Best of our wild blogs: 14 Jul 15

Biodiversity of Singapore Symposium IV on Sat 01 Aug 2015 @ NUS
Otterman speaks

Sign up for ASEAN Power Shift 2015!
Green Drinks Singapore

The Internship
Life of a common palm civet in Singapore

Oil slick at East Coast Park (12 Jul 15)
wild shores of singapore

Nesting bulbul: 1. A nest outside my bedroom window
Bird Ecology Study Group

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No proven link between eating raw fish and bacterial infection: MOH

Group B streptococcus bacteria does not usually cause disease in healthy individuals, says the Ministry of Health, in response to a widely circulated post on social media claiming there is "surge" in the number people falling ill after eating contaminated raw fish.
Channel NewsAsia 13 Jul 15;

SINGAPORE: There has not been any proven link between eating fish, raw or otherwise, and the Group B streptococcus (GBS) bacteria disease, said the Ministry of Health (MOH) on Monday (Jul 13).

MOH said it is aware of a message circulating claiming there has been an outbreak of Group B streptococcus due to consumption of contaminated raw fish. The message, which appeared to have originated from a widely shared Facebook post claimed: "For the past few weeks, hospitals islandwide have been noticing a surge of young and old men who have been coming in sick with fever and painful swollen joints."

The message said all the people who had taken ill had consumed "yusheng", a popular dish at hawker centres, where raw fish is marinated in sesame oil and garnished with red chilli and ginger.

“GBS is a common bacterium that colonises the human gut and urinary tract. It does not usually cause disease in healthy individuals,” said MOH in a Facebook post. “However, in adults, GBS may occasionally cause infections of the skin, joints, heart and brains. The risk factors for GBS infection include underlying chronic or co-morbid conditions.”

But an expert said the bacteria can be transferred to fish. "Only human beings have this kind of bacteria, so if food handlers have this bacteria and they handle fish products - raw fish products - this bacteria can transmit from food handlers to the fish products," explained Professor Yuk Hyun-gyun, from the National University of Singapore.

The Health Ministry, the National Environment Agency and Agri-Food and Veterinary Authority of Singapore are investigating the message, MOH said.

A stall helper at Maxwell Market said the authorities collected raw fish samples from them, as well as other stalls, on Monday afternoon.

- CNA/xq

MOH investigating increase in Group B streptococcus infections
ALFRED CHUA Today Online 14 Jul 15;

SINGAPORE — In light of a message making its rounds online claiming an outbreak of Group B streptococcus (GBS) infections due to the consumption of contaminated raw fish, the Ministry of Health (MOH) has confirmed an increase in GBS cases, and said investigations on the cause are being carried out.

In a Facebook post earlier this evening (July 13), the MOH said it is jointly investigating with the National Environment Agency and the Agri-Food and Veterinary Authority of Singapore over the cause of the apparent outbreak.

An MOH spokesperson said in response to media queries that “there has not previously been any proven link between eating fish, raw or otherwise, and GBS disease”.

Nonetheless, its hospital doctors have alerted of an increase in the number of cases of GBS infections.

“While one of our larger hospitals saw an average of about 53 (range 31 to 73) cases of GBS infection each year in the past five years, they have treated about 76 cases so far this year. Ten of these cases reported recent consumption of raw fish. Investigations are on-going as to the reason(s) for the increase in cases,” the spokesperson added.

The MOH said GBS is a common bacterium that colonises the human gut and urinary tract and usually does not cause disease in healthy individuals. However, in adults, GBS may occasionally cause infections of the skin, joints, heart and brains.

“Vulnerable groups of people, especially young children, pregnant women or the elderly, should exercise caution by avoiding raw ready-to-eat food,” the ministry spokesperson said.

TODAY understands from the messages sent — on mobile phones and on social media — that those who had suffered from the infection had eaten raw fish in food centres and restaurants at various parts of the island.

10 victims of bacterial outbreak say they had eaten raw seafood
Straits Times 13 Jul 15;

SINGAPORE - Authorities here are investigating a message that went viral on Monday that claimed that there is a bacteria outbreak from eating contaminated raw fish.

The ministry said that it has been alerted by hospital doctors to an increase in cases of GBS infection.

One of the larger hospitals here has treated 76 cases of GBS this year, higher than the average of about 53 each year in the past five years, said an MOH spokesman.

"10 of these cases reported consumption of raw fish. Investigations are on-going as to the reasons for the increase in cases," said the spokesman.

