Update on Global Human Swine Influenza (28 April)

28 Apr 2009

1. The World Health Organisation had raised the pandemic alert phase for the swine flu outbreaks from Phase 3 to Phase 4. The change to a higher phase indicates that there is sustained human-to-human transmission, capable of causing community-level outbreaks. This increases the risk of a pandemic.  In line with this, MOH will also be elevating our alert level from green to yellow. This is to better brace ourselves to handle situations where there may be isolated imported cases but no sustained local transmission.

   Global Update

2. As at 28 April 09, there are reportedly 26 confirmed cases of human swine influenza A (H1N1 viruses) in Mexico, 50 in the United States (New York City, California, Texas, Kansas and Ohio), 6 in Canada (Nova Scotia and British Columbia), 1 in Spain and 2 in Scotland, 11 in New Zealand and 1 in Israel. The World Health Organisation (WHO) has declared that the outbreak of the new strain of human swine influenza in Mexico and the US constitute a Public Health Emergency of International Concern (PHEIC), and has  recommended that countries intensify its surveillance and precautionary measures.  The United States has also declared a public health emergency to deal with the emerging human swine influenza. These reports raise concerns about a global human-to-human spread of a novel influenza virus.

   Situation in Singapore

3. As of 28 April 09, there are no human cases of swine flu in Singapore. There are 17 cases in total referred for further medical assessment. 16 have been referred to the Communicable Disease Centre (CDC)  and one case was seen at SGH. Three cases referred to the CDC (including the two referred yesterday) have all tested negative for Influenza A. The case seen in SGH has tested negative as well. Most of the other new cases are Singaporeans who have recently returned from the United States. 

4. Cases seen at the CDC and in the other hospitals would undergo a preliminary test for Influenza A, the virus type associated with swine flu and the circulating strains. The preliminary test result will be available within a day but confirmation of the swine influenza strain will take up to 7 days.

   Precautionary Measures implemented

5. All healthcare institutions in Singapore have intensified their infectious disease control measures under the heightened Yellow Alert level. Some of these precautionary measures have been proactively implemented while still in green status. Additional measures include donning full personal protective equipment especially in high risk areas such as the emergency department and intensive care unit,  rescheduling elective admissions, cutting down visitors to patients, and recording of contact particulars of visitors.  These will help reduce unnecessary exposure, provide for surge capacity and facilitate contact tracing when the need arises.  Hospitals will also restrict inter-hospital movement of patients and staff, except in  emergencies.   Polyclinics and specialist outpatient clinics are also setting up triage centres to manage symptomatic patients with a travel history to affected areas, or contact with such persons.

6. Since our SARS experience in 2003, MOH has ramped up isolation capacity in public hospitals. MOH has also stocked up about 1.15 million courses of Tamiflu and 50,000 courses of Relenza. We have stockpiled enough antiviral drugs like Tamiflu and Relenza to treat Singaporeans should the need arise. Members of the public should thus avoid stock piling of these antiviral drugs. These antiviral drugs designed for treating influenza such as swine flu, should be used judiciously. Indiscriminate use may ultimately limit their effectiveness as drug-resistant viruses may develop.

7. As part of national level measures, the Civil Aviation Authority of Singapore (CAAS) had implemented precautionary measures at Singapore Changi Airport on 26 April. Thermal scanners have been deployed at the Arrival Halls of T1, 2 and 3. From 29 April, the thermal scanners will also be deployed at the Budget Terminal and at the Seletar Airport. From 29 April at 0800 hours, the Maritime and Port Authority of Singapore (MPA) will also deploy thermal scanners at the arrival halls of Singapore’s International Passenger Terminal and Regional Ferry Terminal at Habourfront Centre and Tanah Merah Ferry Terminal to screen all arriving passengers.   Thermometers will also be used at West Coast Pier, Marina South Pier, Changi Ferry Terminal and Changi Point Ferry Terminal to screen all arriving passengers. In addition, health alert notices containing information about swine flu will be handed out to arriving passengers.

   Advice from MOH

8. Members of the public are advised to postpone or avoid non-essential travel to Mexico. In the event that travel to Mexico is unavoidable, the public is advised to take precautionary measures such as avoiding crowded areas and maintaining high standards of personal hygiene at all times. Upon returning from the affected area (ie Mexico and the state of New York, California, Texas and Kansas of the United States), members of the public should continue to maintain high standards of personal hygiene and to monitor their own health.

9. Members of the public who have travelled to affected places and who develop respiratory illness with fever (Temperature > 38°C) within seven days after their return should put on a surgical mask and seek medical consultation immediately. They should also disclose their travel histories to their doctors.

10. MOH advises the public to maintain high standards of personal hygiene, such as washing hands frequently with soap and water, especially after contact with respiratory secretions (e.g. after sneezing and coughing). Those who are unwell with respiratory illness should stay at home and wear a surgical mask if possible.

11. MOH is monitoring the situation closely and will update the public should there be any new developments. For more information on Swine Flu, please access MOH’s website at www.moh.gov.sg or call our hotline at 1800-333 9999.

MINISTRY OF HEALTH

CIVIL AVIATION AUTHORITY OF SINGAPORE