Punggol pre-schoolers get screened for TB; second such case in a week

KENNETH CHENG Today Online 30 Aug 16;

SINGAPORE — In the second case of tuberculosis (TB) at a pre-school to emerge in less than a week, children and staff of Bridges Montessori Preschool have undergone screening after a trainee teacher there was diagnosed with active TB.

And at least one pre-schooler, a two-year-old girl, has tested positive for latent TB — the disease in its non-infectious, asymptomatic form.

The school, located on Punggol Seventeenth Avenue, found out on Aug 12 that the trainee teacher, a foreign national, had been diagnosed with the disease, said its director, Ms Irene Toh, 58.

The next day, it began informing parents of its 50-odd pre-schoolers via email and WhatsApp about the case and the steps the school was taking.

The trainee, who had sat in on classes as an observer, had spent about three weeks in the school. Twenty-nine pre-schoolers, who were in the affected area where the trainee was based, as well as seven staff members were screened for TB last Tuesday. Ms Toh could not say how many others have tested positive for TB.

Contacted by TODAY, the Ministry of Health (MOH) did not address queries about the case, but noted that latent TB infections are not uncommon in Singapore. Last week, a similar case emerged at Little Greenhouse pre-school in Bukit Batok, where pre-schoolers and staff had to be screened for TB after a teacher from China was diagnosed with active TB the week before.

The Early Childhood Development Agency told TODAY that there have been three reported TB cases among the 1,300 childcare centres here this year. Centres were generally vigilant and have the necessary measures in place to prevent its spread, a spokesperson said, and new employees must undergo a chest X-ray and a doctor must certify them free from active TB before they can start work.

Bridges Montessori’s Ms Toh said before the trainee teacher arrived in Singapore last month, she had undergone a series of medical tests, including one for TB.

It was only after a pre-employment check-up at the Singapore Anti-Tuberculosis Association that a doctor spotted a “scar” in the trainee’s lungs, and referred her for further checks.

At the time, Ms Toh said that the doctor had advised that she could continue with “normal activities”.

The trainee’s S-Pass was cancelled on Aug 19, after both parties came to a “mutual agreement”. The trainee felt awkward returning to the pre-school and wanted to head home to her family, said Ms Toh.

The mother of the two-year-old with latent TB, who wanted to be known only as Ms Tan, 40, told

TODAY she was “very, very upset” that her daughter may have go through a protracted treatment process. Patients with latent TB can receive treatment to prevent the disease progressing to active TB.
“(It) is a lot to handle for a child. (They) are pre-schoolers,” Ms Tan said.

Ms Toh said the school did not want this to happen. “We’ve (followed) all the necessary SOPs (standard operating procedures) that were given by the ministries and more,” she added.

The school’s premises were fumigated and sanitised by a health and environmental cleaning agency on Aug 15, and Tuberculosis Control Unit (TBCU) officers conducted a site assessment on Aug 16.

Figures provided by the MOH showed that the number of new active TB cases among long-staying foreigners has been on a steady decline over the years, as the number of cases among residents edged up to 1,498 last year. Last year, there were 502 cases involving long-staying foreigners, compared with 643 in 2012.

But doctors TODAY interviewed said TB screening for non-residents could be more stringent.

Citing global literature, Dr Leong Hoe Nam, an infectious-diseases specialist at the Mount Elizabeth Novena Specialist Centre, said globalisation — including the movement of migrants to the developed world — has contributed to an increase in TB not only in Singapore, but around the world.

He suggested that Singapore adopt the United States’ practice of employing both blood tests and a chest X-rays when screening individuals planning to work or study in the US. Currently, blood tests are not required. Also, currently, only patients with pulmonary TB — in the lungs — have their contacts screened for the disease, but this should be done for all TB patients, said Dr Leong. TB can occur in different parts of the body, like the gut.

Mount Elizabeth Hospital respiratory medicine specialist Ong Kian Chung said when abnormalities show up on chest X-rays and TB is a possibility, patients should be required to undergo blood tests. Such blood tests, which cost about S$200 each, should be made available more cheaply to patients, he added.

Alternatively, all abnormal pre-employment X-rays could be referred to the TBCU, but this might increase their workload “significantly”, Dr Ong said.

