Sunday 29 November 2015

NEA bans use of all freshwater fish in ready-to-eat raw fish dishes from 5 December 2015

*updated 5 Dec 2015

By Jasmine Osada, The Straits Times, 5 Dec 2015

The National Environment Agency (NEA) has banned the use of all freshwater fish in ready-to-eat raw fish dishes with immediate effect.

The agency said in a media release on Saturday (Dec 5) that tests conducted by the Agri-Food and Veterinary Authority (AVA) and NEA have found freshwater fish to have significantly higher bacterial contamination than saltwater fish, and to have higher risks of infection when consumed raw.

As a further step to protect consumers from public health risks, the National Environment Agency (NEA) will ban with...
Posted by National Environment Agency - NEA on Friday, December 4, 2015

All retail food establishments that want to sell raw fish dishes must use only saltwater fish intended for raw consumption. This refers to fish that are typically bred or harvested from cleaner waters, and are stored and distributed according to cold chain practices.

NEA will be issuing notices to all retail food establishments to inform them of the ban.

Posted by Lianhe Wanbao 联合晚报 on Saturday, December 12, 2015

Food stalls including those at hawker centres, coffee shops and food courts are required to stop all sales of raw saltwater fish as well, until they have shown that they can comply with the practices required for handling raw fish.

Restaurants operators can continue operations, but will still be subjected to the same inspections and checks by NEA.

The AVA and NEA also said in the media release that they will be working with the industry to meet the expected increase in demand for yusheng dishes during the upcoming Chinese New Year season.


1. Do not consume freshwater fish raw.

2. If you wish to eat raw fish, consume only saltwater fish intended for raw consumption.

3. Fish intended for raw consumption must go through appropriate cold chain management practices. It must also be handled hygienically throughout the supply chain and kept separate from other fish intended for cooking, to avoid cross contamination.

4. Most fish sold at Singapore’s wet markets, fresh produce section of supermarkets and fishery ports do not meet these conditions, and should not be eaten raw.

5. Vulnerable groups of people, such as young children, pregnant women, elder persons, or people with chronic illnesses such as diabetes, should avoid the consumption of all varieties of raw fish.

6. Members of the public are reminded that cooking is still the most effective way to kill bacteria.

There were 355 cases of Group B Streptococcus (GBS) infections and two deaths last year. Some of the people infected had...
Posted by The Straits Times on Sunday, March 6, 2016

Recent GBS outbreak 'biggest in the world'
It is also the first time food-borne transmission of the bacteria to people has been proven, says NUH consultant
By Jasmine Osada, The Sunday Times, 6 Dec 2015

The recent Group B Streptococcus (GBS) bacteria outbreak is unique on several fronts.

Not only is the outbreak, caused by the Type III GBS ST283 strain, the largest of its kind in the world, but it is also the first time that food-borne transmission of GBS to people has been proven, said Dr Hsu Li Yang of the National University Hospital.

"This particular strain of GBS is also seen to cause very severe infections in healthy people, while most strains of GBS that affect humans tend to only cause infection in newborns or people with very weak immune systems," said Dr Hsu, a consultant at the hospital's Division of Infectious Diseases.

But he added that cases of GBS infection are expected to decrease, after the National Environment Agency (NEA) banned the use of all freshwater fish in raw fish dishes.

There have been about 360 cases of GBS infections since the start of this year, with about 150 cases linked to the consumption of Chinese-style raw fish dishes that use freshwater fish.

Dr Hsu said: "The recent outbreak of GBS infections has been linked to the consumption of raw freshwater fish. Now that the major source of infections has been closed off with NEA's ban, we should see only sporadic cases from now on. It is also very unlikely that this infection can be spread from person to person.

"At worst, we will see a few cases of infections caused by this particular strain of GBS every year."

Dr Hsu said consumers should be mindful that eating raw saltwater fish such as that used for sushi and sashimi also comes with risks.

The major concern is parasites. The two most common parasites caused by the consumption of raw saltwater fish are the fish tapeworm and anisakis, he said.

The fish tapeworm can grow to several metres long in a person's intestines. As the tapeworm spends part of its life cycle living inside saltwater fish, eating raw fish means there is a chance of an infection.

The other worm, anisakis, is one of the most common parasites among sashimi eaters in Japan. People infected tend to experience symptoms akin to having a gastric ulcer.

