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[h=2]Medical experts: We need to acknowledge and address TB in foreigners[/h]
May 7th, 2012 |
Author: Editorial
In a paper published in the Singapore Medical Journal recently [Link], 2 medical experts from the TB Control Unit of the Dept of Respiratory and Critical Care Medicine at Tan Tock Seng Hospital, revealed an alarming statistics of TB cases in Singapore.
Dr Cynthia Bin-Eng Chee and Dr Yee Tang Wang have revealed that total number of new TB cases reported in Singapore rose 46% from 2004 to 2010. During this period, the proportion of foreigners increased from 29% to 47% of the total case burden. In 2008, the TB incidence rate among Singapore citizens and permanent residents increased for the first time in ten years, despite the on-going efforts of the Singapore TB Elimination
Programme.
Dr Chee and Dr Yee felt that additional measures and resources are needed to curb this rising trend and pivotal to this is to address TB among foreigners.
Singapore’s population increased from 4.17 million in 2004 to 5.08 million in 2010 following a liberalised immigration policy and rapid economic growth after 2005. During this period, there was a 46% rise in the total number of new TB cases, from 1,916 cases in 2004 to 2,791 cases in 2010, with the proportion of foreigners increasing from 29% to 47% of the total case burden:
Graph shows the no. of new TB cases notified in Singapore for the period 2000–2011. Preliminary data shows that 3,049 new TB cases were reported in 2011, with foreigners accounting for 49% of the total case burden.
In 2008, the TB incidence rate among Singapore citizens and permanent residents (PRs) increased, for the first time in ten years, to 39 per 100,000 population from a historical low of 35 per 100,000 population in the previous year. This trend reversal occurred despite the efforts of the Singapore TB Elimination Programme in implementing Directly Observed Therapy (DOT), in which a public health nurse supervises the taking of each dose of TB medication, for approximately 60% of Singapore’s TB cases; a computerised surveillance module to track the treatment progress and outcome of all cases treated in the country; and a national policy of preventive treatment for latently infected close contacts.
It is clear that such measures are no longer enough and additional measures and resources are critically needed in the battle with TB. The 2 Tan Tock Seng TB experts felt that of critical importance is to acknowledge and address TB in foreigners and its impact on the local population.
An analysis of TB among the foreign-born in Singapore showed that, while cases from Malaysia, China and India accounted for the highest numbers over the last decade, the last five years saw a marked increase in the number of TB cases among unskilled workers from Indonesia, the Philippines and Myanmar.
Foreigners applying to work, study or live in Singapore for more than six months and those applying for Permanent Residency are required to undergo chest radiograph screening for “active TB”. Persons reported to have “scarring” on their screening chest radiograph have been granted long-term passes without further investigation or follow-up on the presumption that “scarring” equates to disease inactivity. The 2 TB experts cautioned that such presumption can be dangerous. They recommended sputum smear and culture for TB in these cases to at least detect the bacteriologically positive cases while recognizing that with this approach, some active but bacteriologically negative cases may be missed.
Given the rising number of foreigners developing TB after being granted long-term stay, the experts said that it may be time for Singapore to consider the merits of performing sputum acid-fast bacillus (AFB) smear and TB cultures for those with radiologically deemed “inactive TB” at the point of screening.
In Dr Chee and Dr Yee’s views, foreigners with TB who live and work in Singapore should be treated under DOT by Singapore’s National TB Programme (NTP) in order to accord them the best chance of cure. A repatriation policy has not only potentially devastating consequences for the patient, but would also not serve the greater good of the global community, including our own.
Since the cost for medical consultation, two sets of sputum AFB smears and TB cultures, chest radiograph and baseline blood investigations is in the region of approximately S$300.00, in the interest of public safety, the 2 experts recommended that medical evaluation of this airborne infectious disease should be made as affordable as possible (or ideally at no cost) to all, regardless of residency status. This matter could perhaps be addressed by mandating outpatient insurance coverage for TB for all foreigners residing in Singapore, and allowing Medisave funds to be used to cover outpatient expenses for this condition.
