Govt stepping up fight against TB

New guidelines for doctors among measures in bid to halt spike in cases

By Poon Chian Hui, The Straits Times, 17 Oct 2012

THE fight against tuberculosis (TB) will be stepped up in a bid to arrest the spike in cases after a decade of decline.

TB rates in Singapore rose for the first time in almost a decade in 2008 after an all-time low of 1,256 cases the year before.

Rates are still going up - there were 1,533 new cases last year, up from 1,478 the year before.

The infectious disease can be fatal but antibiotic treatment usually works.

The Ministry of Health (MOH) is ramping up public education - such as getting the Health Promotion Board (HPB) to reach out to schools and workplaces - and making sure people in close contact with an infected person get screened promptly.

To help doctors better identify and treat patients, new clinical practice guidelines will be published in the third quarter of next year, an MOH spokesman said.

They are being drawn up by experts including infectious disease specialists, public health doctors, microbiologists and radiologists.

These initiatives are a result of the ministry's review of the Singapore TB Elimination Programme. It consulted foreign experts earlier this year.

The spokesman said: "We now face new areas of concern in our TB control efforts, such as the ageing population, increased global trade and travel, and continuing community transmission."

Such measures will help patients like Madam Tan, 40, a mother of three who did not want to give her full name. For one year, she suffered coughs but did not know she had TB despite visiting half a dozen general practitioners and Chinese physicians.

"Whatever medicine I took, I didn't seem to get well," she said.

It was only when she went to the same GP three times in July that suspicions arose. She is under treatment till early next year.

Such diagnostic delay is believed to be a major factor in the resurgence of TB.

Dr Cynthia Chee, from the Tuberculosis Control Unit (TBCU) at Tan Tock Seng Hospital (TTSH), said the average duration of coughing before the disease is detected is two months.

This is too long, she said, and halving this delay to one month would be "a realistic target".

TBCU polls show the delay on the patient's part is three weeks, compared with eight weeks at the health-care system level.

Dr Koh Hau Tek, medical director of the privately run Parkway Shenton clinics, said TB symptoms include fever, persistent coughing, breathlessness, blood in sputum and weight loss.

"Since these symptoms are fairly non-specific and may be part of other diseases, it is usually tricky to diagnose at the primary-care level," he said. For example, persistent coughs may be due to certain allergies or bronchitis.

MOH is also coming up with measures to improve the process of investigating close contacts and to offer them preventive therapy. But details are not available yet.

Some 20 per cent of infectious patients do not have any close contacts screened, either because they fail to identify them, or those who were named declined screening, said Dr Chee.

There is also the challenge of getting people to stay the course during treatment, which takes six to nine months. From 2004 to last year, some 200 legal orders were served by the ministry. If these people do not comply, they may be detained at the Communicable Disease Centre at TTSH until they are cured.

Meanwhile, the HPB has been distributing booklets on identifying the disease to secondary school teachers and parents since May. It has also made talks on TB available to teachers on request.