Dr Hsu said the parasites can be killed by freezing the fish. It is thus important to keep fish chilled or frozen until it is cooked or served. At home, food should be handled properly to avoid cross-contamination and minimise the risk of infection.

Stalls told to stop selling raw fish dishes after link to GBS bacteria confirmed
By Linette Lai, The Straits Times, 28 Nov 2015

Hawkers have been told to stop selling Chinese-style raw fish dishes - including raw fish porridge - immediately, unless they can show that the fish are from safe suppliers, the authorities said yesterday.

Investigations have confirmed a link between such dishes and what appears to be a particularly aggressive strain of Group B Streptococcus bacteria (GBS) - Sequence Type (ST) 283 - that has made some people here seriously ill and could have killed one person.

The Ministry of Health (MOH) told The Straits Times that it has been notified of 355 cases of GBS infection this year, of which around 150 belonged to the ST283 strain.

Two infected patients died, MOH said. One death is being investigated, while another is not linked to the outbreak.

"Following the investigations, the National Environment Agency advises that all retail food establishments that sell ready-to-eat raw fish dishes are to source raw fish from suppliers that adopt proper cold chain management and hygienic handling practices of the fish," said the agency, the Agri-Food and Veterinary Authority and MOH in a statement.

ADVISORY ISSUED ON CONSUMPTION OF RAW FISH: Recent investigations by AVA, MOH and NEA into the outbreak in July have...
Posted by National Environment Agency - NEA on Friday, November 27, 2015

Food handlers and fishmongers tested negative for the virulent strain, but fish were a likely source, investigations revealed.

Between August and last month, nearly 400 fish samples across the supply chain, from fishery ports to wet markets and food outlets, were tested. GBS was detected in a fifth of the samples, and 4.1 per cent of total samples tested positive for ST283.

Song fish (Asian bighead carp), toman fish (snakehead) and tilapia, all freshwater species, were the ones which tested positive for ST283.

The authorities stressed that most fish sold in wet markets or at fishery ports are intended for cooking and should not be eaten raw, as they could carry a number of parasites or bacteria.

Food stall operators taking raw fish dishes off the menu
They cannot be sure which suppliers adopt correct practices; NEA holds briefing for food establishments
By Yuen Sin and Linette Lai, The Straits Times, 28 Nov 2015

Rather than take the risk of being held responsible for any casualties, food operators The Straits Times spoke to said they will take all Chinese-style raw fish dishes off the menu, and comply with any restrictions imposed by the National Environment Agency (NEA).

Mr Lim Meng Seng, who runs a porridge stall in Old Airport Road, has stopped selling raw fish porridge since July when the NEA issued an advisory against using song fish and toman fish - also known as the Asian bighead catfish and snakehead respectively - in dishes.

"We are not sure which suppliers adopt the correct cold chain management and handling practices so, to be safe, I will stop selling raw fish dishes completely," Mr Lim said. "I only sold about 20 to 50 dishes of yusheng porridge a day so it's not worth the risk."

Yesterday, the NEA held a briefing for operators of establishments that sell such Chinese-style raw fish dishes.

It advised them to stop the sale of all types of Chinese-style raw fish dishes, unless the fish come from suppliers that adopt proper cold chain management and hygienic handling practices.

These include transporting fish at temperatures lower than 5 deg C.

Fish meant to be eaten raw should also be packed in a hygienic environment and kept separate from raw fish meant for cooking, so as to avoid cross-contamination.

Fish at wet markets tend not to be separated in such a manner.

Country manager Sim Tharn Chun, 52, was hospitalised on Thursday last week after eating a raw fish dish at Tiong Bahru hawker centre. He was admitted to Khoo Teck Puat Hospital and remains in critical condition. The incident has put the safety of raw fish dishes back in the spotlight.

A Ministry of Health investigation into the spike in the number of Group B Streptococcus (GBS) infections earlier this year found a link between the consumption of Chinese-style raw fish dishes and the disease.

GBS are a common type of bacteria found in the gut or urinary tract of about 15 per cent to 30 per cent of adults, and do not usually cause disease in healthy people. But they may occasionally cause serious infections of the joints, brain, heart and blood.

Owners of food outlets which breach these regulations risk having enforcement action taken against them, which can range from fines of a few hundred dollars to revocation of their licences for repeated offences.

