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SINGAPORE: It might seem like a disease out of place and time in a First World city, but surprisingly, tuberculosis (TB) is some 75 per cent more prevalent in Singapore than in most developed countries.
Last year, the Republic had 1,256 new TB cases. This worked out to 35.1 cases per 100,000 residents, slightly down from the previous year's 35.6 cases.
Even so, this incidence rate is high, compared to the fewer than 20 cases per 100,000 residents in most developed countries. And about a third, or 36 per cent, of new TB cases here in 2006 comprised foreigners, according to the Singapore Anti-Tuberculosis Association (SATA).
The figures were released by SATA and the Ministry of Health (MOH) to mark World TB Day next Monday.
Among the foreigners with TB, three-quarters were work permit holders. The number of new TB cases among short-stay non-residents also increased by 41 cases to hit 391.
SATA's acting medical director Dr Tan Sai Tiang said foreigners who are detected with TB during their mandatory health screening in Singapore will be denied a work permit or social visit pass. Even so, some foreigners either contract TB in Singapore — the disease can be contagious in crowded environments such as workers' quarters — or pick it up during a spell in their home country. Such cases are treated with medication or isolated if necessary.
But "whether they are foreigners or locals, those with TB pose the same contagious risk to the community", Dr Tan noted.
TB can spread through the air via respiratory droplets. The bacteria is also very hardy and can lie dormant in the body for many years.
In Singapore, the word TB used to sound the death knell for many. "In the old days, TB was highly contagious, as many people lived close together, sometimes under unsanitary conditions, and their immune systems were bad," said Dr Tan.
That could explain why more than half the new cases last year were seniors aged 50 or older — as they could have been exposed to the virus earlier in their lives.
SATA provides free basic TB treatment (costing more than $1,000 over six months) to Singaporeans, permanent residents, work permit holders or their dependents living here.
It is important for TB patients to complete the full treatment course — failure to do so could lead to a relapse, as in the case of resistant strains.
In 2006, there were 137 cases of relapse, mostly in patients aged 50 and above.
Under the Infectious Diseases Act, the MOH carries out public health enforcement measures against those who persistently default on treatment.
Since July 2004, legal notices have been issued to 91 TB patients, requiring them to undergo directly-observed therapy, in which the medication is taken under the supervision of a healthcare worker. Of these, 45 have completed their treatment, 40 are still on treatment and six have died.
While drug resistance in TB cases is a worldwide concern, Singapore saw only four cases of multi-drug-resistant TB last year.
It is compulsory for children to be vaccinated against TB but the vaccine is not 100-per-cent fool-proof and lasts for just 15 years. "However, we are not commonly exposed to TB in Singapore because of our good sanitation and living conditions," said Dr Tan.
If one does contract TB, the good news is, "TB is curable in almost all cases", said SATA chief executive Dolly Goh.
"There is more work to be done to reduce the incidence of TB to a level commensurate with our First World status."
- TODAY/so
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