Bacteria outbreak: Stalls told to stop selling Chinese-style raw-fish dishes

LAURA ELIZABETH PHILOMIN Today Online 28 Nov 15;

SINGAPORE — Food stalls here have been ordered to stop selling Chinese-style raw-fish dishes until they can comply with stipulated guidelines, after investigations by the Ministry of Health (MOH) found a definite link between eating these dishes and Group B Streptococcus (GBS) infection, which can potentially cause permanent disability and even death in severe cases.

To date, two persons have died from GBS infections this year, said MOH today (Nov 27), without providing details. One of the cases was not linked to the ongoing outbreak, and the other is being investigated.

MOH said it has been notified of 355 cases of GBS infections so far. Of these, about 150 cases had the Sequence Type (ST) 283 strain which causes Type III GBS disease. In comparison, there were, on average, 150 cases of GBS infections per year from 2011 to last year.

The consumption of Chinese-style ready-to-eat raw-fish dishes was found to be associated with Type III GBS disease, said the National Environment Agency (NEA) in a joint media briefing yesterday with the MOH and the Agri-Food and Veterinary Authority of Singapore (AVA). MOH had said previously it has not found any links between the GBS infection and the consumption of Japanese raw meat or fish dish sashimi. Examples of popular Chinese-style raw-fish dishes are “yusheng”, which is usually eaten during Chinese New Year, and raw-fish porridge.

Over 70 stalls selling Chinese-style raw fish dishes have been identified by the authorities. NEA met with the owners of some of these stalls to brief them on its directive and guidelines, which include buying fish from suppliers which can provide certification on the health of the fish from authorities in the country of origin. Other measures include proper cold chain management, such as keeping fish for raw consumption chilled at the right temperature, and proper hygiene practices like using separate kitchen tools for preparing raw fish.

NEA said it has ruled out food handlers as the source of the bacteria. Tests on stool samples from 82 food handlers and fishmongers from retail food establishments, market stalls and wholesalers found that they did not carry the ST283 strain. Contamination of the fish could have occurred along the food chain supply, the probe concluded.

The authorities began investigations following reports in July that there was a spike in local GBS infections. Within the same month, NEA issued an advisory to food stalls, asking them to temporarily stop the sale of raw fish dishes made from Song fish and Toman fish. Since then, the number of GBS cases notified to MOH has decreased to “a usual baseline of less than 5 per week and continues to remain low”, the ministry said. Most of these cases were not due to raw fish consumption.

Between August and last month, the AVA and the NEA carried out tests on 400 fish samples from various species and across the food chain supply including fishery ports, wet markets, fresh produce section of supermarkets, and retail food establishments.

A fifth of the samples were found to contain the GBS bacteria, and 4.1 per cent tested positive for the ST283 strain.

Infectious disease experts TODAY spoke to pointed out that GBS bacteria is found naturally on fish and handling practices could have led to cross-contamination where fish meant to be eaten raw were mixed with fish for cooking and carrying the ST283 strain.

Dr Leong Hoe Nam, from the Rophi Clinic in Mount Elizabeth Novena Specialist Centre, said: “Someone must have started a new practice of handling the fish in the recent year and it’s still ongoing. It could be very harmless handling of just using the same box (to hold the fish) and then the cross-contamination occurred.”

The particular strain could also be causing the spike in GBS infections because it seems to be associated with “greater virulence or greater deadliness”, said Dr Hsu Li Yang, a physician at the ID Clinic in Mount Elizabeth Novena Specialist Centre.

Mr Derek Ho, NEA’s director-general of environmental public health, reiterated that most food in fisheries and markets here are not meant for raw consumption. “They’re meant for cooking… If you want to eat food that’s raw, you should ensure they are procured from proper sources,” he said. Some supermarkets have dedicated counters for selling raw products, he noted.

However, experts felt that food stalls would face difficulties in following NEA’s guidelines. As a result, most could stop selling the dishes, they noted. Dr Hsu said: “(Food stalls) have to be able to trace the source of the fish down to how they store it, how they serve it and prepare it… Even if they get it from a supplier who can tick all these boxes for them, they still have to go through great lengths in terms of how they store the fish in the hawker stall and prepare it.”