TB transmission typically occurs through close and prolonged contact with an infectious individual, but those with active TB become non-infectious rapidly, once treatment begins. All newborns here are given the Bacillus Calmette-Guerin (BCG) vaccine, but this vaccine may work only against certain forms of TB, such as TB in the brain.


Pre-schoolers screened for tuberculosis after teacher gets disease
KENNETH CHENG AND ILIYAS JUANDA Today Online 25 Aug 16;

SINGAPORE — About 80 pre-schoolers enrolled at a centre in Bukit Batok have been screened for tuberculosis (TB), after a teacher there was found to have contracted the infectious disease.

The teacher, a Chinese national who taught at the Little Greenhouse pre-school on Bukit Batok Street 31, had phoned in sick last Thursday morning. She had shown no signs of being sick in the days prior, said Ms Ruth Kua, deputy chief operating officer of Global EduHub, the pre-school’s parent company.

The teacher, who has active TB, did not update the pre-school on her condition after she was diagnosed, according to Ms Kua. The pre-school, which has 104 students, was only informed of the TB case last Friday, she said.

The Ministry of Health (MOH), in response to queries, said that the ministry and Tan Tock Seng Hospital’s TB Control Unit (TBCU) were notified of the diagnosis last Wednesday, and that the patient is now undergoing treatment.

“TB transmission typically requires close and prolonged contact with an infectious individual. It is not spread by contact with items or surfaces touched by a person with TB,” said a ministry spokesperson. “Persons with active TB disease rapidly become non-infectious once treatment starts. The childcare centre is not required to close.”

TB is endemic in Singapore and can occur in various settings including pre-schools, but it mainly affects older adults, said the spokesperson. The TBCU has started contact tracing for the case and have identified 124 staff and students for screening.

About three-quarters of the students were screened at the school on Wednesday, while five of its staff were screened at TTSH.

In addition to sanitising the premises last Saturday, Ms Kua said the pre-school phoned or messaged parents from Friday to Sunday, asking them to check on their children’s health. “So far, the majority have reported to us that they are OK,” she said.

The teacher, who will be on medical leave for two weeks, remains on contract with the school till next June. “The teacher needs her own rest and has an MC (medical certificate),” said Ms Kua. “The school has to honour it. We did not terminate her, as that would mean that she did not perform her job well as a teacher.”

About five children were taken home by their parents after Wednesday’s screening so they could rest, but Ms Kua described parents’ reaction to date as “very calm”.

Ms Kua also said she had sought advice from the Early Childhood Development Agency on the need to close the centre temporarily, and was told that there was “no need at all”. “But we have to monitor the situation closely and to see what’s the next step,” she added.

As for why screenings began only on Wednesday, Ms Kua said time was needed to allow the TBCU to do an assessment, and get the parents’ consent to screen their children.

TODAY understands that time was needed for contact tracing before screening began. The MOH said that only a very small proportion of TB cases occur in children and last year, only 0.6 per cent of TB cases among Singapore residents occurred in those aged below 15.

“Those with positive screening test results will be followed up at TBCU for further assessment and treatment if necessary. These cases may not be linked to the staff member with active TB,” the MOH spokesperson said.

Parents TODAY spoke with were shocked and concerned by the news initially, but say they were satisfied with the school’s handling of the matter so far, noting that the school has been prompt in updating them on the situation.

Said warehouse supervisor Muhammad Nurzady, 34: “They don’t keep us in the dark and update us regularly. Even in the past, back when my older children were here and when there were cases of hand, foot and mouth disease, the school has been consistent in keeping us informed.”

Mdm Jasmine Chua, a 40-year-old human resource administrator, was worried when she first heard about the case, but felt more assured after the school’s explanations.

One parent who wanted to be known only as Mrs Tan had kept her son at home as she did not want to take any risks. At the school on Wednesday to speak to staff about the situation, she added that it was good that the school had sanitised the toys and premises.

Mr James Ong, a laboratory manager, did not mind the wait for screenings to begin. As parents, they had to be given sufficient information before giving consent for the screening,
he said. Last year, there were 1,498 new TB cases among Singapore residents, up from the 1,454 cases in 2014.

In June, the authorities revealed that an unusual cluster of six multi-drug-resistant cases had emerged in a housing block in Ang Mo Kio.

In December last year, the National University Hospital had to call in 178 children for tests after a paediatric nurse was diagnosed with pulmonary TB. Five children were found to have latent TB, which is TB in its uninfectious, asymptomatic state.

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