Changes to boost disease-outbreak control

Linette Lai, The Straits Times AsiaOne 9 Jul 16

Healthcare professionals will soon be able to anonymously report infectious disease outbreaks, and IT systems used to track these incidents will be beefed up.

These are some of the changes made at the recommendation of a task force set up last December to strengthen outbreak detection and response in Singapore.

The eight-member team's 15 recommendations also included measures to improve how the Ministry of Health (MOH) monitors infectious diseases, as well as establish a clear decision-making structure.

The team also proposed changes to boost communication between healthcare institutions and ensure such outbreaks can be properly handled even outside acute hospitals.

The task force, headed by Minister of State for Health Chee Hong Tat, was established in the wake of the hepatitis C outbreak at the Singapore General Hospital last year.

Then, 25 kidney patients admitted between January and September were diagnosed with the viral infection. Eight of them died.

Following this, an independent review committee was set up to probe the causes behind the outbreak. It concluded that poor infection control practices and a slow response time were to blame.

The task force was then created to strengthen Singapore's ability to detect and respond to such outbreaks. It submitted 15 recommendations to Health Minister Gan Kim Yong on June 30, all of which were accepted.

The team comprised experts in infectious diseases, systems engineering and data science.

For example, MOH said in a statement yesterday, healthcare professionals will be able to anonymously report outbreaks "to encourage a culture of open reporting".

"People on the ground sometimes have a better sense of what is going on," said Adjunct Associate Professor Lim Poh Lian, who heads the infectious diseases department at Tan Tock Seng Hospital.

"Doing so takes away some of the barriers to why people might not want to come forward, because they might not want to cause trouble."

The ministry has designated its Communicable Diseases Division as the unit in charge of overseeing surveillance of all infectious diseases and outbreak reporting.

MOH has also expanded the list of notifiable infectious diseases, which doctors are required by law to report to the authorities, from 43 to 49.

The list, which originally included diseases such as dengue and Ebola, will now also include botulism, tetanus, leptospirosis, murine typhus, rabies and Japanese encephalitis.

On the technology front, the task force recommended that MOH improve its data analytic capabilities to monitor the situation and trigger alerts if abnormalities are detected.

MOH said it will consolidate data from different sources and design the system to trigger alerts if needed. It will also share the data collected with healthcare institutions, after putting in safeguards to protect individuals' privacy.

"This two-way information flow will help to improve surveillance and early detection, enhance situational awareness across institutions, and encourage sharing within the healthcare system for better infection prevention and control," it said.

MOH had previously announced the initial recommendations of the task force in March. These included setting up a new National Outbreak Response Team, as well as simplifying the process of notifying the authorities of infectious diseases.

Professor Leo Yee Sin, who is director of the Institute of Infectious Diseases and Epidemiology and chaired the independent review committee, said the changes show a conscious effort to continue improving our healthcare system.

"This is quite a major change," she said. "Although the entire system in Singapore is well known to be good internationally, we have to look into continuing to improve all our processes."

List of notifiable diseases to be expanded; steps taken to beef up outbreak response: MOH
Channel NewsAsia 8 Jul 16;

SINGAPORE: The Ministry of Health (MOH) will expand the list of notifiable diseases, and took steps to make the reporting of cases more user-friendly, at the recommendation of a taskforce to strengthen outbreak detection and response, it announced on Friday (Jul 8).

The taskforce, led by Minister of State for Health Chee Hong Tat, was set up at the recommendation of an Independent Review Committee on the Hepatitis C outbreak that was discovered at Singapore General Hospital (SGH) in June 2015. The committee had said that a gap in the national response system to outbreaks led to SGH not recognising the Hepatitis C cluster in a timely manner and resulted in delays in escalating the matter.

In a media statement on Friday, MOH noted that the taskforce called for the strengthening of surveillance through improving the comprehensiveness of information gathered for infectious diseases.

To this end, MOH said it would expand the list of notifiable infectious diseases from the current 43 to include six additional diseases: botulism, tetanus, leptospirosis, murine typhus, rabies and Japanese encephalitis.

To facilitate earlier detection of outbreaks, the taskforce also recommended setting up an enhanced surveillance system to extract test results related to infectious disease data from laboratories. MOH said positive diagnostic test results would also be automatically reported to the ministry, to simplify the process and improve data analysis.


The taskforce also recommended making the notification of cases and reporting of incidents more user-friendly, and MOH said it has modified its processes to allow doctors to notify MOH via multiple modes (e.g. online, fax, phone) to best suit the workflow of their clinical practice. It said that doctors need notify MOH of each case only once, without having to duplicate the notification from laboratories.

The ministry said it would also leverage information technology systems to facilitate infectious disease reporting, including the use of system prompts built into daily workflows and linked databases that allow for auto-population of data fields.

To encourage a culture of open reporting, MOH said it would put in place a system to accept anonymous reports of infectious disease outbreaks and incidents from healthcare professionals.


The taskforce recommended that MOH enhance its data analytic capabilities to monitor the local infectious disease situation, detect abnormalities and trigger alerts. This includes the surveillance of disease syndromes that can help pick up cases of new and unfamiliar diseases.

MOH said it would consolidate data from different sources and design its IT system to trigger warnings if there are abnormalities detected.

MOH also accepted the taskforce’s recommendation to share the aggregate data which it has collected with healthcare institutions, "with appropriate safeguards to protect data confidentiality," it said.


The taskforce called for MOH to establish clear accountability to integrate infectious disease information and to deal with outbreaks.

To this end, MOH said it would strengthen the resources of the Communicable Diseases Division (CDD) "to deal with an increasingly connected and complex environment, with emerging infectious diseases spreading across borders, and through animals and food".


The Health Ministry said it would work with healthcare institutions to strengthen local capabilities for infection control and outbreak response. "We will implement platforms to encourage inter-institutional learning, including peer reviews and collaboration with academia and research institutions. We will develop capabilities within the Regional Health Systems to respond to and control outbreaks within their areas, including in community facilities beyond acute hospitals," it added.

In March, MOH set up a National Outbreak Response Team to augment efforts to deal with major infectious diseases. This will complement the establishment of the National Centre of Infectious Diseases in 2018, MOH said.


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