Dr Leong described NEA’s directive to the food stalls as “a right order but... a tall order”. “It’s good to come up with some protocols but implementation will be extremely difficult… It requires a higher understanding of science, and it’s a new level of understanding and education,” he said.


NEA issues new advisory cautioning consumption of ‘inherently risky’ raw foods
Stallholders will be banned from selling raw fish dishes, unless they comply with guidelines. NEA says it will work with stallholders on how to abide by its guidelines, after further investigations into the spike of Group B Streptococcus (GBS) infections reported in June.
Justin Ong, Vimita Mohandas, News 5, Channel NewsAsia 27 Nov 15;

SINGAPORE: The National Environment Agency (NEA) issued an advisory on Friday (Nov 27) for the sale and consumption of raw fish after further investigations into the spike of Group B Streptococcus (GBS) infections reported in June.

With findings showing a link between the consumption of raw fish dishes and disease caused by GBS, NEA has cautioned the public over the inherent risks of consuming raw food, while food stalls are to immediately stop selling raw fish dishes until they adhere to guidelines set out by the agency.

In the first half of the year, the number of GBS cases at hospitals rose from an average of 150 a year in the past four years to 238 a year. In July, with some samples of raw fish found to contain GBS bacteria, the NEA advised stallholders to temporarily stop selling raw fish dishes using Song and Toman fish.

To date, there have been 355 cases of GBS infections reported this year, of which about 150 cases were the Type III GBS ST283 strain linked to the consumption of Chinese-style ready-to-eat raw fish dishes, said the Ministry of Health (MOH).

There have been two deaths among the GBS cases this year, according to MOH. One death was of a recently reported case and it is still under investigation, while the other was not linked to the outbreak, the ministry added.

While there has been a dip in GBS cases to less than five a week, the cause of these baseline infections remains unknown, said NEA.

A joint-investigation with the Agri-Food & Veterinary Authority of Singapore (AVA) and the MOH has determined that food handlers are unlikely to be the source of the GBS bacteria, after 82 such individuals were tested and returned negative results.

Between August and October, the AVA and NEA also tested about 400 samples of a variety of commonly-used fish and found GBS present in 20.1 per cent while 4.1 per cent carried the Type III GBS ST283 strain associated with the consumption of Chinese-style raw fish dishes like yusheng.

The authorities could not pinpoint the exact source of contamination but said it could have occurred at any part of the food supply chain, from fishery ports to wet market stalls to food shops. It did not rule out that the GBS bacteria could have been imported from its original source.

"The fish that we receive in Singapore are either farm bred or wild caught," said Mr Derek Ho, NEA’s director-general of its Environmental Public Health Division. "They could be from farms or sea. They could come into Singapore through various channels - through the fishery ports. Some are air flown in and of course at various supply chains from the ports it goes to distribution points for example, the wet market stalls before it finally ends up at the retail end."

CONSUMERS SHOULD EXERCISE CAUTION

In light of its findings, NEA has advised consumers to exercise caution over the consumption of raw fish and in general, raw foods, as harmful bacteria may be present. Cooking raw food is still the most effective way to kill bacteria, it said.

“Most food we find in our fishery ports and markets are not meant for raw consumption," said Mr Ho. "They are meant for cooking, so we shouldn’t be buying from markets and thinking these could be just cut up and you can eat it raw."

“If you want to eat food that’s raw, you should ensure they are procured from proper sources,” he added. “For example, if you are preparing your own yusheng, you should ensure the raw fish you intend for raw consumption is procured from sources where the fish is intended for that purpose ... in supermarkets, we have dedicated counters for selling such raw products.”

The NEA director-general also said: “The consumption of raw foods in itself is inherently risky, especially for vulnerable groups. If you are pregnant, immune-compromised, or have young children, it’s best you don’t take raw food.”

STALLHOLDERS NEED TO COMPLY WITH GUIDELINES

According to Mr Ho, NEA would inform over 70 stalls selling raw fish dishes that with immediate effect, “they should cease sales of such raw fish, until such time they are able to comply with the advisory and guidelines which will be issued to them for safe handling of ready-to-eat raw fish”.

