Expert help to revamp tuberculosis (TB) programme

Key proposals include using latest drugs and offering free treatment

By Poon Chian Hui, The Straits Times, 24 Mar 2012

TWO tuberculosis (TB) specialists are here at the invitation of the Ministry of Health to tackle the growing scourge.

Professor Lee Reichman and Dr Paula Fujiwara, both based in the United States, have met health-care professionals and the authorities, and made three key recommendations:

Use the latest drugs available;

Offer free TB treatment; and

Screen foreigners, particularly those coming here to work, back in their home countries.

The two doctors, who have worked in TB-plagued regions such as Africa, were last here in the 1990s, when TB was on the rise in Singapore. It declined in the ensuing decade, hitting a low in 2007, with 1,256 new cases that year.

Since then, the numbers have gone up again: There were 1,533 new cases last year, up from 1,478 in the previous year.

These figures came from the Health Ministry yesterday, ahead of World Tuberculosis Day today.

Last year's figure of 1,533 new cases means 40.5 in 100,000 Singaporeans and permanent residents had TB, against 3.4 in the US and 21 in Japan.

TB, caused by a bacteria that typically attacks the lungs, is marked by symptoms such as prolonged coughs, fever and fatigue. Left untreated, the infection can spread to others and eventually kill.

Speaking to The Straits Times yesterday, Prof Reichman said making the newest drugs available would simplify and shorten treatment, so patients would be more likely to complete it.

Under the old regimen, patients take several types of pills or injections, or both over six to nine months. Faced with such an arduous course of treatment, patients were failing to complete it, and remaining infectious.

In contrast, the newest drugs are taken in 12 weekly doses administered over three months.

Prof Reichman, who heads the New Jersey Medical School Global Tuberculosis Institute, noted that last December's edition of the New England Journal of Medicine featured a study that indicated the new regimen had proved effective for more than 8,000 patients.

With regard to making TB treatment free, Dr Fujiwara told The Straits Times that people might be reluctant to see a doctor when they develop a cough because they worry about the cost of the tests, X-rays and consultation.

'But if they're confident that treatment will be free, this won't be an issue,' said the director of the Department of HIV and TB at the International Union Against Tuberculosis and Lung Disease.

'It's not just the stigma, it's the money. Treatment of TB should be free because it's for the public good,' she added.

TB drugs here are free only if patients take them daily under the eye of a polyclinic health-care professional. However, patients are billed for consultations, sputum tests and X-rays; the initial consultation can come to $300.

The rising number of foreigners coming here for work or study underpins the specialists' suggestion that these foreigners be screened on home soil.

Last year, 593 foreigners were diagnosed with TB - up from 550 in 2010.

Professor Sonny Wang of the TB Control Unit in Tan Tock Seng Hospital said the surge in TB cases locally might stem from foreigners spreading it here.

Prof Reichman said that, for a successful programme in screening foreigners before arrival, arrangements have to be made with certified doctors overseas to run the necessary tests.

Prof Reichman and Dr Fujiwara, although disappointed that TB numbers are rising again here, said they are confident Singapore can contain the problem.

Prof Reichman said: 'I'd stake my reputation on that.'