Institute of Infectious Diseasesand Epidemiology

Issue #3. November 2014

As the Institute of Infectious Diseases & Epidemiology (IIDE) celebrates her 2nd anniversary, we have made good progress in clinical excellence, medical education, research, public health and community involvement throughout the year. On top of managing the emerging infectious diseases outbreaks, we continue to press on with exciting activities, including the recently concluded Global Initiative on Sharing All Influenza Data (GISAID) Symposium and Training Workshop. Looking back in pride at our accomplishments, it serves as a greater motivation for us to scale new heights to achieve more and to bring home the message of the importance of managing infectious diseases well. In this 3rd issue of our newsletter, we continue to share our experiences of the exciting activities that we have organised and educational articles to keep you at the forefront of infectious diseases management.

Yours sincerely,

Prof Leo Yee SinDirector, Institute of Infectious Diseases and EpidemiologyClinical Director, Communicable Disease CentreSenior Consultant, Department of Infectious DiseasesTan Tock Seng Hospital

Messagefrom the Director

Singapore Health and Biomedical Congress (SHBC) 2014 – IIDE ForumMore than 100 health professionals attended IIDE’s Infectious Diseases Forum at the Singapore Health and Biomedical Congress on 26 September 2014. Led by Dr Ling Li Min (Senior Consultant, Department of Infectious Diseases, TTSH) and RN Amy John (Clinical Nurse Educator, TTSH), this forum was IIDE’s inaugural Institute of Infectious Diseases and Epidemiology Forum at SHBC 2014. As Singapore’s largest healthcare scientific meeting and competition, SHBC was an excellent opportunity for IIDE to engage our National Healthcare Group colleagues. Topics were carefully selected to address current issues of interest. Our colleagues from other departments, Dr Lee Lay Tin (Occupational Health), SNM Christopher Soh (Emergency Department) and SSN Ho Yeng May (Infection Control) also shared their perspectives. The whole session was interactive and engaging, with many questions coming from the audience.

past EvEnts

In support of the Dengue Strategic Plan for the Asia-Pacific Region (2008 – 2015) endorsed by World Health Organisation (WHO) member States, IIDE worked with the Ministry of Foreign Affairs, Environmental Health Institute (of the National Environment Agency ) and the WHO to organize the 4th Asia-Pacific Dengue Workshop, held in TTSH from 26 August to 29 August 2014.

Outbreak Investigations and Management CourseThis is the inaugural outbreak investigations and management course jointly organized by IIDE and Lee Kong Chian School of Medicine. Some 30 healthcare and public health professionals from both public and private healthcare institutions in Singapore and overseas attended the course. The participants learnt about hospital pandemic preparedness, received epidemiologic training in outbreak investigations and discussed current public health issues in emerging infections, antimicrobial resistance and healthcare-associated infections.

In this 4-day workshop, participants from 15 WHO member countries including Tanzania, Yemen, China and Malaysia, built up on their knowledge and skills relevant to strengthening the clinical management of dengue. They also shared on their country experiences and case studies to identify linkages and gaps in the diagnosis and treatment of dengue patients.

4th Asia-Pacific Dengue Workshop

4th ASEAN Dengue Day

IIDE held its annual ASEAN Dengue DaySeminar on 14 June 2014. This is ourfourth seminar and it brought together thehealthcare community to share knowledgeand skills to advance dengue managementin Singapore. The seminar attractedmore than 200 healthcare professionals,including many primary care physiciansand nurses.

4th Asia-Pacific Dengue Workshop

past EvEnts

Educational articlE

Mayo experience and what he sees in local situation and his wishes for IIDE

It’s the year 1623. London is an overcrowded, unsanitary city teeming with infections and the poet and cleric John Donne is recovering from epidemic typhus, a bacteria carried in the gut and faeces of infected body lice (Frost 1976). Inspired by his brush with death, Donne wrote his Devotions upon Emergent

Australasian Society for Infectious Diseases (ASID) and Singapore ID Clinical Research Network (SCRN) SymposiumIIDE, the Australasian Society for Infectious Diseases, the Society of Infectious Disease Initiative and the Society of Infectious Disease Singapore co-hosted an evening symposium on 10 July 2014 in Tan Tock Seng Hospital. This gathered more than 40 clinicians and researchers from diverse institutions who are keen to explore multi-centre infectious disease research collaboration.

(Left to right)Dr David Lye, Tan Tock Seng HospitalDr Josh Davis, John Hunter Hospital, AustraliaDr Sophia Archuleta, National University HospitalDr Steven Tong, Royal Darwin Hospital, Darwin, AustraliaDr Hsu Liyang, Singapore Infectious Disease InitiativesProf Leo Yee Sin, Tan Tock Seng Hospital

Contrary to the once-held, mistaken belief that Infectious Diseases will be obliterated, the sobering reality is that microbes are dynamic: The last three decades have seen the various scourges – HIV/AIDS (1980s), Nipah (1999), SARS (2003), Chikungunya (2008), pandemic influenza (2009), MERS-CoV (2012) and more recently Ebola(2014). Amidst this backdrop, Dengue, healthcare-associated infections, and antibiotic resistant bacteria continue to pose challenges both here and worldwide.

