VZCZCXRO9503
RR RUEHCHI RUEHDT RUEHHM RUEHNH
DE RUEHGP #0925/01 2400941
ZNR UUUUU ZZH
R 270941Z AUG 08
FM AMEMBASSY SINGAPORE
TO RUEHC/SECSTATE WASHDC 5681
INFO RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 2834
RUEHBY/AMEMBASSY CANBERRA 2164
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHDC

UNCLAS SECTION 01 OF 02 SINGAPORE 000925 
 
SENSITIVE 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: TBIO SENV ECON SN
SUBJECT: SINGAPORE:  ADDRESSING INFECTIOUS DISEASE CONCERNS 
 
REF: 2007 SINGAPORE 1241 
 
¶1.  (U) SUMMARY:  The Regional Emerging Diseases Intervention 
(REDI) Center (a joint USG-GOS initiative) and the Singapore 
Ministry of Health (MOH) co-sponsored a regional forum on 
HFMD August 21 and 22 to address the increasingly severe 
outbreaks of HFMD in the Asia-Pacific region.  More than 80 
experts in disease surveillance and intervention attended. 
In one presentation, the Deputy Director of the Surveillance 
and Response Branch of the Singapore MOH outlined the 
measures the GOS has instituted to slow the spread of the 
disease, including closures of childcare centers.  Incidence 
of chikungunya (a mosquito-borne disease with dengue-like 
symptoms) is rising significantly in Singapore, with 150 
cases reported this year.  Many cases appear to be the result 
of local transmission, rather than the result of infections 
contracted while traveling abroad.  Dengue infections, which 
surpassed MOH's epidemic threshold last year, have been much 
lower thus far in 2008.  END SUMMARY. 
 
HFMD Regional Forum August 21-22 
-------------------------------- 
 
¶2.  (U) The REDI Center and the Singapore MOH co-sponsored a 
regional forum on HFMD August 21 and 22.  More than 80 
experts in disease surveillance and intervention attended the 
two-day forum to share information and case studies on the 
recent HFMD outbreaks in the Asia-Pacific region, including 
those caused by a more severe strain known as enterovirus 71 
(EV71).  Several representatives from the Centers for Disease 
Control and Prevention (CDC) mission in Bangkok attended 
along with Singapore MOH officials.  Other attendees included 
health officials and practitioners from China, Taiwan, 
Thailand, Brunei, Malaysia, Indonesia, and Australia. 
 
¶3.  (SBU) The Singapore MOH has reported approximately 18,000 
HFMD cases this year, and approximately 1.6 percent of those 
were caused by EV71, Steven Ooi, Deputy Director of the 
Surveillance and Response Branch of the MOH explained in his 
presentation at the forum.  This month a three-year-old died 
from an EV71 infection, the first HFMD death in Singapore 
since a severe outbreak in 2000 and 2001.  The GOS has 
instituted measures to monitor and combat the spread of HFMD, 
including requirements for hospitals, physicians, and public 
childcare centers to notify MOH of any HFMD infections within 
24 hours.  The GOS forced some schools and childcare centers 
to close for 10 days--a period that covers two incubation 
cycles for the virus--to conduct thorough clean-ups when 
there was a high incidence of HFMD.  Physicians also have to 
certify that an infected child has fully recovered before 
returning to school, Dr. Ooi stated. 
 
¶4.  (SBU) The GOS is still struggling with how to handle the 
socio-economic effect school closures and social isolation 
can have on families with working parents.  Dr. Ooi said 
there are two groups of parents in Singapore:  one demanding 
immediate closures when HFMD is detected and another group 
that relies heavily on the childcare centers and schools 
because both mother and father are employed.  There is no 
hard evidence to suggest closures and social distancing 
effectively stop the spread of the disease, since children 
find ways to interact outside of these locations, Dr. Ooi 
stated.  Therefore, the GOS is also focused on educating 
people about other critical HFMD control points and has 
issued guidelines on proper hand-washing and food preparation 
for children, parents, and childcare workers. 
 
