It is the last day of 2015, and therefore timely to reflect back on the significant events of the year. Oftentimes, the true impact of certain events are not known until much later in the future, and media hype (or lack thereof) creates its own bias which is hard to overcome. Here is a personal (and I stress “personal”) list of significant events in infectious diseases that have affected Singapore in 2015 then, in no particular order of importance:
- Group B streptococcus outbreak involving raw freshwater fish
A fascinating yet unfortunate event that has lead to an end of one of our local hawker food dishes – raw (and cheap) fish at porridge stalls. This is also the first time in the world that a GBS outbreak with such severe infections has been linked to fish (and food). The research into the outbreak and the particular GBS clone is progressing well and I hope that we will have more updates next year.
- Hepatitis C outbreak at the Singapore General Hospital
Much has been written about this outbreak at SGH involving 25 patients with renal disease and kidney transplants, with 7 resultant deaths. I have not blogged about it as the issues were in many ways unclear (mostly cleared after the Independent Review Committee’s report, however) and many experts (and non-experts) have weighed in already. Nonetheless, this triggered off a ministry-level re-look at the way surveillance of infectious diseases should be performed in Singapore, and I hope that the debate will in some ways be open to the public as well.
- SG50 Project on infectious diseases and Singapore
Of course this will always be considered significant in a personal list!
- Middle East Respiratory Syndrome (MERS) coronavirus outbreak in South Korea
Although no cases of MERS-CoV infection have traveled to Singapore to date, the outbreak in Korea was a sobering reminder of both SARS in 2003 in Singapore as well as what can still happen in an emerging infectious disease outbreak if we are not prepared. The public health messaging by both MOH and the Singapore government in this regard was nuanced and well considered.
- Deaths of pioneers in local infectious diseases – Prof Feng Pao Hsii and Dr Moses Yu
We celebrated the 50th anniversary of Singapore’s independence this year. It is a reality that death comes for us all, and two of the pioneers who contributed greatly to the practice of infectious diseases and clinical microbiology in Singapore passed on this year.
- Continued spread of antimicrobial-resistant pathogens in Singapore, especially carbapenem-resistant Enterobacteriaceae (CRE)
Unlike hepatitis C, GBS and MERS (and Ebola), the threat of antimicrobial resistance in Singapore continues to be under the radar. Still, there has been far more global attention to this problem this year, and hopefully we will be able to concretely address this issue in Singapore from 2016. Far more people have died from infections caused by “superbugs” than hepatitis C or GBS this year.
The finding of a plasmid-borne gene that conferred resistance to last-line antibiotic colistin in Escherichia coli from pigs and humans in various parts of the world (including neighbouring Malaysia) has raised again the spectre of untreatable bacterial infections. We do not seem to have bacteria with this particular gene in Singapore yet, but it is probably just a question of time.
- Vector-borne diseases
Dengue made almost no headlines this year, except for a spike of cases this month, and NEA’s future foray into mosquito control using wolbachia-impregnated male mosquitoes. Dengue cases fell by almost 40% (10,830 cases by the 51st week of the year) compared to last year.
I am more concerned about the Zika virus, which is also carried by Aedes mosquitoes (just like dengue). It appears to have caused a huge outbreak in Latin America, and is associated with a steep rise in birth defects in those affected countries. Researchers from the Environmental Health Institute showed in 2013 that the local Aedes albopictus mosquito is fully capable of transmitting this virus.
Luckily, the largest outbreak ever of Ebola in West Africa appears to have finally come to an end.