DEATHS CAUSED BY MENINGOCOCCAL INFECTION

Dr Lily Neo asked the Minister for Health (a) whether he will comment on the two recent deaths in Singapore due to meningococcal infection as a result of close contact with pilgrims from Mecca; (b) how many such infections were there in Singapore over the past two years from 1999 - 2000; and (c) whether he expects an increase in the incidence of meningococcal infection due to the W135 strain.

The Senior Parliamentary Secretary to the Minister for Health (Mr Chan Soo Sen) (for the Minister for Health): Mr Speaker, Sir, meningococcal disease is a contagious bacterial disease caused by the meningococcus bacteria. It is spread by person-to-person contact through respiratory droplets from the nose and throat of infected people. The disease is caused by a number of different strains of the bacteria, of which the strains A, B and C are responsible for about 90% of all cases. The disease is potentially fatal, with a fatality rate of about 5% to 10%, and this is despite the fact that the disease may have been diagnosed and treated early.

In year 2000, the World Health Organisation reported an international outbreak of the meningococcal disease related to travel to Saudi Arabia, which was caused by the uncommon strain, W135. In Singapore last year, ie, year 2000, there were eight reported cases of meningococcal disease related to travel to Saudi Arabia, of which five were caused by the W135. In 1999, there were no cases reported at all. So we have cases only from the year 2000.

In view of this international outbreak, in May 2000, the Ministry of Health and the Ministry of the Environment issued a joint press statement advising all travellers to Saudi Arabia to be vaccinated with the quadrivalent meningococcal vaccine. This provides protection against disease caused by the A, C, Y as well as W135 strains, instead of the vaccine against only strains A and C required by Saudi Arabia. The Majlis Ugama Islam Singapura (MUIS) was informed of this advice.

Although vaccinated persons are protected against the disease, a small number of returning pilgrims who have been vaccinated may still carry the bacteria in their nose and mouth and transmit the infection to close contacts. The Ministry of Health would like to advise that returning pilgrims can reduce transmission to close contacts by simply observing good personal hygiene and by reducing direct close contact and exposure to respiratory droplets.

So far in 2001, there were four reported cases in Singapore of meningococcal disease caused by the W135. Of the four, three of them were contacts of returning pilgrims from Saudi Arabia who had been vaccinated with the quadrivalent vaccine. The other was a foreigner with a travel history to Africa. Of the four, three patients recovered, while the fourth, unfortunately, developed serious complications and died.

The situation is under control. We do not expect a significant increase in cases. The Ministry of Health and the Ministry of the Environment will again remind all travellers to Saudi Arabia to be vaccinated with the quadrivalent vaccine and advise returning travellers and their close contacts to seek immediate medical attention if they are unwell. All hospitals and medical practitioners have been asked to be vigilant of meningococcal disease in returning pilgrims and their close contacts.

Dr Lily Neo (Kreta Ayer-Tanglin): Sir, may I ask the Senior Parliamentary Secretary whether the advice on the use of W135 vaccine could have been given earlier, as there were many pilgrims who were infected with significant mortality in Saudi Arabia for more than two years now?

Mr Chan Soo Sen: Sir, as I have said, we issued the advice in the year 2000 when we assessed that there was a threat of infection. That was one year ago. In 1999, there were no cases and we did not feel that it was necessary to issue a warning at that point of time.

Dr Lily Neo: May I correct the Senior Parliamentary Secretary? There were cases in 1999.

The other question I want to ask is whether his Ministry could be more alert on prevalent contagious diseases due to our globalised world and be more vigilant and proactive in taking preventive measures before death strikes.

Mr Chan Soo Sen: Sir, the answer to that question must be "yes".

Dr Lily Neo: If it is yes, I hope the Ministry will be more active and proactive from now on.

The other question I would like to ask is whether his Ministry has given attention to public education, especially to those pilgrims involved, on such topics as how virulent the W135 strain can be, the carrier status of those returning pilgrims who may harbour the bacteria in their noses and mouths for up to three days, and why it is advisable for returning pilgrims to avoid contact with their family members on returning.

Mr Chan Soo Sen: Sir, what we do is to provide information to MUIS, and MUIS would advise the pilgrims. If MUIS requests us to go down and advise the pilgrims, we will do so.