“These include ensuring the fish is procured from sources where there is assurance that the waters are cleaner, and there’s a proper cold chain system in terms of processing and handling of fish,” said Mr Ho. “And right down to the stall itself to ensure proper segregation of fish intended for raw consumption from other raw products meant for cooking.”

“Proper segregation from the source all the way down to the point of sale will ensure the ready-to-eat fish is of the highest quality and safe for consumption,” he said.

The ban on the sale of raw fish dishes will be in place unless stall holders complied with guidelines. NEA said it would directly engage and work with stallholders on how to properly recognise the advisory and abide by its guidelines.

The agency said it would keep the raw fish stalls under active monitoring and surveillance. If any rules are flouted, NEA said it would have legal provisions to take action, whether through demerit points, fines ranging from S$300 to S$2,000, or the suspension of the stall’s license in cases of repeat offences.

Asked if it would provide monetary support for stalls with raw fish dishes as their main livelihood, NEA said: “We are not considering financial assistance at this point. Stallholders have to make the necessary adjustments.”

HAWKERS REPORT A DROP IN BUSINESS

Stall holders Channel NewsAsia spoke with said business has dropped since the GBS Bacteria was found to have been linked to raw fish.

"Ever since authorities started looking into the matter, and after the media started covering the incident, the market (raw fish stalls) has been affected," said Mr Kiang Choon Tong, owner of Soon Heng Pork and Fish Porridge at Amoy Street Food Centre. "While we usually sell about 70 to 80 portions a day, now we can't even sell 10 plates a day. Because the moment people hear 'yusheng', they're scared."

Mr Kiang added that business has been poor since July.

"It's really hard to survive," he said. "People now have a fear of yusheng. They're all scared after reading or watching news reports."

Mr Wong Yeow Loy, owner of Tian Tian Porridge at Chinatown Complex Market, shared similar experiences. He said he has seen a "40 per cent drop" in sales.

Both stallholders say they have stopped from using Song fish and are now using Xi Dao fish (Wolf Herring).

"Xi Dao fish and Song fish, in terms of pricing, Xidao is more expensive by nature," said Mr Kiang. "Song fish is more popular, both with stall holders and customers, as its value for money."

"Xi Dao tastes really good. But because of its price, many avoid it," he added. "However, more discerning customers would still choose Xi Dao instead."

Due to the increase in cost, the price of each dish has also gone up.

"We had to increase our prices ever since we started using Xi Dao fish. It used to be S$2.50 per plate for Song fish, now it's S$5," said Mr Wong. "I'd like to tell customers that the Xi Dao fish is approved for use, so that they will have more confidence (in buying the dish).

"We intend to stick with using Xi Dao fish until the Song fish has been approved for use again."

- CNA/kk


355 cases of GBS infections so far this year: MOH
LAURA PHILOMIN Today Online 17 Nov 15;

SINGAPORE — To date, the Ministry of Health (MOH) said there have been 355 cases of Group B Streptococcus (GBS) infections this year, with two deaths so far.

Of these, 150 cases were the Type III GBS ST283 strain linked to the consumption of Chinese-style ready-to-eat raw fish dishes. One death was of case recently reported to MOH and is still under investigation while the other was not linked to the outbreak, said the ministry.

“Since mid-July 2015, following the advisory issued by NEA to licensed food retail establishments to temporarily stop the sale of RTE raw fish dishes using Song fish and Toman fish, the number of GBS cases notified to MOH has decreased to a usual baseline of less than 5 per week and continues to remain low. Most of these cases did not report raw fish consumption. The cause of the baseline infections remains unknown,” it added.

The National Environment Agency (NEA) has ordered all food stalls to stop selling Chinese-style raw fish dishes until they can comply with stipulated guidelines.

There were, on average, 150 cases of GBS infections per year from 2011 to last year.


Raw-fish stalls close, tweak menu after bacteria scare
STACEY LIM Today Online 28 Nov 15;

SINGAPORE — In the wake of new guidelines that hawkers must comply with to keep selling raw-fish dishes, those interviewed by TODAY expect the prospects for selling this mainstay of their menus to remain dismal. Some also felt that there should be more scrutiny of suppliers of raw fish.

The new guidelines, issued by the National Environment Agency (NEA), came after investigations by the Ministry of Health found a definite link between eating these dishes and Group B Streptococcus (GBS) infection.

