MDR-TB Cluster in AMK, Singapore
There are many criticisms made of our local press, but it is clear that we have good journalists. Ms Kelly Ng from Today has figured out what MOH appeared to have left out from its press release, which is that the Ang Mo Kio MDR-TB cluster ultimately has its roots in the 2012 Parklane cybercafe outbreak. The index case of the Ang Mo Kio cluster was also one of the Parklane cybercafe patrons who developed MDR-TB 4 years ago. It appears that he had been living with his friend and his friend’s mother then, and had – according to this friend – infected both of them due to “negligence in taking medicine”. While he appeared to have been diagnosed with active MDR-TB during the original contact investigations in 2012, his mother had latent MDR-TB that only progressed onto active MDR-TB 3 years later.
Should this person’s mother (and others diagnosed with latent MDR-TB during the original contact investigations in 2012) receive treatment for latent MDR-TB? Experts are split on this issue currently, because there is not enough high-quality evidence to favour one approach over the other. So some would advocate preventive treatment – usually using a fluoroquinolone-based regimen – while others would recommend close follow-up for at least 2 years.
With regards to the Parklane MDR-TB cybercafe outbreak, the TB Control Unit and MOH had written up a report a year ago, and it is apparent from the write-up (I was involved in the molecular epidemiology aspect of the MDR-TB isolates) that the officials had experienced considerable difficulty with contact investigations perhaps due to the unusual social circumstances. Ultimately, one of several important long-term approaches to TB control is to educate the public and remove all stigma from this infectious disease. If TB patients are willing to name all their close contacts, and even go the extra step of actively telling these contacts to come for TB screening, we will certainly be able to reduce the transmission of TB gradually in the long run. One part of destigmatization has to do with ensuring job security – from the Today report, we can only sympathise with the young man who had to quit his job because of the side effects of MDR-TB treatment. Hence TB control is not just dependent on the government, but should also involve active participation from the community, healthcare services and businesses.
I include an excerpt from the video interview we conducted of Prof Sonny Wang, longstanding TBCU director, last year for the SG50 Infectious Diseases project. His insights of MDR-TB are worth noting, particularly his grim prognosis that the current programme of TB control would fail if MDR-TB became the predominant form of TB in our population.
Really interesting stuff.
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