Task force studying measures to tackle disease outbreaks

Audrey Tan, Straits Times AsiaOne 29 Dec 15;

Clearer guidelines and a simplified process for reporting cases of infectious diseases are among the measures being considered by a task force set up to boost Singapore's ability to tackle infectious disease outbreaks.

The task force was set up earlier this month by the Ministry of Health (MOH) in the wake of lapses revealed by the hepatitis C infections at the Singapore General Hospital (SGH) earlier this year.

"What we want is to encourage and enable medical professionals to report cases which they come across by providing clearer guidelines and simplifying the reporting process where possible, for example, by having a direct link from the laboratory to MOH on positive cases," said Minister of State for Health Chee Hong Tat, who chairs the task force.

He said the task force will look at the "modes of notification, timelines and escalation process" of infectious diseases, but be mindful about not adding to the workload.

"The task force will be careful about the downsides of adding more reporting and administrative burden for our healthcare institutions and medical professionals," he said, citing a need to keep standard operating procedures simple and help medical professionals "focus on their core responsibilities and to comply with existing infection-control protocols".

The task force will also relook the list of notifiable diseases under the Infectious Diseases Act, and have a national-level "Swat team" of infectious disease experts who can be mobilised at short notice.

It also plans to make better use of data analytics and information technology systems to boost the detection of potential outbreaks.

"Our current system depends too heavily on human judgment to process large amounts of information and decide whether the risks are significant enough for escalation and further investigation," said Mr Chee, who is also Minister of State for Communications and Information, at the launch of an SG50 book and video about Singapore's experience in overcoming infectious diseases.

Currently, most measures to prevent and control infectious diseases here come under the Infectious Diseases Act, which includes provisions for the director of medical services of MOH to get patient information from doctors to investigate an outbreak, for instance.

To date, 25 patients who were warded at SGH have been diagnosed with the same family of hepatitis C virus. Eight patients have died, with the hepatitis C virus infection "a likely contributory factor" in seven of the deaths.

Professor Paul Tambyah, secretary-general of the Asia Pacific Society of Clinical Microbiology and Infection, said the measures identified were a good starting point.

But he said Singapore could also look at adopting a "one health" approach, which looks at human and animal health together.

This could be an area of interest, especially with the recent outbreak of Group B Streptococcus infections linked to raw freshwater fish.

Professor Leo Yee Sin, director of the Institute of Infectious Diseases and Epidemiology at Tan Tock Seng Hospital, said the measures were critical areas for the task force to follow up on.

One area of interest is how to improve the notification system, she said, adding that she thought Singapore was in a good position to do this, as a lot of the recording is done electronically.

"The trick is how to take the electronic information and make sense of it using electronic and big data analysis," she said.

"But recognising the amount of data is not enough. Step Two would be to identify and analyse the data, and (take) response action."

Outbreak response unit 'a good idea'
Audrey Tan, The Straits Times Asia One 31 Dec 15;

The idea to have a quick-response "Swat team" to tackle outbreaks of infectious diseases in Singapore is a good one, experts have said.

The idea had come from a Ministry of Health (MOH) task force set up in the aftermath of the outbreak of hepatitis C at the Singapore General Hospital, which was linked to several deaths earlier this year.

The experts said that such a team would provide healthcare institutions with the expertise needed to deal with complex and unusual outbreaks.

The "Swat team" would also be able to provide an "unbiased assessment" of the situation, said Dr Leong Hoe Nam, an infectious diseases specialist from Mount Elizabeth Novena Hospital.

"Doctors within the hospital... may be under inappropriate pressure to report findings that are less truthful but better for the hospital's reputation," he said.

On Monday, Minister of State for Health Chee Hong Tat said that the MOH task force was considering setting up a national-level "Swat team". It would comprise infectious disease experts who can be mobilised quickly to respond to outbreaks in any healthcare institution here.

The "Swat team" is one of four measures being considered by the task force, which was set up earlier this month.

Other measures include reviewing standard operating procedures, making better use of technology and reviewing the list of notifiable diseases under the Infectious Diseases Act.

Associate Professor David Lye, senior consultant at Tan Tock Seng Hospital's Infectious Diseases Department and Institute of Infectious Diseases and Epidemiology, said that similar response units have been implemented overseas.

He said: "An example of this would be the Epidemic Intelligence Service (EIS), part of the United States Centres for Disease Control and Prevention (CDC).

"The US has a lot of small hospitals and there are outbreaks every year, everywhere. The EIS attends to some of these outbreaks in smaller hospitals, as well as overseas. That is definitely a great idea and should be developed further."

For instance, the CDC last year sent EIS officers to West Africa in response to an Ebola outbreak there, in the largest international outbreak response in the CDC's history.

Professor Paul Tambyah, secretary-general of the Asia-Pacific Society of Clinical Microbiology and Infection, said that while it is not yet clear what form the Singapore "Swat team" will take, the EIS was "very effective". He said: "They get sent anywhere, and investigate anything - community outbreaks, hospital outbreaks."

But Dr Leong pointed out that for the "Swat team" to be effective, it must be given access to cutting-edge laboratory research.

"Science has changed over the last five years, and we can now get genetic signatures of the viruses concerned ," he said.

"This is often a research tool not available to hospitals. Yet, it is crucial and should be considered a country resource."

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