Unite to End Tuberculosis

1.       Each of us plays a part in keeping our community safe and free of Tuberculosis (TB). The World Health Organization’s (WHO) theme for this year’s World TB Day is “Unite to End TB” as it calls for greater collaboration within and across governments, and with partners from communities, civil society, researchers and the private sector, to take a whole-of-society and multidisciplinary approach to tackle TB.

2.        On World TB Day on 24 March, Singapore stands united with the global community in the fight against TB.

Update on TB Situation in Singapore

3.        TB is a global public health threat. In 2015, there were more than 10 million cases of active TB globally, with 1.8 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 rate as high as 30 to 40 per cent.

4.        TB is endemic in Singapore and latent TB infection is not uncommon in our population, with rates of up to 30% in the older age groups, as TB had been prevalent in Singapore until the 1970s. In 2016, there were 1,617 new cases of active TB among Singapore residents - this is higher than the 1,498 cases in 2015. Older age groups and males continue to make up a significant proportion of the new active TB cases. Please refer to Annex A for details. 

TB Screening and Treatment in Singapore

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 Tuberculosis Control Unit (TBCU) carries out contact tracing and screening of close contacts to ensure that those at risk of infection are tested and receive appropriate treatment.

6.        There is no need for work places or other places where a recently diagnosed active TB case has visited to be closed. Persons diagnosed with active TB are placed on treatment, and appropriate medical leave, and rapidly become non-infectious once treatment starts. Hence, there is no further risk of exposure in the workplace. Workplace or 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 display symptoms of active TB, such as unexplained prolonged cough of three weeks or more should seek medication attention early to ensure prompt diagnosis and treatment.

Importance of Treatment Adherence

8.        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 program (e.g. taking their medication on time), there is a higher chance of developing drug-resistant TB, and disease relapse. Directly Observed Treatment (DOT) remains a pillar of the Singapore TB Elimination Programme (STEP) as it is the best way of assuring patients’ adherence for the sake of their health and others around them. DOT comprises the daily administration of TB medicines by a trained nurse to the patient, and is available in 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.

9.        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 benefit not only the patient, but also protect his family, workplace and community from infection.

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

ANNEX A 

Update on the Tuberculosis Situation in Singapore 

MOH was notified of 1,617 new cases of tuberculosis (TB) among Singapore residents[1] in 2016, which is higher than the 1,498 cases in 2015. Correspondingly, the incidence rate was 41.1 cases per 100,000 population in 2016, compared to 38.4 cases per 100,000 in 2015. 

Most of the cases (81.3%) among Singapore residents were Singapore-born. Older age groups and males continue to make up a significant proportion of the new cases. Of the 1,617 new cases notified, 1,114 (68.8%) were 50 years of age and above, and 1,006 (65.9%) are male. 

There were 142 relapsed cases among Singapore residents of which 123 (86.6%) were Singapore-born.  

The emergence of multi-drug-resistant TB (MDR-TB) remains a serious public health challenge. In 2016, Singapore had three new cases of MDR-TB who were Singapore-born residents. The number 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 Tables 1, 2 and 3 for the detailed statistics.

Table 1

Number of cases and distribution of tuberculosis infection by site,
Singapore residents* 1960 – 2016 

* Singapore citizens and permanent residents

Table 2

Distribution of TB cases by age group and country of birth,
Singapore residents, 2016 

Table 3

Ethnic-gender distribution of reported tuberculosis (new case) 
Singapore residents, 2016 

[1] Residents refer to Singaporeans and Permanent Residents