UPDATE ON TUBERCULOSIS SITUATION IN SINGAPORE

On World Tuberculosis (TB) Day on 24 March, Singapore joins the global community in reiterating our commitment to continue the fight against TB. The World Health Organization’s (WHO) theme for 2024’s World TB Day is “Yes! We Can End TB!”.

2.             TB remains a global public health threat. In 2022, there were more than 10.6 million cases of active TB globally, with 1.3 million deaths[1]. In addition, there were an estimated 410,000 cases of multi-drug resistant or rifampicin-resistant TB (MDR/RR-TB)[1]. MDR/RR-TB is more difficult to treat and has lower cure rates, with a treatment success rate of 63% in 2022[1].

Update on Local TB Situation

3.             In 2023, there were 1,201 new cases of active TB disease among Singapore residents. This is lower than the 1,251 cases in 2022. The incidence rate was 28.9 cases per 100,000 population in 2023, compared to 30.4 cases per 100,000 in 2022. Older age groups and males continue to make up a significant proportion of the new active TB cases. Of the 1,201 new cases notified in 2023, 939 (78.2%) were 50 years old and above, and 797 (66.4%) were males. In 2023, Singapore had two new cases of MDRTB among residents. Please refer to the Annex for details.

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. Persons with latent TB infection carry the TB bacteria in their body, but they are not infectious as the bacteria are not active.

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, under the National TB Programme, contact tracing and screening of close contacts are carried out to ensure that those at risk of infection are tested and receive appropriate treatment.

6.             Persons diagnosed with active TB disease will be started on treatment immediately and placed on medical leave. Once treatment starts, the person will rapidly become non-infectious and no longer pose as a source for infection. There is no further risk of exposure in the workplace or school, and there is therefore no need for workplaces or places where a recently diagnosed TB disease case has visited to be closed. Close contacts found to have latent TB infection are not infectious and can continue their activities as usual.

7.             As part of the Ministry of Health’s ongoing efforts to ensure that TB patients continue to receive the latest evidence-based care that is contextualised to our local setting, the Singapore Tuberculosis Clinical Management Guidelines have been updated on 19 March 2024. First published in 2016, the Guidelines provide medical practitioners in Singapore with an evidence-based resource to guide the clinical management of TB. The full Guidelines are available on the Annals of the Academy of Medicine, Singapore and MOH website.

8.             To better reflect the integrated strategies to prevent and manage TB, the TB Control Unit and TB Contact Clinic will be renamed as the National TB Care Centre and National TB Screening Centre respectively by the third quarter of 2024. The name changes will not affect the services provided by the two Centres.

Supporting people with TB

9.             The full course of active TB treatment takes six to nine months, and possibly longer for drug-resistant TB. If persons diagnosed with TB do not adhere strictly to the treatment programme (e.g. taking their medication on time), there is a higher chance of disease relapse and developing MDRTB.

10.          Directly Observed Treatment (DOT) remains a pillar of the National TB Programme. It comprises the administration of TB medicines by a trained healthcare worker to persons diagnosed with TB and is available at all the polyclinics. TBCU also manages an outreach DOT programme for persons who are unable to commute to clinics for their medications due to age or infirmity. Under outreach DOT, trained healthcare workers administer TB medication at the patient’s home. To increase the accessibility of TB treatment, video-observed therapy is also available for selected patients on a case-by-case basis. These patients would also have demonstrated good adherence to their treatment.

11.          Support and encouragement from family members, friends and co-workers of persons diagnosed with TB are vital in ensuring that persons diagnosed with TB 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 not only benefit persons diagnosed with TB, but also protect their family, workplace, and community from infection.

12.          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 are unwell and display symptoms, such as cough, should seek medical attention early to ensure prompt diagnosis and treatment. Those identified as contacts should go for screening, so that they can be offered preventive treatment if tested positive for latent TB infection.

13.          With everyone playing their part, we can ensure that persons diagnosed with TB are treated effectively and reduce community transmission of TB in Singapore. More information on TB is available at the MOH website or HealthHub.

MINISTRY OF HEALTH

23 MARCH 2024

[1] Source: WHO Global Tuberculosis Report 2023 (accessed on 19 February 2024). https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2023