¶5.  (SBU) One of the key questions raised during the HFMD 
Forum is why the outbreaks in Asia, particularly China, 
Taiwan, Hong Kong, and parts of Southeast Asia, are so much 
more severe or even deadly than outbreaks elsewhere in the 
world (Note:  HFMD and EV71 are found worldwide.)  There was 
no easy answer to this question, and several attendees noted 
the importance of regional forums to compare cases and 
identify new ways to collaborate on research.  A few 
participants, including some from the CDC, raised the 
possibility of genomic attributes in the population that may 
require further study. 
 
¶6.  (SBU) The Asia-Pacific Enterovirus Surveillance Network 
(APNET), has been researching EV71 outbreaks in Asia since 
¶2000.  APNET began as an informal collaboration among 
clinicians and virologists working in Singapore, Malaysia, 
and Australia to study the pathogenesis of the virus.  It has 
expanded to include research in Papua New Guinea and Vietnam. 
 Currently, the Wellcome Trust and the National Health and 
Medical Research Council of Australia fund APNET, but the 
funding ends in October 2009, Professor Peter McMinn, of the 
 
SINGAPORE 00000925  002 OF 002 
 
 
University of Sydney, explained in his presentation.  Some 
CDC representatives indicated they saw value in APNET's work 
and might be interested in collaborating on research 
projects. 
 
Chikungunya Cases on the Rise 
----------------------------- 
 
¶7.  (U) The incidence of chikungunya in Singapore has 
increased significantly over the summer months.  As of June 
2008, there were 28 cases reported in Singapore, but the 
number has grown to about 150, according to MOH, and 
approximately 80 of those cases were contracted locally. 
When the disease initially appeared in January the MOH 
believed the cases were isolated to people who had been 
infected abroad.  Now, locally acquired infections have been 
linked to 18 different areas in Singapore.  Public statements 
from the MOH and the Ministry of the Environment and Water 
Resources (MEWR) suggest the GOS believes the majority of 
infections are still "imported" and that the disease has not 
taken root here. 
 
¶8.  (SBU) To prevent the disease from spreading, the National 
Environment Agency (NEA) has been conducting intensive 
operations to find and eradicate mosquito breeding areas. 
The NEA also studied the blood of infected Singaporeans and 
found the virus strain was similar to that causing outbreaks 
in Malaysia.  The GOS has advised travelers to take 
precautions such as wearing long sleeve shirts, long pants, 
and using insect repellent when going to southern Malaysia. 
There is sufficient interest in the increasing numbers of 
chikungunya cases in Singapore that the REDI Center is 
considering organizing a regional forum on the disease 
similar to the one held on HFMD.  We will continue to monitor 
and report on relevant developments in chikungunya cases. 
 
 
Dengue Fever Rates Down 
----------------------- 
 
¶9.  (SBU) The NEA and MOH remain focused on dengue as a 
long-term health problem for Singapore, but the rate of 
infection in 2008 has been much lower than last year when 
dengue reached MOH's epidemic threshold of 378 cases per week 
(reftel).  There have been 3673 dengue cases reported in 
Singapore this year compared to 5507 cases in the same period 
in 2007.  The NEA remains vigilant in eradicating mosquito 
breeding areas.  Mosquitoes in Singapore continue to adapt to 
the urban environment and are able to breed in ever smaller 
amounts of water, such as the water collected in a leaf, Dr. 
Lyn James, Director of the Communicable Diseases Division of 
MOH, told Econoff at a meeting in May.  Fewer Singaporeans 
seem to have natural immunity to dengue strains and have 
become more susceptible to infection even as the GOS has 
become more effective in eradicating mosquitoes where they 
breed, Dr. James also surmised.  However, she has not seen an 
obvious increase in infections among children, and many new 
cases seem to be in young adults.  Dr. James attributed that 
to lifestyle more than immunity, noting smaller children and 
older adults may spend more time indoors. 
 
Visit Embassy Singapore's Classified website: 
http://www.state.sgov.gov/p/eap/singapore/ind ex.cfm 
HERBOLD