CDC director gets legal powers to detain, isolate chikungunya cases

Loh Chee Kong, Today Online 24 Jan 08;

IT was a measure last invoked at the height of the Sars outbreak in 2003. And now, the authorities are again stepping up the fight against another foreign virus, by conferring legal powers on a high-ranking public health administrator to stem the spread of chikungunya fever.

Today has learnt that on Monday, the Government gazetted Communicable Diseases Centre clinical director Leo Yee Sin as a Health Officer, under the Infectious Diseases Act, from Jan 17 to July 16.

The appointment gives her the authority to order the detention or isolation of confirmed or suspected chikungunya cases.

She can also inspect and search any premises where a suspected outbreak has taken place and seize samples of any substances for laboratory tests, without the need for a warrant and "with such force as may be necessary".

A Ministry of Health (MOH) spokesperson said Associate Professor Leo's appointment would facilitate efforts "to ensure timely isolation or quarantine of these patients who pose a public health threat", given that such persons may object to being admitted to hospital.

Another suspected chikungunya case was announced yesterday — the first Singaporean so far — bringing the total to 10 since the first locally transmitted case was detected on Jan 14.

All had surfaced in the Clive Street area, where 1,380 people have been screened. And the National Environment Agency (NEA) is extending its eradication of mosquito sites beyond the area as a "preventive measure".

Why such measures for the chikungunya virus, given that its outbreak has been non-fatal and geographically limited here, and the global medical community has no conclusive proof that it can kill?

Not only is relatively little known about it, it also has no specific drug or vaccine. The Singapore Immunology Network (SIgN) is working with the NEA and MOH to develop a vaccine.

In the last three years, thousands worldwide have had the fever, pointing to a re-emergence of the disease on a possibly unprecedented scale. Citing a 2005 outbreak on the Indian Ocean island of Reunion that reportedly claimed 238 lives, SIgN's senior scientist Dr Lisa Ng said the disease "can become fatal" and MOH would "want to be as careful as possible".

Said Dr Ng: "As chikungunya is still very understudied, MOH would want to be as prepared as possible. You can't wait for a disease to be fatal before you take it seriously."

The MOH, however, said it has "no plans currently" to enact border screening for chikungunya, like the Sars crisis. It said Assoc Prof Leo's new powers will "only be for the period necessary to prevent and control the outbreak", and may be extended "when necessary". The outbreak is considered over only when no new cases are found within 24 days of the last one.

Assoc Prof Leo told Today the legal powers will aid her work on the ground, such as in handling patients and probing the source of the outbreak, "as we aim to remove viremic patients (those who have the virus circulating in their blood) from the source".

Lowdown on Fever

Chikungunya fever – which, like dengue, is transmitted through the Aedes mosquito – is distinguished by symptoms that include a sudden onset of fever, chills, headache, nausea, vomiting and joint pain.

The virus was first discovered after a 1952 outbreak in Tanzania.

The worst outbreak to date was recorded two years ago on the Indian Ocean island of Reunion, where within 16 months, a third of its 777,000-strong population was struck down. The outbreak reportedly claimed 238 lives.