Tuberculosis rate in Singapore up for first time in 10 years

Lynda Hong, Channel NewsAsia 22 Mar 09;

SINGAPORE: The incidence rate of tuberculosis or TB among Singapore residents has risen for the first time in 10 years.

According to the Health Ministry, the incidence rate last year was 39.8 per 100,000 residents, higher than the 35.1 in 2007.

The actual number of patients also grew by 15.5 per cent to 1,451 last year, up from 1,256 in 2007.

The incidence rate last rose in 1998 when it hit 57 per 100,000 residents, higher than the 55 per 100,000 in the previous year.

After 1998, the rate had been declining until last year.

The Health Ministry says the rise is likely due to more cases of people who are carriers of the TB bacteria developing the disease subsequently as well as increased transmission of TB in the community.

Of the new TB cases, 59.3 per cent or 860 cases were residents aged 50 years and above and 70.4 per cent or 1,022 cases were males.

The Health Ministry says the stigma attached to TB patients and the prolonged treatment required (between six and nine months) are barriers that prevent people from coming forward for diagnosis and treatment.

It says that with the increase in TB incidence, everyone should play their part in controlling TB and keeping the community safe.

Anyone with symptoms such as prolonged cough, fever, night sweats, unexplained weight loss and tiredness,
should seek medical treatment as soon as possible.

Those who fail to adhere to the TB treatment may continue to be infectious and have a higher risk of developing drug-resistant TB and relapse of the disease.

Under the Infectious Diseases Act, TB patients who persistently default treatment may be detained at the Communicable Diseases Centre at Tan Tock Seng Hospital till they are cured.- CNA/ir

TB cases on the rise in Singapore
Today Online 23 Mar 09;

TUBERCULOSIS, or TB, is rearing its ugly head once again, with the rate of new infections in Singapore last year rising for the first time in a decade, the Ministry of Health (MOH) said yesterday.

In an update ahead of World Tuberculosis Day tomorrow, the MOH said there were a total of 1,451 new cases of TB among Singapore residents last year, up from 1,256 in 2007. The incidence rate of 39.8 per 100,000 residents last year is higher than the 35.1 in 2007.

The rise in new cases is likely due to the increased reactivation of latent TB infection and increased transmission of the disease within the community, the MOH said. The older age groups and males account for a larger proportion of the new cases. Among these, nearly 60 per cent were aged 50 years and above, and over 70 per cent were males.

TB, caused by bacteria, usually attacks the lungs, but other parts of the body can also be affected, such as the brain, kidneys and bones. While it is potentially fatal if not treated properly, TB is curable and the spread of the disease is preventable, the MOH said.

Patients suffering from prolonged cough, fever, night sweats, unexplained loss of weight and appetite and tiredness — symptoms that suggest TB infection — should seek medical attention as soon as possible.

With early diagnosis and treatment, transmission of TB within the community can be curbed, the MOH said. Patients with TB must complete the full course of treatment over six to nine months to ensure they are fully cured.

The MOH warned that it would take enforcement action against those who persistently default treatment and thus pose a public health risk. It will ensure that these patients comply with treatment under the Infectious Diseases Act.

TB rates up for first time in 10 years
Lee Hui Chieh, Straits Times 23 Mar 09;

THAT prolonged coughing spasm is being heard a lot more these days.

For the first time in more than a decade, the rate at which residents here are contracting tuberculosis is on the rise.

And more younger people aged below 30 are being hit - a worrying trend that hints at greater spread of the infectious respiratory disease in the community.

Last year, 39.8 in every 100,000 Singaporeans and permanent residents contracted it, up from 35.1 in 2007.

The number of TB patients grew by 15 per cent to 1,451 last year, up from 1,256 in the previous year.

The last time the tuberculosis rate grew was in 1998, when it hit 57 per 100,000 residents. It had been declining since - until last year.

The Health Ministry released the update ahead of World Tuberculosis Day tomorrow.

The disease hit 9.2 million people and killed 1.7 million globally in 2006.

It spreads through droplets exhaled by infected people, over a prolonged period.

About one in 10 of those who catch it develops the active form of the disease. Tuberculosis remains latent in the rest, but may be activated later when the immune system is weakened by ageing or other diseases like diabetes.

The surge here could be due to more people with the latent form developing the active one, the Health Ministry said.

As the population is ageing, more older people - who could have caught latent tuberculosis in the 1960s and 1970s when the disease was rampant - may have developed the active form as their immune defences began crumbling.

Transmission in the community could also be increasing, it added.

The clue: A growing number of younger patients, who are likely to have been infected recently, said Dr Cynthia Chee, senior consultant at Tan Tock Seng Hospital's (TTSH) tuberculosis control unit.

Last year, 191 patients were aged 15 to 29, up from 135 in 2006.

The rising number of medical travellers, foreign workers and new immigrants here, many from tuberculosis-burdened countries like India and China, could have added to rising rates, Dr Chee said.

Before foreigners can work or live here, they are tested for active, but not latent, tuberculosis.

The number of foreigners who were reported with tuberculosis here has risen from 758 in 2007, to 993 last year.

Dr Chee thinks that the rise could also be due to patients' delaying treatment, leading to more being infected.

Some see a doctor a few months after developing a cough, she said, adding: 'People think tuberculosis is not a problem here...It could be due to complacency on everyone's part.'

Others fear losing their jobs after telling their employers they are infected, which has happened to some of her patients, she added.

Singaporean Abdul Rahim Mahmood, 44, paid a high price for complacency.

He had been diagnosed with tuberculosis in 2005, but stopped taking his pills after a few weeks, instead of six months, because he thought he had recovered.

Last August, after six months of coughing, he vomited blood and was warded.

Doctors found that the bacteria had damaged his spine, and he had to have surgery to repair it with a metal implant.

He said: 'The doctor said if I didn't go for surgery, I would be paralysed within two months. Of course I was scared.'

Now, his back still aches, but he has retained the use of his legs. And he takes his medicines faithfully, under the supervision of nurses.

The Health Ministry urged tuberculosis patients to seek treatment early and stick to it, and for their employers, families and friends not to stigmatise them.

It said that it would force patients to take medicines or detain them at TTSH, if they persistently skipped treatment.

Last December, it listed tuberculosis as a disease to be treated like Sars: Patients can be barred from travel, forced to take their medicines and have their illness disclosed to other authorities.