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Some 1,500 new cases a year detected among Singaporeans and PRs since mid-1980s
TUBERCULOSIS (TB) is an illness associated with poor nutrition and living in crowded, unsanitary environments. Such conditions are hardly widespread here, but yet, the illness is still around. The fight against it has hit a plateau, however: Roughly 1,500 new cases have been diagnosed each year for the last 21/2 decades among Singaporeans and permanent residents.
Last year, 1,478 new cases cropped up among these two groups, 36 more than the year before. Foreigners studying or working here added 550 cases last year, up from 524 in 2009. Healthy people are unlikely to catch it from casual contact, but make no mistake about it – the illness can spread if one is exposed to it daily. So if an individual comes down with it, his family members are most at risk. In one family here, for instance, seven of its 13 members have the disease, which spreads through droplets expelled when a TB patient talks, coughs or sneezes.
Symptoms include prolonged cough, fever, night sweats, unexplained loss of weight and appetite, and tiredness. Untreated, TB can kill. But it is curable with six to nine months of treatment, after which the patient is no longer infectious. Not everyone who is infected falls sick. For many, the bacteria remains latent and stays that way. However, a weakened immune system creates a hotbed for the bacteria to multiply, activating the disease.
Today is World TB Day; German doctor Robert Koch identified the cause of the disease on March 24, 1882. In 2009, 9.4 million people worldwide were diagnosed with the disease, and 1.7 million people died from it. Here, 66 people died from TB that year. Madam Hamidah, a librarian who declined to give her full name, was diagnosed with the illness in December 2008, following weeks of coughing. Her husband and son, then aged 16, were given precautionary medication to protect them from it, since they were living with her. But in June the following year, her son sprang a fever that would not go away even with medication. Doctors at Changi General Hospital found a pus-filled lump on his neck, which turned out to be caused by TB. The bug usually attacks the lungs, but it can also infect the kidneys, spine and brain. In the son’s case, a lymph node, part of the body’s immune system, was infected – despite his having been on preventive medication.
Last year, 213 patients had TB in parts of their bodies other than their lungs. This is not too worrying, except in the cases of two children who had inflammation of their brain lining caused by the TB bacteria, said Dr Cynthia Chee, a senior consultant in Tan Tock Seng Hospital’s TB Control Unit. One child has died and the other is still being treated. Madam Hamidah still does not know how she contracted TB. She is the first in her family to come down with it, and knows no one with the disease. She thinks she may have caught it while mingling in a crowd at a wedding. Fortunately, her husband and two other children did not catch it. She and her son have been cured, following six months of Directly Observed Treatment (DOT).
DOT requires patients to visit a polyclinic three times a week, so they can be seen taking the cocktail of drugs and have their response monitored. The regimen continues even after the symptoms are gone, to ensure that every last bug is killed. Beating the disease demands discipline in following the drug regimen. Those less diligent risk the disease returning with a vengeance, and will then need stronger drugs. Last year, 126 patients had a relapse. Worse, the bug can build up resistance to TB drugs. Three multi-drug resistant TB cases cropped up here last year.
Singapore is taking a carrot-and-stick approach to eradicating TB. The Singapore Anti-Tuberculosis Association CommHealth, a not-for-profit organization set up in 1947 to beat TB here, gives $300 to $450 in grocery vouchers to patients who complete their DOT. On the other hand, patients who persistently default on their treatment can expect to be detained at the Communicable Diseases Centre until they are cured, said the Health Ministry.
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