Getting TB in Singapore: Recovered patient urges people to learn about endemic disease

SINGAPORE: In 2020, Kelvin (not his real name) had a double whammy. He was diagnosed with tuberculosis (TB) and found himself out of a job for about six months while undergoing treatment. 

It all started in May that year when the 23-year-old had a persistent cough that did not improve despite medication and a visit to a doctor. On his second visit to the doctor, he was referred to Tan Tock Seng Hospital (TTSH), where he was diagnosed with TB.

Speaking to the media ahead of World TB Day, which falls on Mar 24 every year, Kelvin said he was not aware of TB before he contracted it.

“At first, it was not easy to accept my diagnosis. I felt shocked and found it difficult to accept. I thought it was an ordinary cough,” he said.

Losing his job temporarily as a retail associate in a large chain was an even bigger burden, said Kelvin, who did not want to be named for fear of discrimination.

“It was not an easy journey, especially when I was not allowed to work. I was worried about finances. My father was unemployed, (so) losing my income was a huge blow to my family,” he said.

He managed to return to his job only in January 2021, after getting help from TTSH's TB Control Unit and the Tripartite Alliance for Fair and Progressive Employment Practices (TAFEP).

“I hope people can learn more about TB first before giving those with TB a ‘death sentence’,” Kelvin said.

“People should not feel like they have to keep a distance from those with TB, especially those already taking medicine faithfully and on regular medical follow-up.”

TB SYMPTOMS AND TREATMENT

Clinical director of the TB Control Unit Shera Tan told media that common symptoms of TB include fever, night sweats, chronic cough and loss of weight.

Among the misconceptions about the disease is that patients are infectious throughout their treatment, which takes six to nine months. But they are typically not infectious after two weeks, as long as they adhere to treatment, Dr Tan said.

The length of the treatment period cures the disease and prevents relapse and the development of drug-resistant organisms, she added.

Patients undergo directly observed therapy, which involves them taking three to four types of medication under the observation of a trained healthcare worker.

“The main challenge in the treatment of TB is the long duration of treatment beyond that of symptom resolution and the large number of tablets taken as part of the standard drug regimen,” Dr Tan said.

For the first two months, the therapy is required daily, after which it is needed three times a week.

Kelvin, who went for his therapy at a polyclinic near his home, completed his treatment in nine months and no longer has any symptoms, he said.

Dr Tan said that those diagnosed with TB are not required to be isolated, unlike COVID-19 patients. They however have to wear a mask and are encouraged to go out only for healthcare visits and necessary tasks like buying food. They are also advised to minimise social interaction with people they have not met recently.

At home, they don’t have to take any precautions, she said.

“Patients who are diagnosed with TB are far more infectious before the treatment was started than after,” she said.

WHO IS AT RISK OF TB?

Many are under the impression that TB is no longer present in Singapore, while some people think that the disease only affects those of lower socioeconomic status and is associated with poor hygiene, said Dr Tan.

But anyone can get infected with TB as it is an airborne disease.

At higher risk are those with prolonged close contact with patients such as household members and those with low immunity, Dr Tan added.

About half of all TB patients are asymptomatic, she said. Their disease is typically discovered during medical examinations for purposes such as evaluation for employment, application for long-term stay in Singapore, or even incidental findings in the evaluation of other diseases such as cancer staging.

Other than active TB, there is also latent TB, where the bacteria is kept under control in a dormant state by the body’s immunity. About 10 per cent of Singapore's population have latent TB, which is not transmissible.

“The germs are there, but they are not replicating at a speed that will cause symptoms, so it’s only when they break down from the latent to the active state that they (patients) start to transmit germs to other people,” she said.

Last year, there were 1,306 new cases of active TB among Singapore residents, The incidence rate was 32.8 cases per 100,000 population, the Ministry of Health (MOH) said in a media release last Thursday on World TB Day.

This was a slight dip compared to 2020. Older age groups and males continue to make up a significant proportion of new active TB disease cases, MOH said.

WORKPLACE DISCRIMINATION

TAFEP said it has received an average of six complaints a year over the past five years about workplace discrimination due to medical conditions, including TB.  

A spokesperson for the watchdog noted that employees with TB are able to return to work after two weeks, as they are generally deemed to be non-infectious after completing the first two weeks of treatment.

“Nevertheless, there may still be misconceptions amongst employers and co-workers about the spread of the disease at the workplace,” the spokesperson said.

Senior medical social worker Chiam Ai Ling said that the TB Control Unit continues to be actively involved in the education of medical professionals and the public.

She added that the TB Control Unit helps patients who face stigma or discrimination and dispel misconceptions.

"For those grappling with fears of TB transmission, we engage them with facts and work to put those fears to rest," she said. 

In Kelvin's case, his situation improved after a friend who was a canteen stall operator hired him on a part-time basis while he was unemployed.

Kelvin did not tell him of his disease initially, but when he did, James did not write him off. He spoke to a medical social worker from the TB Control Unit to find out more about the disease.

The 62-year-old felt reassured after he learnt that Kelvin was not infectious if he adhered to his treatment. He also wanted to give Kelvin a chance as he felt that he himself caught a break in life.

“I lost some vision in my right eye due to an accident in primary school. I would not have been able to work or start a family if people had not given me a chance,” James said.

Things got better for Kelvin after James employed him.

“He gave me a lot of encouragement and support. It gave me confidence and hope that things could get better,” he said.

Having recovered from TB, Kelvin said that there is “no need to be too worried about the disease”.

“Just take medicine as instructed by the doctor and live life as usual,” he said.