Ms Janet Goh, 50, who owns Hougang eatery Sin Heng Kee Porridge, said its profits had fallen by 10 per cent since it stopped selling raw fish porridge in August.

"I considered using alternative types of fish and customers keep pressing me to start reselling my raw fish dishes," she said. "I'm disappointed we can't sell these dishes any more... But we have no choice... as we have to put customers' safety first."

Most hawkers buy the fish for yusheng (raw fish) dishes at wet markets.

"Most fish sold at Singapore's general markets and fishery ports are intended for cooking, and should not be eaten raw," the NEA, Health Ministry, and Agri-Food and Veterinary Authority said in a statement yesterday.

Instead, the NEA has advised food stalls to purchase fish from suppliers able to prove the quality of the fish by providing a health certificate from the relevant authority of the country of origin. They added that, depending on the quality of the water that these fish were bred in or harvested from, they could be carriers of parasites or bacteria.

Raw fish meant for consumption "are typically bred in or harvested from cleaner waters", the statement said.

What the experts say about the bacteria
By Linette Lai and Carolyn Khew, The Straits Times, 28 Nov 2015

Q What are Group B Streptococcus (GBS) bacteria?

A They are commonly found in the gut and urinary tract in about 15 to 30 per cent of adults without causing any disease.

But they may occasionally cause infections of the skin, joints, heart and brain. Those who have chronic conditions such as diabetes usually have a higher risk of getting a GBS infection.

Q The GBS ST283 strain has been associated with consuming yusheng, a raw fish dish, but not sashimi so far. Why?

A The reason is still not known but one reason could be that the song, toman and tilapia fish are freshwater fish, whereas most sashimi fish are seawater fish, said senior research scientist Swaine Chen from the Agency for Science, Technology and Research's Genome Institute of Singapore.

Experts have also pointed to cross-contamination as a possible cause.

Q What makes sashimi safe to eat, but not yusheng raw fish dishes?

A Most fish used in Chinese-style raw fish dishes are intended for cooking, and should not be eaten raw.

Fish that are supposed to be eaten raw, such as that for sashimi, are typically bred or harvested from cleaner waters, as well as stored and distributed according to specific cold chain management practices.

This includes transporting them at temperatures below 5 deg C, and packing them independently in a clean and hygienic environment.

Q Can raw meat harbour GBS as well?

A While the ST283 strain has not been looked at in other types of animals, Dr Chen said that the risk from other meats for this particular strain is "very, very low".

Q Will GBS bacteria spread from human to human?

A The bacteria can be transmitted from an infected pregnant woman to her baby during delivery, which can be life-threatening for the baby, said Associate Professor Kevin Pethe, from Nanyang Technological University's Lee Kong Chian School of Medicine.

However, for this strain in particular, the spread from human to human has not happened.

So far, it appears to have spread to humans only via food consumption, said Dr Hsu Li Yang, a consultant in the Division of Infectious Diseases at the National University Hospital.

Q How does the bacteria enter the body?

A The bacteria enter the body through the gut before they go into the blood stream, and cause an infection in the brain, joints or bones, said Dr Leong Hoe Nam, an infectious diseases specialist from Mount Elizabeth Novena Hospital.

Q Why does the GBS strain not affect everyone in the same way?

A In general, people who have weak immune systems or other medical problems have a higher risk of many infections.

Q Were poor hygiene practices of hawkers behind the GBS outbreak earlier this year?

A It is unlikely. The stool samples of 82 food handlers and fishmongers were tested, and none of them was positive for the specific strain of GBS associated with the outbreak.

Q If the bacteria did not come from mishandling by hawkers, where did they originate from?

A There is not enough data to be sure. However, the possibility of them being imported bacteria from fish farms or suppliers overseas cannot be ruled out.

Q Does this mean that hawkers will no longer be allowed to sell Chinese-style raw fish dishes with porridge in the future?

A No. They will be allowed to sell such dishes as long as they are able to show that their fish come from suppliers with a health certificate attesting to their quality.

They must also adhere to all other practices required to sell such fish, such as handling this kind of raw fish separately from other raw products that are going to be cooked.

Eateries take steps to keep raw fish dishes safe
Fish suppliers alerted to GBS infections and restaurants monitoring imports
By Jessica Lim, Consumer Correspondent, The Sunday Times, 29 Nov 2015

Several eateries selling raw fish dishes here are making doubly sure that their supplies are up to the mark, given a rise in Group B Streptococcus (GBS) infections here this year.