It added that it is jointly investigating the claim about the outbreak of Group B streptococcus (GBS) with the National Environment Agency (NEA) and the Agri-Food & Veterinary Authority of Singapore (AVA).

"Vulnerable groups of people, especially young children, pregnant women or the elderly should exercise caution by avoiding raw ready-to-eat food (e.g. raw oysters, sashimi, etc)."

MOH said in that the strain is a "common bacterium that colonises the human gut and urinary tract" and does not usually cause disease in healthy individuals.

"There has not previously been any proven link between eating fish, raw or otherwise, and GBS disease. However, in adults, GBS may occasionally cause infections of the skin, joints, heart and brains. The risk factors for GBS infection include underlying chronic or co-morbid conditions."

The claim was circulated widely on Monday via Whatsapp message on mobile phones and also the social media.

Recent spike in bacterial infection cases: Authorities probing link to raw fish
One of the larger hospitals has treated about 76 cases so far in 2015, compared with an average of about 53 cases each year in the past five years, the Health Ministry says.
Channel NewsAsia 14 Jul 15;

SINGAPORE: The Ministry of Health (MOH) and various agencies are investigating the increase in cases of Group B streptococcus (GBS) infection, which have been linked with the consumption of raw fish, the ministry said on Monday (Jul 13).

One of the larger hospitals in Singapore saw an average of about 53 cases of GBS infection each year in the past five years, with a range of 31 to 73 cases a year. However, it has treated about 76 cases so far this year and in 10 of these cases, recent consumption of raw fish was reported, MOH said in reply to queries by Channel NewsAsia.

"Investigations are ongoing as to the reason(s) for the increase in cases," the ministry added.

Doctors say this figure could well be just the tip of the iceberg because the data excludes numbers from private hospitals. And unlike more serious diseases, like tuberculosis, it is not compulsory for doctors to report cases of GBS infection.

"This disease can hurt the individual who is unwell. But if you take into context, the whole population of Singapore, only a small, few numbers fall very, very, sick," said Dr Leong Hoe Nam, an infectious diseases specialist at Mount Elizabeth Novena Hospital. "Yes, we have had patients with permanent disability and even deaths from this illness. So contextualising it - the actual risk is very, very small, but should you get the infection, it could be quite serious and even life-threatening."

Earlier on Monday, MOH said it was aware of a message circulating claiming that there has been an outbreak of GBS due to consumption of contaminated raw fish. The message said all the people who had taken ill had consumed "yusheng", a popular dish at hawker centres, where raw fish is marinated in sesame oil and garnished with red chilli and ginger.

GBS is a mild germ that lives in the human body and does not usually affect healthy people. However, at least one healthy male has been struck with severe GBS infection.

His wife, Ms Lim, said he ate raw fish late last month. A few days later, the 52-year-old came down with high fever and painful joints. A trip to their family doctor did not help and he was later warded because his joints hurt till he could not move.

His knee swelled up to twice its size. He went through two rounds of surgery to drain the fluid and doctors confirmed the case as a GBS infection.

Ms Lim said she was shocked to see how her quickly her husband's health worsened.

Doctors said this is what is so unusual about the new strain.

"It is able to evade the immune system," said Dr Leong. "The usual methods in which the immune system blocks it off - it is able to evade it and go into the system a little bit faster. I do not think we will find a cure to it, but we probably may be able to find the source to it. If we can shut down the source, everything should be fine."

Doctors are now collecting samples from patients and coming up with standard questions to ask patients with symptoms of GBS infection. At the same time, food supply companies are stepping up efforts to ensure their products are safe for consumption.

One company uses chilled water - below six degrees Celsius - to wash fish in the belief that it reduces chances of bacterial growth.

All food handlers are also required to be registered with the National Environment Agency and undergo stringent food handling courses.

- CNA/kk/ek

GBS bacterial infection 'unusual' for healthy adults, doctors say
The Straits Times AsiaOne 16 Jul 15;

SINGAPORE- A bacteria called Group B streptococcus (GBS) is infecting healthy adults who are usually not known to be vulnerable to it, doctors say.

They said that new-born babies, and those with poorer immunity, such as those who have diabetes, cancer, and HIV, are usually more vulnerable to the infection.

"However, the current outbreak we are seeing is afflicting young adults and the old," Dr Leong Hoe Nam, Infectious Diseases Specialist from Mount Elizabeth Novena Hospital said.