Some hawker stalls selling raw-fish dishes have already stopped operating in the wake of earlier reports about such links a few months ago, while others are depending on selling other dishes to keep their businesses float.

TODAY’s visits to several food centres yesterday (Nov 28) showed that some of the hawker stalls known for selling raw-fish dishes were either closed or not selling raw fish anymore.

Mr Lim Siew Leong, the 70-year-old owner of Jiu Ji porridge stall at Chinatown Complex Market, still sells raw-fish porridge, but said that business had dropped by 60 to 70 per cent.

“People are scared, but the die-hard customers still come,” said Mr Lim, who has been operating his stall for the past 40 years.

Although fish reared in ponds are “one to four times cheaper”, Mr Lim said he has always been buying fish caught from the sea from Jurong Fishery Port, an international port for foreign fishing vessels to land their fish catch, so that he can assure his customers they are being served better-quality fish.

Some hawkers told TODAY that they had been observing the recommended hygiene practices, and felt that fish suppliers should also come under scrutiny.

Mr Koh Tong Hien, 58, who manages a stall at Tekka Market with his wife, suggested the delivery trucks carrying raw fish should be examined.

“It is quite odd for a porridge stall to stop selling raw fish, it is something people look for to eat with their porridge, just like how some prefer peanuts or chicken meat,” he said.

Mr Koh has just started selling fish head bee hoon as well to make up for the drop in demand for his raw-fish porridge dishes.

Mr Kiang Choon Tong, owner of Soon Heng Pork and Fish Porridge at Amoy Street Food Centre, said the NEA should have given hawkers more time and introduced hygiene standards for suppliers of raw fish instead of banning hawkers from selling raw-fish dishes unless they comply with the guidelines.

Mr Kiang, who said he is now earning S$200 to S$300 less a day, added: “There’s nothing we can do but to stop selling the raw fish.”


Thoroughly cooked fish poses no GBS risk: Experts
LAURA PHILOMIN Today Online 28 Nov 15;

SINGAPORE — Eating fish that is thoroughly cooked poses no risk of a person contracting Group B Streptococcus (GBS) infection, even for those with weakened immune systems. Infectious disease experts said this in the wake of the Health Ministry’s investigation findings that linked these infections to the consumption of Chinese-style raw- fish dishes.

The National Environment Agency (NEA), which has ordered stallholders to stop selling these dishes indefinitely, warned of inherent risks in eating raw food. As a general precaution, it has advised vulnerable groups of people such as children, pregnant women, the elderly or those with chronic illnesses to avoid consuming raw food.

But experts said the risk is not eliminated just because a fish is cooked. They stressed that cooking fish thoroughly is the key.

A case in point is a 75-year-old woman who in late September contracted GBS, which doctors suspect came from her consumption of steamed fish that was not thoroughly cooked. She had to be hospitalised for two weeks and put on antibiotics for one month.

Her 37-year-old daughter, who declined to be named, said her mother had an underlying condition called cellulitis, which makes it difficult for fluids to flow through her body and causes leg swelling.

Dr Leong Hoe Nam from the Rophi Clinic at Mount Elizabeth Novena Specialist Centre said that thoroughly cooking food kills all bacteria and properly cooked fish poses no risk, even to those with weaker immune systems.

“As part of public health education, the only GBS that we’re scared of with regard to fish consumption is this particular outbreak strain (ST283),” added Dr Hsu Li Yang, infectious disease physician at the ID Clinic at Mount Elizabeth Novena Specialist Centre. “But as long as fish is cooked, it should be fine.”


MOH confirms link between Chinese-style raw fish and GBS bacteria
The Straits Times AsiaOne 27 Nov 15;

SINGAPORE - Food stalls are no longer allowed to sell Chinese-style raw fish dishes unless they comply with guidelines set out by the National Environment Agency (NEA).

The guidelines include purchasing from suppliers who can show the quality of the fish - by providing a valid health certificate, for instance - and ensuring that the fish are kept at below five degrees Celsius during transportation and chilling.

