SINGAPORE IS NOT IN THE CLEAR
The unfolding TB crisis in the broader region is unlikely to bypass Singapore, even though it has a well-established and successful TB control programme.
Local TB incidence has decreased by over tenfold since pre-independence years to 28.9 cases per 100,000 population in 2023. Singapore has never received foreign funding for TB control since independence.
But Singapore is heavily reliant on migrant workers. Most domestic helpers and workers in construction, marine shipyard and process sectors come from high-burden TB countries. A significant proportion of the skilled foreign workforce, including nurses, also hail from these countries.
When TB control programmes deteriorate in these countries, the risk of import and spread in Singapore also increases.
Currently, migrant workers are screened for active TB disease with a chest X-ray as part of their medical examination prior to being issued their work permits. This screening is repeated every two years that they spend in Singapore as a condition for work permit renewal.
When abnormalities are detected, further evaluation is conducted for TB and other lung diseases. Suspected TB cases are either treated at the National TB Care Centre at Tan Tock Seng Hospital or repatriated.
It is likely that there is considerable over-diagnosis and over-treatment of TB in this population – out of an overabundance of caution.
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