The Ministry of Health (MOH) said it is jointly investigating a claim about a outbreak of GBS infection with the National Environment Agency (NEA) and the Agri-Food & Veterinary Authority of Singapore (AVA), after a message about it went viral on Monday.

Hospital doctors also alerted MOH to an increase in cases of GBS infection here.

A spokesman said that that one of the larger hospitals here has treated 76 cases of GBS infection so far this year, higher than the average of about 53 each year in the past five years.

MOH said that the strain is a "common bacterium that colonises the human gut and urinary tract" and does not usually cause disease in healthy individuals.

While the current cases have not been confirmed to be caused by the consumption of raw fish, Dr Leong pointed to research that shows that GBS is commonly found in tilapia.

Dr Leong said that the particular strain causing the infection currently appears to be "more potent," and may be evading the immune system and causing infection in more people than usual.

The infection can be treated with common antibiotics such as penicillin, Dr Leong said. He added that recognising it early and getting timely treatment is important. The most common symptom of an infection is a fever.

The infection usually manifests itself in the form of lung, soft tissue or joint infection.

It can also come in the form of brain infection, said Dr Yik Keng Yeong, a general practitioner who has been practising for 35 years, said. Dr Leong has had one patient who died of the infection.

MOH asks doctors to report cases of GBS infection
This is to help authorities investigate reports that people who ate yusheng, a raw fish dish, fell ill with a bacterial infection.
Leong Wai Kit, News 5 Channel NewsAsia 20 Jul 15;

SINGAPORE: The Ministry of Health (MOH) has asked doctors in the private sector to report new cases of Group B Streptococcus (GBS) disease, to help the authorities investigate a possible link between the bacterial infection and consumption of a raw fish dish called "yusheng", doctors told Channel NewsAsia.

This comes after MOH and various agencies started an investigation, due to a recent spike in GBS cases.

Usually, doctors are not required to submit information to the ministry for GBS, unlike for more serious diseases like tuberculosis. The move shows the authorities are taking investigations seriously, said Mount Elizabeth Novena Hospital infectious diseases expert, Dr Hsu Li Yang.

MOH said a week ago that one of the larger hospitals in Singapore saw an average of 53 cases of GBS in the past five years, but treated 76 patients so far this year. Ten of those patients reported recent consumption of raw fish. The numbers furnished did not include private sector patients.

Infectious diseases doctors estimate that there are about 200 cases of severe GBS infection in Singapore so far. Private sector doctors told Channel NewsAsia at least two new cases emerged in the last week, and that of 30 patients interviewed since May, 70 per cent of them told doctors they had eaten raw fish. However, doctors said it is too early to conclude that raw fish is the culprit.

"It is something to worry about, but at the same time it is not proof that eating raw fish is the cause of the infection. I say this for many reasons. One of which - and the more important one is - there are many people selling raw fish and if I were to condemn the eating of raw fish quickly, then it affects their livelihoods," said Dr Hsu.

MOH has previously said there is no proven link between eating fish, raw or otherwise and GBS disease, in healthy individuals.

GBS PATIENTS REPORT PAINFUL JOINTS

Mr Howard Kuay, who contracted a GBS infection, said his knee began to swell a week after he ate raw fish, but that he did not think much of it.

"I would think that it's a worn-out ligament, or maybe dengue fever. I didn't know what this Group B Streptococcus was. And the doctor immediately said: 'We need to operate on your knee,' because it was swelling with water. He injected a needle into my knee and pulled out murky fluid and he told me it was supposed to be clear," he said.

The 30-year-old, who said he has never had any health or joint issues, said the pain was excruciating. "I've broken my hand before and I will tell you that the pain is worse than (a) broken bone. It feels like your knee is very tight. It feels like someone put a metal bar and bolt and tightened it together. You just can't bend it," said Mr Kuay.

A 52-year-old who contracted GBS disease earlier told Channel NewsAsia that after eating yusheng, his knee swelled to double its normal size and that his joints were so painful, he could not move.

While infectious diseases specialists have been trading notes on the recent cases, Dr Benedict Peng, an orthopaedic surgeon at Gleneagles Hospital, said GPs should be in the know as well. "So that if they see a patient with knee pain or fever then they may think that this is a potential problem and not treat it as a simple sprain or a ligament injury," he said.

For now, doctors advise those with weaker immune systems to avoid eating raw food.

- CNA/dl

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