This comes as the Ministry of Health (MOH) confirmed an association between the consumption of Chinese-style raw fish, such as song fish (Asian Bighead Carp) and toman fish (Snakehead fish), and Type III Group B Streptococcus (GBS) disease, specifically due to Sequence Type (ST) 283. The ministry was investigating the spike in the number of GBS infections reported here since the middle of this year.

Most recently, a 52-year-old man fell into a coma days after consuming a bowl of yusheng-style raw fish porridge on Nov 15.

Food handlers are unlikely to be the source of the bacteria causing GBS infections, the NEA, MOH and Agri-Food & Veterinary Authority of Singapore (AVA) said in a joint statement today.

"The stool samples of 82 food handlers and fishmongers from retail food establishments, market stalls, and wholesalers were tested. None of them carried the Type III GBS ST283 strain," the statement said.

Between August and October, the AVA and NEA tested fish samples from retail food establishments, wet markets, fresh produce section of supermarkets and fishery ports. GBS was detected in 20.1 per cent of these samples, and 4.1 per cent were confirmed positive for Type III GBS ST283. The contamination of the fish could have occurred along the food supply chain, the NEA, MOH and AVA said.

They added that the number of GBS cases reported has decreased to the usual baseline of fewer than five per week and continued to remain low since mid-July, when the NEA issued an advisory to food stalls to temporarily stop selling Chinese-style raw fish dishes. The cause of these baseline infections remains unknown.

Members of the public are advised to purchase Chinese-style raw fish from establishments that have separate processes to handle these raw fish from other raw food meant for cooking.

Most fish sold at Singapore's general markets and fishery ports are intended for cooking, and should not be eaten raw. Proper cooking would ensure that naturally-occurring bacteria or parasites are killed. Procuring fish that are intended for raw consumption reduces the risk of foodborne illness, the authorities said. Such fish are typically bred or harvested from cleaner waters, and are stored and distributed according to appropriate cold chain management practices.


Raw fish porridge falls out of favour after GBS cases
Linette Lai, The Straits Times AsiaOne 27 Nov 15;

Several hawkers selling raw fish porridge said they stopped doing so when the National Environment Agency (NEA) advised against it four months ago, and have not restarted sales since then.

"Everyone is scared to death of eating raw fish now," said Mr Kiang Choon Tong, 68, who owns Soon Heng Pork and Fish Porridge at Amoy Street Food Centre.

"Even if I sell it, nobody will buy it. As long as there's raw fish in the porridge, nobody wants to eat it," said Mr Kiang, who now sells pork porridge instead.

Mr Kiang Joon Chin, 60, who owns Zhen Zhen Porridge at Maxwell Food Centre, said: "We haven't been selling any raw fish porridge since July, after the scare. We sell porridge with only cooked ingredients now."

The Straits Times visited three food centres yesterday and found that some hawkers have stopped selling raw fish porridge. Those that do use a species of fish not linked to the bacteria scare in July.

Raw fish dishes are under the spotlight again after 52-year-old salesman Sim Tharn Chun was hospitalised on Thursday last week after eating a raw fish dish at Tiong Bahru hawker centre. He was admitted to Khoo Teck Puat Hospital, and remains in critical condition.

In July, the Health Ministry (MOH) said it found a link between the consumption of raw fish and Group B Streptococcus (GBS) infections in a "limited number" of cases.

Shortly after, NEA issued an advisory to more than 70 raw fish porridge stalls asking them to temporarily stop selling raw fish dishes made from Song fish, or Asian bighead carp, and Toman fish, also called snakehead. The raw fish pieces are usually served with sesame oil, ginger and chilli.

Preliminary findings from MOH's investigations found some samples from the two species had traces of GBS. In August, MOH reported that GBS cases had fallen from an average of 20 cases a week since the start of the year to around three cases a week in the first three weeks of August. GBS is a common bacteria found in the gut or urinary tract of about 15 per cent to 30 per cent of adults, and does not usually cause disease in healthy people. But it may occasionally cause serious infections of the joints, brain, heart and blood.

It is not known how many GBS cases have been diagnosed in Singapore since January. An MOH spokesman said in July that one of the larger hospitals had treated 76 cases of GBS this year, up from a yearly average of 53 in the past five years.

Yesterday, Mr Sim's wife, Mrs Cathryn Sim, 43, said her husband's condition is not improving.

