The Year in Infectious Diseases 2017 (Singapore)
A personal and primarily local look back at the year. What are the major infectious diseases events in modern Singapore in 2017?
The World Health Organization (WHO) has a list of outbreaks by year on its website, and the 2017 list is depressingly long. There are the usual “suspects” like cholera (Africa) and diphtheria (in Yemen and in Cox Bazar, Bangladesh – the latter arising among the Rohingya migrants displaced from Myanmar. Then there are the more recent recurring epidemics, such as MERS-CoV in the Middle East and influenza A(H7N9) in southern China. And then a couple of major surprises, such as the huge outbreaks of plague in Madagascar and yellow fever in Brazil that raised alerts even in Singapore.
Outbreaks-wise, it has been relatively peaceful in Singapore. This is not to say that we have not had the “usual” occurrences of tuberculosis (in fact, the incidence of TB in Singapore rose again in 2017) , food poisoning, ongoing “slow” hospital epidemics with multidrug-resistant bacteria, etc. but nothing on the scale of Zika and multidrug-resistant TB in 2016, or Group B Streptococcus and hepatitis C in Singapore General Hospital (SGH) in 2015.
The case (technically an outbreak of one case) that made the most impression was that of the young Bangladeshi worker that died of diphtheria in August this year, resulting in the mass screening of all his close contacts at his dormitory and workplace.
All in all, a very good year for us outbreaks-wise. There were many potential outbreaks/epidemics/introductions of infectious diseases that thankfully failed to take place in Singapore, including dengue, Zika, MERS-CoV, yellow fever, and severe fever with thrombocytopenia syndrome.
The second Singapore International Infectious Disease Conference (SIIDC) was very held this year in August, with more international speakers and participants compared to the initial conference in 2015. There was a lot of concern that things would not work out after the SARS Courage Fund pulled out (it sponsored the first edition in 2015, hence also the change of name this year), but the determination and resourcefulness of the organizing committee chaired by Prof Yee Sin Leo and Prof Eng Eong Ooi, along with the many well wishers, resulted in a resounding success.
2017 was a huge year for Singapore with regards to the control of antimicrobial resistance (AMR). The launch of the National Strategic Action Plan on Antimicrobial Resistance in November – a government “blueprint” sponsored by the Ministry of Health (MOH), National Environment Agency (NEA), Agri-Food and Veterinary Authory of Singapore (AVA), and the PUB Singapore’s National Water Agency – was a major milestone. The next couple of years will be important for determining whether intent translates into action and results.
The National Adult Immunization Schedule was launched in Singapore by MOH in October. While it is not as comprehensive as some, including myself, might wish, it is a major milestone and perhaps also marks a shift in thinking in preventive medicine locally.
The other major vaccine “event” is a global one – Sanofi Pasteur’s dengue vaccine (Dengvaxia) was found on analysis of 6 years of follow-up data to incur a risk of more severe dengue in those vaccinees who had previously not been infected by dengue. This resulted in the US FDA ordering the suspension of the sales/marketing/distribution of Dengvaxia in November, and a national recall of the vaccine in the Philippines. Dengvaxia was licensed in Singapore with strict recommendations in October 2016, and the Health Sciences Authority recently issued an advisory reminding health professionals to only administer the vaccine for those who had previously been infected by dengue.