contributing to the rise in TB incidence, such as the progression of latent TB to symptomatic TB disease in our elderly due to their existing co-morbidities, greater mobility of our population and continued community transmission. Enhanced measures to detect and treat TB, as well as additional measures to prevent community transmission, are being explored. These measures will target each of the above contributory factors to strengthen the overall control of TB in Singapore.
13 At the individual level, we can also do our part by seeking medical attention early if we have symptoms to ensure early diagnosis, and adhering to the full treatment should we suffer from TB. As TB is a respiratory illness, patients should also observe proper cough etiquette (e.g. coughing into tissue) to prevent transmission.
14 The stigma attached to TB patients and prolonged treatment required of TB patients may be barriers to people coming forward for diagnosis and treatment. At the community level, family, friends and employers of TB patients can play a critical role by giving them support and encouragement to complete their treatment.
15 Employers should be supportive of TB treatment for their workers, by granting them the flexibility to go to polyclinics for DOT, when necessary. Generally, a person becomes non-infectious after just 2 weeks of treatment, which is covered by medical leave. There is thus no risk to the workplace when the TB patient returns to work. Treatment compliance and completion will benefit the patient, his family, workplace and the community.
16 As part of its outreach efforts to schools, the Health Promotion Board will be producing information booklets for parents and teachers to equip them with relevant knowledge on TB. Starting April this year, these booklets will be distributed to 179 primary schools and 170 secondary schools. To reduce stigma and discrimination at workplaces, HPB will continue to partner with Tsao Foundation and the Singapore National Employers Federation (SNEF) to conduct community and workplace talks.
17 With everyone playing a part, we can reduce the community transmission of TB in Singapore. More information on TB is available at the MOH FAQs at http://www.pqms.moh.gov.sg/apps/fcd_faqmain.aspx or HPB website at http://www.hpb.gov.sg/diseases/article.aspx?id=586
1 Residents refer to Singaporeans and Permanent Residents
2 Non-residents refer to foreigners on long term stay here for work, study or visit