SINGAPORE: ADDRESSING INFECTIOUS DISEASE CONCERNS

UNCLAS SECTION 01 OF 02 SINGAPORE 000925 SENSITIVE SIPDIS E.O. 12958: N/A TAGS: TBIO SENV ECON SN SUBJECT: SINGAPORE: ADDRESSING INFECTIOUS DISEASE CONCERNS REF: 2007 SINGAPORE 1241 ¶1. (U) SUMMARY: The Regional Emerging Diseases Intervention (REDI) Center (a joint USG-GOS initiative) and the Singapore Ministry of Health (MOH) co-sponsored a regional forum on HFMD August 21 and 22 to address the increasingly severe outbreaks of HFMD in the Asia-Pacific region. More than 80 experts in disease surveillance and intervention attended. In one presentation, the Deputy Director of the Surveillance and Response Branch of the Singapore MOH outlined the measures the GOS has instituted to slow the spread of the disease, including closures of childcare centers. Incidence of chikungunya (a mosquito-borne disease with dengue-like symptoms) is rising significantly in Singapore, with 150 cases reported this year. Many cases appear to be the result of local transmission, rather than the result of infections contracted while traveling abroad. Dengue infections, which surpassed MOH's epidemic threshold last year, have been much lower thus far in 2008. END SUMMARY. HFMD Regional Forum August 21-22 -------------- ¶2. (U) The REDI Center and the Singapore MOH co-sponsored a regional forum on HFMD August 21 and 22. More than 80 experts in disease surveillance and intervention attended the two-day forum to share information and case studies on the recent HFMD outbreaks in the Asia-Pacific region, including those caused by a more severe strain known as enterovirus 71 (EV71). Several representatives from the Centers for Disease Control and Prevention (CDC) mission in Bangkok attended along with Singapore MOH officials. Other attendees included health officials and practitioners from China, Taiwan, Thailand, Brunei, Malaysia, Indonesia, and Australia. ¶3. (SBU) The Singapore MOH has reported approximately 18,000 HFMD cases this year, and approximately 1.6 percent of those were caused by EV71, Steven Ooi, Deputy Director of the Surveillance and Response Branch of the MOH explained in his presentation at the forum. This month a three-year-old died from an EV71 infection, the first HFMD death in Singapore since a severe outbreak in 2000 and 2001. The GOS has instituted measures to monitor and combat the spread of HFMD, including requirements for hospitals, physicians, and public childcare centers to notify MOH of any HFMD infections within 24 hours. The GOS forced some schools and childcare centers to close for 10 days--a period that covers two incubation cycles for the virus--to conduct thorough clean-ups when there was a high incidence of HFMD. Physicians also have to certify that an infected child has fully recovered before returning to school, Dr. Ooi stated. ¶4. (SBU) The GOS is still struggling with how to handle the socio-economic effect school closures and social isolation can have on families with working parents. Dr. Ooi said there are two groups of parents in Singapore: one demanding immediate closures when HFMD is detected and another group that relies heavily on the childcare centers and schools because both mother and father are employed. There is no hard evidence to suggest closures and social distancing effectively stop the spread of the disease, since children find ways to interact outside of these locations, Dr. Ooi stated. Therefore, the GOS is also focused on educating people about other critical HFMD control points and has issued guidelines on proper hand-washing and food preparation for children, parents, and childcare workers. ¶5. (SBU) One of the key questions raised during the HFMD Forum is why the outbreaks in Asia, particularly China, Taiwan, Hong Kong, and parts of Southeast Asia, are so much more severe or even deadly than outbreaks elsewhere in the world (Note: HFMD and EV71 are found worldwide.) There was no easy answer to this question, and several attendees noted the importance of regional forums to compare cases and identify new ways to collaborate on research. A few participants, including some from the CDC, raised the possibility of genomic attributes in the population that may require further study. ¶6. (SBU) The Asia-Pacific Enterovirus Surveillance Network (APNET),has been researching EV71 outbreaks in Asia since ¶2000. APNET began as an informal collaboration among clinicians and virologists working in Singapore, Malaysia, and Australia to study the pathogenesis of the virus. It has expanded to include research in Papua New Guinea and Vietnam. Currently, the Wellcome Trust and the National Health and Medical Research Council of Australia fund APNET, but the funding ends in October 2009, Professor Peter McMinn, of the SINGAPORE 00000925 002 OF 002 University of Sydney, explained in his presentation. Some CDC representatives indicated they saw value in APNET's work and might be interested in collaborating on research projects. Chikungunya Cases on the Rise -------------- ¶7. (U) The incidence of chikungunya in Singapore has increased significantly over the summer months. As of June 2008, there were 28 cases reported in Singapore, but the number has grown to about 150, according to MOH, and approximately 80 of those cases were contracted locally. When the disease initially appeared in January the MOH believed the cases were isolated to people who had been infected abroad. Now, locally acquired infections have been linked to 18 different areas in Singapore. Public statements from the MOH and the Ministry of the Environment and Water Resources (MEWR) suggest the GOS believes the majority of infections are still "imported" and that the disease has not taken root here. ¶8. (SBU) To prevent the disease from spreading, the National Environment Agency (NEA) has been conducting intensive operations to find and eradicate mosquito breeding areas. The NEA also studied the blood of infected Singaporeans and found the virus strain was similar to that causing outbreaks in Malaysia. The GOS has advised travelers to take precautions such as wearing long sleeve shirts, long pants, and using insect repellent when going to southern Malaysia. There is sufficient interest in the increasing numbers of chikungunya cases in Singapore that the REDI Center is considering organizing a regional forum on the disease similar to the one held on HFMD. We will continue to monitor and report on relevant developments in chikungunya cases. Dengue Fever Rates Down -------------- ¶9. (SBU) The NEA and MOH remain focused on dengue as a long-term health problem for Singapore, but the rate of infection in 2008 has been much lower than last year when dengue reached MOH's epidemic threshold of 378 cases per week (reftel). There have been 3673 dengue cases reported in Singapore this year compared to 5507 cases in the same period in 2007. The NEA remains vigilant in eradicating mosquito breeding areas. Mosquitoes in Singapore continue to adapt to the urban environment and are able to breed in ever smaller amounts of water, such as the water collected in a leaf, Dr. Lyn James, Director of the Communicable Diseases Division of MOH, told Econoff at a meeting in May. Fewer Singaporeans seem to have natural immunity to dengue strains and have become more susceptible to infection even as the GOS has become more effective in eradicating mosquitoes where they breed, Dr. James also surmised. However, she has not seen an obvious increase in infections among children, and many new cases seem to be in young adults. Dr. James attributed that to lifestyle more than immunity, noting smaller children and older adults may spend more time indoors. Visit Embassy Singapore's Classified website: http://www.state.sgov.gov/p/eap/singapore/ind ex.cfm HERBOLD