She said she needed answers on whether "raw fish in Singapore is healthy. I'm not going to blame the hawkers because they don't know".


Raw fish and GBS infection: 7 questions about the bacteria answered
Linette Lai, The Straits Times AsiaOne 28 Nov 15;


1. WHAT IS GROUP B STREPTOCOCCUS BACTERIA (GBS)?

It is a bacterium commonly found in the gut and urinary tract of about 15 to 30 per cent of adults without causing any disease. But it may occasionally cause infections of the skin, joints, heart and brain. It can lead to meningitis, which is an inflammation of the membranes surrounding the brain and spinal cord.

Having chronic conditions, such as diabetes, put people at a higher risk of getting GBS infections.


2. IF GBS IS A COMMON BACTERIA, WHY IS IT THAT SOME PEOPLE HAVE FALLEN SO ILL AFTER BEING INFECTED?

The serious cases this year have been found to be associated with a particular strain of GBS known as Sequence Type 283 (ST283). Although this strain is not fully understood as yet, it is believed to be more aggressive than others.

There are many different strains of GBS, not all of which have been fully studied. However, these bacteria are generally not considered food-borne pathogens.

3. ARE SOME PEOPLE MORE PRONE TO INFECTION?

In general, newborns and people with poorer immunity, such as those who have diabetes, cancer and HIV, are usually more vulnerable to the infection, say doctors. But the cases this year affected both young adults and the old.

Traditionally, GBS infections have been associated with pregnancy as mothers who are carriers of the bacteria may pass it to their babies during birth.

4. WHAT ARE THE SYMPTOMS OF GBS INFECTIONS AND HOW CAN THEY BE TREATED?

The most common symptom of infection is a fever, said Dr Leong Hoe Nam, an infectious diseases specialist with Mount Elizabeth Novena Hospital.

It is important to recognise and treat it early, said Dr Leong, adding that it can be treated with common antibiotics such as penicillin.

Other more serious symptoms include infection of the joints, brain, lungs and other soft tissue in the body. The kind of symptoms a person has depends on the site of the bacterial infection.

5. WHY IS THE BAN ONLY ON CHINESE-STYLE RAW FISH DISHES? IS IT SAFE TO EAT SASHIMI?

Most of these Chinese-style dishes use fish that are intended for cooking and should not be eaten raw. They may contain parasites or bacteria, which are killed by cooking.

Fish used for sashimi are usually bred or harvested from cleaner waters.

6. HOW WOULD I KNOW WHAT KINDS OF RAW FISH ARE SAFE TO EAT?

You should make sure that the people you are buying from handle raw fish separately from other raw food that is meant to be cooked. For example, they should have separate counters, chopping boards, and knives to prepare fish meant to be served raw.

7. WERE POOR HYGIENE PRACTICES OF HAWKERS THE CAUSE OF THE GBS OUTBREAK EARLIER THIS YEAR?

It is unlikely. The stool samples of 82 food handlers and fishmongers were tested, and none of them were positive for the specific strain of GBS associated with the outbreak.


Eateries take steps to keep raw fish dishes safe
Jessica Lim, Straits Times AsiaOne 29 Nov 15;
Several eateries selling raw fish dishes here are making doubly sure that their supplies are up to the mark, given a rise in Group B Streptococcus (GBS) infections here this year.

Many are doing this even though they are not serving the three types of fish linked to the infection - song fish (Asian bighead carp), toman fish (snakehead) and tilapia.

Mr Kevin Cheong, 46, owner of Hinoki Japanese Dining in the Central Business District, called his raw fish suppliers last week to get the assurance that their fish are GBS-free.

"We asked them for necessary certification and are monitoring the situation," he said. His firm imports only sashimi-grade raw fish from Japan, Norway, Thailand and Indonesia, and all its supplies come from farms certified by the Agri-Food and Veterinary Authority (AVA), he added.

However, since the GBS scare began in July, demand for raw fish at his eatery has dipped 15 per cent year- on-year with a few customers asking if he served the three fish types linked to the infections. "Some are avoiding raw fish altogether," he said, adding that staff have been reminded to follow proper hygiene procedures.