Many are doing this even though they are not serving the three types of fish linked to the infection - song fish (Asian bighead carp), toman fish (snakehead) and tilapia.

Mr Kevin Cheong, 46, owner of Hinoki Japanese Dining in the Central Business District, called his raw fish suppliers last week to get the assurance that their fish are GBS-free.

"We asked them for necessary certification and are monitoring the situation," he said. His firm imports only sashimi-grade raw fish from Japan, Norway, Thailand and Indonesia, and all its supplies come from farms certified by the Agri-Food and Veterinary Authority (AVA), he added.

However, since the GBS scare began in July, demand for raw fish at his eatery has dipped 15 per cent year- on-year with a few customers asking if he served the three fish types linked to the infections. "Some are avoiding raw fish altogether," he said, adding that staff have been reminded to follow proper hygiene procedures.

Japanese restaurant chain Sakae Sushi, which has about 50 outlets here, has informed its suppliers about the GBS scare and is monitoring the matter closely. Mr Douglas Foo, the chain's founder and chairman, said he visits the farms of his raw fish suppliers - in countries such as South Africa - to take samples from the water the fish are reared in for lab tests. Independent auditors visit the farms regularly and each batch of raw fish that arrives here is tested for various bacteria, including GBS.

Supplies are tagged with radio frequency identification chips to track if the cold chain has been broken. The fish are harvested, chilled and iced at the farms, then stored in large refrigerators and either flown or shipped to Singapore. "If the cold chain is broken, the batch will be rejected," said Mr Foo, adding that the restaurant group has not yet seen a dip in demand for raw fish.

The authorities stated last Friday that there is a definite link between the GBS infections - which can lead to meningitis - and Chinese-style raw fish dishes, including raw fish porridge. Hawkers have been told to stop selling such dishes unless they can prove the fish used are from safe suppliers. The Ministry of Health said it has been notified of 355 cases of GBS infection this year.

Supermarket chain FairPrice and the Dairy Farm Group - which runs Cold Storage and Giant - said they have strict standards for temperature control and personal hygiene, and do regular audits. Prime Supermarket chief executive Chong Wee Cheong said the AVA took samples of its fish for testing two months ago and they passed. At Sheng Siong, demand for song, tilapia and toman fish have fallen by 5 per cent from the same time last year. Head purchaser Kong Cheu Soon said staff have been reminded to tell customers the fish are not for eating raw. AVA tests on its supplies have come up negative.

But consumers like Madam Amutha Kumaran, 45, a sales executive who has two children, are playing it safe. "I told my family not to eat any more raw fish," she said.

Additional reporting by Linette Lai

Timeline of the GBS outbreak
By Linette LaiThe Straits Times, 28 Nov 2015

Early July

A text message claiming that a man has died from a Group B Streptococcus (GBS) infection after eating contaminated sashimi goes viral. The Health Ministry (MOH) says hospitals have alerted it to a rise in the number of such infections, and that it is investigating.

July 24

Hawkers are advised to temporarily stop selling dishes containing two types of raw fish - song (Asian bighead carp) and toman (snakehead). MOH says it has found a link between eating such raw fish and GBS infections in a "limited number" of cases, but more investigations have to be done before a definite conclusion is reached.

Aug 27

MOH says its investigations have not found any links between GBS infections and the consumption of Japanese raw meat or fish sashimi.

It also says there has been a "significant downtrend" in the number of GBS cases since hawkers were advised to stop selling the Chinese- style raw fish dishes. There are fewer than five cases each week now.

On the same day, technician Tan Whee Boon, 50, whose limbs turned black and gangrenous after emergency treatment for a GBS infection, has his feet amputated. His hands were amputated about a week before.

Nov 26

Salesman Sim Tharn Chun, 52, is reported to be in critical condition at Khoo Teck Puat Hospital after a GBS infection. He had contracted meningitis, an infection of the membranes surrounding the brain and spinal cord.

Nov 27

MOH says there is a definite link between the consumption of Chinese-style raw fish dishes and GBS infections. Hawkers are told to stop selling them, unless they can prove the fish comes from safe suppliers.

MOH says that among all the GBS cases this year, two have died. One death is still under investigation while the other was not linked to the outbreak.

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