Project 2: Tuberculosis and migration in the context of Singapore
Introduction to Tuberculosis (TB)
TB is a severe and highly transmissible disease caused by Mycobacterium tuberculosis. Proper TB treatment is necessary to prevent morbidity and mortality. Although Singapore has comparatively low TB incidence, there is a rising concern for TB resurgence. For the past 30 years, the Singapore government has been striving to eliminate TB in Singapore through improvement of healthcare facilities and the implementation of Singapore Tuberculosis Elimination Programme (STEP).
Epidemiology of TB in Singapore Figure 1: Incidence rate of tuberculosis among Singapore residents, 1960-1980 and 1987-2013
The efforts successfully brought down the TB incidence …show more content…
Even though Bacillus Calmette-Guerin (BCG) vaccination has been given to all new-borns since 1957 , most persons aged >60 does not have TB immunisation as they were born before the immunisation was made compulsory. This explains for the high TB infection rate among elderly patients aged > 65 years old (accounted for 31.9% of the TB cases . In addition, most Singaporeans only received one dose of TB vaccine at birth and since TB antibody titres fall over time, they will become more susceptible to TB infection. Thus, the transmission will result in new TB cases in both foreign-born and local …show more content…
Foreign domestic workers are additionally required to go for rescreening every six months.
However, as chest radiography is used for TB screening, only active TB cases will be identified and treated to limit onward transmission. Individuals with LTBI will remain undetected and may contribute significantly to the reservoir of TB disease if reactivation occurs in later years as a study showed “about 10% of immunocompetent adults with LTBI will eventually progress to active disease, and half of them will do so in the first 2 years following infection.”
Proposed measures
Singapore should aim to manage the pool of TB disease contributed by LTBI reactivation through (i) Screening for LTBI in migrants from high-risk groups and, (ii) Rescreening of high-risk migrants. The risk of reactivation should be assessed based on the prevalence of comorbidities (such as diabetes mellitus, HIV), duration of stay, intended occupation and the country of
Introduction to Tuberculosis (TB)
TB is a severe and highly transmissible disease caused by Mycobacterium tuberculosis. Proper TB treatment is necessary to prevent morbidity and mortality. Although Singapore has comparatively low TB incidence, there is a rising concern for TB resurgence. For the past 30 years, the Singapore government has been striving to eliminate TB in Singapore through improvement of healthcare facilities and the implementation of Singapore Tuberculosis Elimination Programme (STEP).
Epidemiology of TB in Singapore Figure 1: Incidence rate of tuberculosis among Singapore residents, 1960-1980 and 1987-2013
The efforts successfully brought down the TB incidence …show more content…
Even though Bacillus Calmette-Guerin (BCG) vaccination has been given to all new-borns since 1957 , most persons aged >60 does not have TB immunisation as they were born before the immunisation was made compulsory. This explains for the high TB infection rate among elderly patients aged > 65 years old (accounted for 31.9% of the TB cases . In addition, most Singaporeans only received one dose of TB vaccine at birth and since TB antibody titres fall over time, they will become more susceptible to TB infection. Thus, the transmission will result in new TB cases in both foreign-born and local …show more content…
Foreign domestic workers are additionally required to go for rescreening every six months.
However, as chest radiography is used for TB screening, only active TB cases will be identified and treated to limit onward transmission. Individuals with LTBI will remain undetected and may contribute significantly to the reservoir of TB disease if reactivation occurs in later years as a study showed “about 10% of immunocompetent adults with LTBI will eventually progress to active disease, and half of them will do so in the first 2 years following infection.”
Proposed measures
Singapore should aim to manage the pool of TB disease contributed by LTBI reactivation through (i) Screening for LTBI in migrants from high-risk groups and, (ii) Rescreening of high-risk migrants. The risk of reactivation should be assessed based on the prevalence of comorbidities (such as diabetes mellitus, HIV), duration of stay, intended occupation and the country of