Japanese restaurant chain Sakae Sushi, which has about 50 outlets here, has informed its suppliers about the GBS scare and is monitoring the matter closely. Mr Douglas Foo, the chain's founder and chairman, said he visits the farms of his raw fish suppliers - in countries such as South Africa - to take samples from the water the fish are reared in for lab tests. Independent auditors visit the farms regularly and each batch of raw fish that arrives here is tested for various bacteria, including GBS.

Supplies are tagged with radio frequency identification chips to track if the cold chain has been broken. The fish are harvested, chilled and iced at the farms, then stored in large refrigerators and either flown or shipped to Singapore. "If the cold chain is broken, the batch will be rejected," said Mr Foo, adding that the restaurant group has not yet seen a dip in demand for raw fish.

The authorities stated last Friday that there is a definite link between the GBS infections - which can lead to meningitis - and Chinese-style raw fish dishes, including raw fish porridge. Hawkers have been told to stop selling such dishes unless they can prove the fish used are from safe suppliers. The Ministry of Health said it has been notified of 355 cases of GBS infection this year.

Supermarket chain FairPrice and the Dairy Farm Group - which runs Cold Storage and Giant - said they have strict standards for temperature control and personal hygiene, and do regular audits. Prime Supermarket chief executive Chong Wee Cheong said the AVA took samples of its fish for testing two months ago and they passed. At Sheng Siong, demand for song, tilapia and toman fish have fallen by 5 per cent from the same time last year. Head purchaser Kong Cheu Soon said staff have been reminded to tell customers the fish are not for eating raw. AVA tests on its supplies have come up negative.

But consumers like Madam Amutha Kumaran, 45, a sales executive who has two children, are playing it safe. "I told my family not to eat any more raw fish," she said.

Additional reporting by Linette Lai


Man, 22, dies from GBS infection
AsiaOne 3 Dec 15;

A 22-year-old man died from Group B Streptococcus (GBS) infection on Tuesday (Dec 1), mere hours after he was admitted to the Singapore General Hospital, local media reported.

According to Lianhe Wanbao, Certis Cisco protection officer Roy Ng fell sick on Nov 23.

For over a week, Mr Ng had a persistent fever that rose to 40 degrees celsius at one point.


He also suffered from abdominal pain, vomiting, and had blood in his urine, his father told the Chinese evening daily.

The elder Mr Ng decided to send his son to the hospital after noticing that he looked pale in the early hours of Tuesday. He struggled to breathe and also wrapped his arms around his abdomen from the severe pain.

At the hospital, doctors found that Mr Ng's blood pressure had plunged to nearly half of the normal reading of 130/80, and there was fluid buildup in his lungs.

They operated on the young man in an emergency surgery but pronounced him dead three minutes later.

A doctor told Mr Ng's father that the bacterial infection had spread to his heart and kidneys, causing them to fail.

The Straits Times reported on Wednesday (Dec 2) that the Ministry of Health (MOH) is now investigating whether Mr Ng's death from GBS infection is related to the consumption of Chinese-style raw fish dishes also known as yusheng.

According to the deceased's father, he did not like eating yusheng. However, the elder Mr Ng was unsure if his son had consumed them while dining out with his friends.

Mr Ng's death marks the third fatal case of GBS infection this year.

MOH said last Friday (Nov 27) that it was notified of 355 GBS cases from the beginning of the year. Of these, 150 were linked to consumption of yusheng.

Joint investigations conducted by the National Environment Agency, Agri-Food & Veterinary Authority of Singapore, and the health ministry confirmed an association between the consumption of yusheng with Sequence Type (ST) 283 - an aggressive strain of the GBS bacteria.

Uncooked freshwater fish such as Song fish (Asian bighead carp), Toman fish (snakehead) and tilapia were among those found containing ST283.

The authorities also ordered hawkers to stop selling the raw fish dishes unless they can prove that the fish came from safe sources.

What it should have been
Straits Times 9 Dec 15;

In the Nov 29 report, "Eateries take steps to keep raw fish dishes safe", Hinoki Japanese Dining owner Kevin Cheong was quoted as saying that he imported raw fish only from farms certified by the Agri-Food and Veterinary Authority (AVA). The AVA has clarified that it does not certify such farms but conducts inspection and sampling of imported food, including fish, at import points.