Dr Chee and Dr Yee thought that the political will to address the rising number of foreign and local TB cases in Singapore must translate into action and increased resources to remove barriers to early diagnosis, to enable all patients to undergo DOT, and to ensure that all healthcare providers who manage TB patients are responsible and accountable to the public health system.
Both Dr Chee and Dr Yee warned that the time to act is now or otherwise, future generations of Singaporeans will pay the price.
Dr Cynthia Bin-Eng Chee and Dr Yee Tang Wang have revealed that total number of new TB cases reported in Singapore rose 46% from 2004 to 2010. During this period, the proportion of foreigners increased from 29% to 47% of the total case burden. In 2008, the TB incidence rate among Singapore citizens and permanent residents increased for the first time in ten years, despite the on-going efforts of the Singapore TB Elimination
Programme.
Dr Chee and Dr Yee felt that additional measures and resources are needed to curb this rising trend and pivotal to this is to address TB among foreigners.
Singapore’s population increased from 4.17 million in 2004 to 5.08 million in 2010 following a liberalised immigration policy and rapid economic growth after 2005. During this period, there was a 46% rise in the total number of new TB cases, from 1,916 cases in 2004 to 2,791 cases in 2010, with the proportion of foreigners increasing from 29% to 47% of the total case burden:
In 2008, the TB incidence rate among Singapore citizens and permanent residents (PRs) increased, for the first time in ten years, to 39 per 100,000 population from a historical low of 35 per 100,000 population in the previous year. This trend reversal occurred despite the efforts of the Singapore TB Elimination Programme in implementing Directly Observed Therapy (DOT), in which a public health nurse supervises the taking of each dose of TB medication, for approximately 60% of Singapore’s TB cases; a computerised surveillance module to track the treatment progress and outcome of all cases treated in the country; and a national policy of preventive treatment for latently infected close contacts.
It is clear that such measures are no longer enough and additional measures and resources are critically needed in the battle with TB. The 2 Tan Tock Seng TB experts felt that of critical importance is to acknowledge and address TB in foreigners and its impact on the local population.
Foreigners applying to work, study or live in Singapore for more than six months and those applying for Permanent Residency are required to undergo chest radiograph screening for “active TB”. Persons reported to have “scarring” on their screening chest radiograph have been granted long-term passes without further investigation or follow-up on the presumption that “scarring” equates to disease inactivity. The 2 TB experts cautioned that such presumption can be dangerous. They recommended sputum smear and culture for TB in these cases to at least detect the bacteriologically positive cases while recognizing that with this approach, some active but bacteriologically negative cases may be missed.
Given the rising number of foreigners developing TB after being granted long-term stay, the experts said that it may be time for Singapore to consider the merits of performing sputum acid-fast bacillus (AFB) smear and TB cultures for those with radiologically deemed “inactive TB” at the point of screening.
In Dr Chee and Dr Yee’s views, foreigners with TB who live and work in Singapore should be treated under DOT by Singapore’s National TB Programme (NTP) in order to accord them the best chance of cure. A repatriation policy has not only potentially devastating consequences for the patient, but would also not serve the greater good of the global community, including our own.
Since the cost for medical consultation, two sets of sputum AFB smears and TB cultures, chest radiograph and baseline blood investigations is in the region of approximately S$300.00, in the interest of public safety, the 2 experts recommended that medical evaluation of this airborne infectious disease should be made as affordable as possible (or ideally at no cost) to all, regardless of residency status. This matter could perhaps be addressed by mandating outpatient insurance coverage for TB for all foreigners residing in Singapore, and allowing Medisave funds to be used to cover outpatient expenses for this condition.
Dr Chee and Dr Yee thought that the political will to address the rising number of foreign and local TB cases in Singapore must translate into action and increased resources to remove barriers to early diagnosis, to enable all patients to undergo DOT, and to ensure that all healthcare providers who manage TB patients are responsible and accountable to the public health system.
Both Dr Chee and Dr Yee warned that the time to act is now or otherwise, future generations of Singaporeans will pay the price.
