Singapore's efforts to achieve measles elimination in 2018

@#The World Health Organization verified that Singapore had eliminated endemic transmission of measles in October 2018. This report summarizes the evidence presented to the Regional Verification Commission for Measles and Rubella Elimination, comprising information about immunization schedules; laboratory testing protocols and the surveillance system; and data on immunization coverage and the epidemiology of cases. Between 2015 and 2017, a total of 246 laboratory confirmed cases of measles were reported. The source or country of infection was unknown for most cases (195; 79.3%). There were 22 clusters, ranging from two to five cases. The most common genotypes detected were D8 and D9. Transmission of B3 was interrupted in 2017, and H1 cases were sporadic and imported. Phylogenetic analyses of the D8 isolates showed the existence of 13 lineages or clusters. Although a few lineages were circulating concurrently, no lineage propagated continuously for a prolonged period, and transmission of each lineage eventually stopped. Although cases and clusters were reported yearly, molecular data showed that none of the lineages resulted in prolonged transmission. There were fewer measles cases in 2017 compared with 2016. The higher number of clusters was likely due to the overall increase in cases because cluster sizes remained small. The occurrence of small clusters is not unexpected since measles is highly infectious. The majority of imported cases did not result in secondary transmission. With the global increase in the number of measles cases, Singapore needs to stay vigilant and continue to promptly test suspected cases; vaccination is the key to preventing infection.

Ministry of Health Clinical Practice Guidelines: Prevention, Diagnosis and Management of Tuberculosis

The Ministry of Health (MOH) has developed the clinical practice guidelines on Prevention, Diagnosis and Management of Tuberculosis to provide doctors and patients in Singapore with evidence-based treatment for tuberculosis. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Prevention, Diagnosis and Management of Tuberculosis, for the information of SMJ readers. The chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

The Singapore Field Epidemiology Service: Insights Into Outbreak Management / 예방의학회지

Field epidemiology involves the implementation of quick and targeted public health interventions with the aid of epidemiological methods. In this article, we share our practical experiences in outbreak management and in safeguarding the population against novel diseases. Given that cities represent the financial nexuses of the global economy, global health security necessitates the safeguard of cities against epidemic diseases. Singapore's public health landscape has undergone a systemic and irreversible shift with global connectivity, rapid urbanization, ecological change, increased affluence, as well as shifting demographic patterns over the past two decades. Concomitantly, the threat of epidemics, ranging from severe acute respiratory syndrome and influenza A (H1N1) to the resurgence of vector-borne diseases as well as the rise of modern lifestyle-related outbreaks, have worsened difficulties in safeguarding public health amidst much elusiveness and unpredictability. One critical factor that has helped the country overcome these innate and man-made public health vulnerabilities is the development of a resilient field epidemiology service, which includes our enhancement of surveillance and response capacities for outbreak management, and investment in public health leadership. We offer herein the Singapore story as a case study in meeting the challenges of disease control in our modern built environment.

Outbreak of novel influenza A (H1N1-2009) linked to a dance club

<p><b>INTRODUCTION</b>This paper describes the epidemiology and control of a community outbreak of novel influenza A (H1N1-2009) originating from a dance club in Singapore between June and July 2009.</p><p><b>MATERIALS AND METHODS</b>Cases of novel influenza A (H1N1-2009) were confirmed using in-house probe-based real-time polymerase chain reaction (PCR). Contact tracing teams from the Singapore Ministry of Health obtained epidemiological information from all cases via telephone.</p><p><b>RESULTS</b>A total of 48 cases were identified in this outbreak, of which 36 (75%) cases were patrons and dance club staff, and 12 (25%) cases were household members and social contacts. Mathematical modelling showed that this outbreak had a reproductive number of 1.9 to 2.1, which was similar to values calculated from outbreaks in naïve populations in other countries.</p><p><b>CONCLUSION</b>This transmission risk occurred within an enclosed space with patrons engaged in intimate social activities, suggesting that dance clubs are places conducive for the spread of the virus.</p>

International health regulations: lessons from the influenza pandemic in Singapore

<p><b>INTRODUCTION</b>Singapore's defense against imported novel influenza A (H1N1-2009) comprised public health measures in compliance with the World Health Organization's (WHO) International Health Regulations (IHR), 2005. We report herein on the epidemiology and control of the fi rst 350 cases notified between May and June 2009.</p><p><b>MATERIALS AND METHODS</b>We investigated the fi rst 350 laboratory-confirmed cases of novel influenza A (H1N1-2009) identified from the healthcare institutions between 27 May and 25 June 2009. Epidemiological details of these cases were retrieved and analysed. Contact tracing and active case finding were also instituted for each reported case, and relevant particulars including flight information were provided to WHO and overseas counterparts.</p><p><b>RESULTS</b>The fi rst 350 novel influenza A (H1N1-2009) cases comprised 221(63%) imported cases, 124 (35%) locally acquired cases and 5 (2%) cases with unknown source. The imported cases consisted of three waves involving the United States (US), Australia and Southeast Asia. In the fi rst wave, 11 (69%) of the 16 imported cases had visited the US within seven days prior to their onset of illness between 25 May and 4 June 2009. In the second wave, 20 (74%) of the 27 imported cases between 5 June and 12 June had travelled to Melbourne, Australia. In the third wave, 90 (51%) of the 178 imported cases between 13 June and 25 June were acquired from intra-regional travel in Southeast Asia. Specifically, 49 cases were from the Philippines and 40 (82%) of them had travelled to Manila. A total of 667 communications were effected through the IHR mechanism; a majority within 24 hours of disease notification.</p><p><b>CONCLUSION</b>Singapore experienced an unprecedented need for international cooperation in surveillance and response to this novel Influenza A (H1N1-2009) pandemic. The IHR mechanism served as a useful channel to engage in regional cooperation concerning disease surveillance and data sharing, but requires improvement.</p>