H1N1-2009

H1N1-2009:

(Mortality rates): 6.

Dr Lam Pin Min asked the Minister for Health (a) what are the mortality rates from seasonal influenza for the past three years as compared to the Influenza A (H1N1-2009); (b) what are the underlying cause(s) of death for both conditions; and (c) whether the mortality rates can be further reduced through appropriate medical prophylaxis.

Mr Khaw Boon Wan: Sir, seasonal influenza as a direct cause for death is very hard to establish. Firstly, we do not routinely test patients for seasonal influenza. Secondly, patients with complications often have other underlying medical conditions. Their deaths may therefore be due to such underlying medical conditions with seasonal influenza as a contributing factor. Deaths due to seasonal influenza are therefore commonly estimated using mathematical modelling techniques. Using such methods, a local study has estimated that there are about 600 influenza-related deaths in Singapore each year. As Influenza H1N1-2009 is a new strain and as the world is still in the midst of a pandemic caused by it, we carried out many more laboratory investigations on some of the infected patients especially those who present with clinical complications. Based on such observations, we have recorded 18 deaths due to this strain of influenza so far. As the methodology of computing these death rates are different, we should not try to directly compare the death rates. The underlying cause of death in influenza infection whether by seasonal influenza or the new strain is commonly pneumonia. Influenza may also cause death by exacerbating pre-existing chronic heart disease resulting in a heart attack or chronic lung disease resulting in respiratory failure. In the case of the new strain, there have also been complications and even deaths among some patients without any underlying medical conditions. This continues to baffle the doctors and scientists and we do not have good answers as yet. While we are comforted by the fact that the new strain remains largely mild among the vast majority of the infected patients, we cannot treat it lightly. And this is the reason why we remain in alert code yellow and not green. To reduce mortality, the most important measure is vaccination. When a safe and effective vaccine becomes available, we will make it widely available to the people. We will recommend it especially to the frontline staff and to those at high risk of developing serious complications from influenza.

Dr Lam Pin Min: I would like to ask the Minister, with the evolution of the H1N1-2009 pandemic, will there be a review of the screening and the surveillance strategy at checkpoints as well in the hospitals? Secondly, whether there are any plans to include vaccinations against the common bacteria that causes pneumonia which in a way resulted in the death of vulnerable patients who died from H1N1-2009-related infections?

Mr Khaw Boon Wan: On the Member's second point, was he referring to pneumococcal vaccine? As another Member has filed a PQ on this, allow me to reply to it fully later on. On the various surveillance and border temperature-screening procedures, we review it all the time. Now that the character and the clinical implications of the new strain are much better understood, we have been progressively reducing the measures. But as I just said five minutes ago, we remain at code yellow. Once the vaccine becomes available as an additional measure to address this pandemic, we would of course review the colour code again. But even with the same colour code, there is scope for calibration of the measures, allowing us to progressively reduce them. At the borders, we no longer do temperature screening. In the hospitals, we maintain some screening. But we are actively looking at possibilities of further reducing temperature screening in the hospitals to perhaps just the high-risk areas such as the emergency departments.

Mdm Halimah Yacob (Jurong): Supplementary question, Sir. There are concerns that with the approaching winter months, there will be a resurgence of the H1N1-2009 flu. I would like to ask the Minister what steps are being taken to address this. Is this a matter of concern for us? What steps are we taking to address that concern? What additional measures will be put in place?

Mr Khaw Boon Wan: Certainly with the return of the Northern winter, there are worries and fears that if the virus mutates and becomes more deadly, the next wave could be very troublesome. That is why scientists all over the world, including ourselves, continue to survey and study the strain very carefully. So far, so good. Viruses always mutate but the mutation of the deadly kind has yet to emerge and hopefully may not emerge in the short or even medium term.

But we have been watching the H1N1-2009 incidence in the Northern Hemisphere, particularly in North America. From the peak of H1N1-2009 making up some 40% or 50% of all patients with flu-like symptoms, it has come down drastically to single-digit percentage, eg, in Canada or in the teens in North America. So the easing of the epidemic in the Northern Hemisphere is taking place, but we have to continue to watch what the winter brings with it. One very positive development is that vaccines have now been created and factories are trying to produce as many as they can and we will get our supply soon. We are finalising our purchase order. I will make some announcement this week.