Prior to my return, I was in Chicago for five years where I completed a residency in Internal Medicine and a fellowship in Infectious Diseases at Rush

University Medical Center. Following that, a further 2 years were spent training in Clinical Microbiology and Orthopedic Infectious Diseases at the Mayo Clinic in Rochester, Minnesota. My interests include rapid diagnostics, antimicrobial resistance, device related infections, and travel-related infections.

This is an exciting time for Infectious Diseases. While we face many challenges, we have also advanced in many fronts. For example in diagnostics, proteomics is now applied routinely for pathogen identification. We are starting to make sense of whole genome sequencing data and are learning how to apply this. While previous years have seen a dearth in the development of new antimicrobials – I think the world as a whole has started to wake up to the threat of antimicrobial resistance and new incentives to develop new agents will hopefully see fruit soon. As Infectious Diseases practitioners, I think we are well-positioned to continue to ask and answer relevant questions which will transform and improve patient care and health. I am excited to be able to join IIDE, and look forward to contributing and working with you all!

It’s been seven years since I last worked at TTSH and it’s great to be back. A major development has been the inception of Institute of Infectious Diseases and Epidemiology (IIDE).

Emerging Infectious Diseases: Threats and Risks to Singapore

Occasions, a meditation on sickness which begins “No man is an Island, entire of itself”.

Singapore is also no island, able to insulate itself from global events. The ability of new pathogens to spread beyond traditional country and species borders is familiar, from HIV and SARS to pandemic influenza. Recently several new outbreaks have become of international

only a few mutations in avian H5N1 influenza enable airborne transmission (Linster 2014).

So far few cases of these emerging infections have been reported outside the outbreak regions. But it is almost inevitable that Singapore will at some point be affected by these or new pathogens.

Awareness among healthcare workers of the clinical and epidemiological features of an emerging infection are crucial. This ensures appropriate infection control measures are in place while tests are undertaken, potentially containing an outbreak at an early stage.

A safety first approach means isolating anyone who is potentially infected in negative pressure rooms with access restricted to healthcare workers in appropriate personal protective equipment. Many people may be screened for infections before a single case is confirmed. Appropriate resources and facilities help to ensure control measures can be practised without overly alarming patients while maintaining standards of clinical care. To this end, IIDE has built a new ward with eight dedicated isolation rooms at CDC. This has been open to patients since September 2014.

Ebola Preparedness Simulation Exercise

Ebola Gowning & De-gowning Training

concern: Ebola, Mers-CoV and influenza H7N9.

Each of these have caused hundreds to thousands of deaths in large, but relatively confined geographical areas. Each are also zoonotic, circulating in animals, bats, camels and birds respectively, before the cross over to humans.

As yet, these viruses do not seem particularly well suited to causing infections in humans. They are parasites, and survival of a parasite depends on keeping its host alive long enough to infect others. Even with Ebola, human-to-human transmission is relatively easy to interrupt.

How quickly these viruses will adapt to humans and improve their ability to spread is unknown. Numerous genetic changes have been described in the Ebola virus strain causing the current outbreak (Gire, 2014). These mutations may have facilitated sustained transmission in West Africa, and may also explain the increased chance of individual survival compared with previous outbreaks. Fortunately, the Ebola virus is unlikely to adapt to airborne transmission. Mutations in the Mers-CoV and H7N9 viruses, however, poses a bigger risk. Controversial recent studies have described how

Ward 70, Communicable Disease Centre

By Dr Shawn VASOO, Associate Consultant, Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital

By Dr Barnaby YOUNG, Associate Consultant, Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital

stay in touch

Feedback and Comments We would like to hear from you! For suggestions or comments regarding the IIDE newsletter, please email: iide_cme@ttsh.com.sg.

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Editorial Team • Dr Wong Chia Siong • Dr Barnaby Young • RN Amy John • Ms Koh Yi Ting • Ms Chloe Lim

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External Visitors

Dr Jody HeymannUniversity of California, Los Angeles Fielding School of Public Health, USA04 September 2014

Professor Peter BlainUniversity of Newcastle upon Tyne, United Kingdom04 June 2014

Ministry of Health of Republic of IndonesiaDirectorate General of Health EffortSulianti Saroso Infectious Disease HospitalIndonesia15 & 16 September 2014

Professor Philippe ParolaUniversity Hospital of Marseille, France13 October 2014

Ms Janaki KrishnaPatient Service

Associate, Specialist Outpatient Clinic J

Recognition of Care Award

Recognises Patient Service Associates for their contribution and dedication

to patient care.

Nurses’ Merit Award 2014

9th Singapore AIDS Conference

The Nurses’s Merit Award by MOH honours nurses for their outstanding performance and dedication to

the nursing profession. NM Nisha received the Award from the Minister of Health,

Mr. Gan Kim Yong on the 6th August this year.

Nisha attained Degree in Nursing in 2011 and is a resource nurse for HIV nursing. She has been with

TTSH for 23 years and is currently the nurse manager in CDC ward 71.

NM AkhterunNisha Binte Idris