Anniversaries and Special Events ; Asia, Southeastern ; Biomedical Research ; Dengue ; Humans ; Singapore

Disease Outbreaks ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; epidemiology ; Singapore ; epidemiology ; World Health Organization

Adolescent ; Adult ; Anti-HIV Agents ; adverse effects ; Child ; Guideline Adherence ; HIV Infections ; drug therapy ; Humans ; Medical Audit ; Middle Aged ; Practice Guidelines as Topic ; Retrospective Studies ; Safety-Based Drug Withdrawals ; Singapore ; Stavudine ; adverse effects ; World Health Organization ; Young Adult

Disease Outbreaks ; prevention & control ; statistics & numerical data ; Humans ; Severe Acute Respiratory Syndrome ; epidemiology ; Singapore ; epidemiology

Adult ; Comorbidity ; Humans ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; diagnosis ; drug therapy ; physiopathology ; Inpatients ; Male ; Pneumococcal Infections ; diagnosis ; drug therapy ; physiopathology ; Streptococcus pneumoniae ; isolation & purification ; Treatment Outcome

Adult ; Antibodies, Viral ; blood ; Follow-Up Studies ; Hantaan virus ; isolation & purification ; Hemorrhagic Fever with Renal Syndrome ; diagnosis ; Humans ; Immunoglobulin G ; blood ; Immunoglobulin M ; blood ; Male ; Singapore ; Travel

Dengue fever (DF) has several hematological manifestations including thrombocytopenia and increased bleeding risk. Prophylactic platelet transfusion-in the absence of major bleeding-is utilized in DF with thrombocytopenia with the intention of preventing hemorrhagic complications. However, prophylactic platelet transfusion in DF is neither standardized nor supported by clinical evidence. We conclude that risks, costs and poor resource utilization associated with prophylactic platelet transfusion in DF far outweigh any potential hematological benefit, and as such, should not constitute routine clinical practice.
Dengue ; complications ; therapy ; Hemorrhage ; etiology ; prevention & control ; Humans ; Platelet Transfusion ; adverse effects ; economics ; Thrombocytopenia ; etiology ; prevention & control

INTRODUCTIONDengue fever remains a significant public health concern in Singapore. Appropriate, timely diagnosis and risk stratification for severe disease are crucial in the optimal management of this illness. In the outpatient setting, the primary care physician plays a key role in dengue diagnosis, management, and triage. We present a descriptive analysis of the variations in dengue knowledge, attitudes, and practices among primary care physicians (PCPs) in Singapore.

MATERIALS AND METHODSA survey of 25 multiple-choice questions was mailed to 2000 PCPs in Singapore. Responses were analysed by physician age group (21-40, 41-60, and >61) and practice setting (government subsidised polyclinic or private practice).

RESULTSOf the 3 questions assessing dengue knowledge, 89.9% chose 2 or 3 of the preferred responses. Half of the respondents utilised dengue diagnostic tests at least 50% of the time, and 75% used serology when doing so. Older respondents and those from private practices used diagnostic tests more often than their counterparts, and both groups favoured non-serology tests. About 85% of surveyed PCPs monitored confirmed or suspected cases daily, and one-third referred patients to a hospital always or often.

CONCLUSIONSWhile no major gaps in knowledge about dengue were identified in PCPs in Singapore, there were significant variations in clinical practice by physician age group and practice setting. The results of this survey provide a useful opportunity to identify strengths and areas in need of improved awareness in primary care management of dengue.

Adult ; Dengue ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Middle Aged ; Physicians, Primary Care ; Public Health ; Singapore ; Surveys and Questionnaires

INTRODUCTIONThe current avian and human H5N1 influenza epidemic has been in resurgence since 2004. We decided to evaluate published evidence in relation to epidemiology, clinical features and course, laboratory diagnosis, treatment and outcome of human H5N1 influenza, and develop institutional clinical management guidelines.

METHODSA search of PubMed was conducted for all English language articles with search terms "avian", "influenza" and "H5N1". The bibliography of articles was searched for other references of interest.

RESULTSPublished case series from Hong Kong in 1997, and Thailand and Vietnam since 2004 have indicated a rapidly progressive primary viral pneumonia resulting in acute respiratory distress syndrome. The majority of human H5N1 infections can be linked to poultry exposure. Hitherto there has been no evidence of efficient human-to-human transmission. Case fatality rates have varied from 71% in Thailand to 100% in Cambodia. Oseltamivir appears to be the only potentially effective antiviral therapy. H5N1 isolates in Vietnam have become resistant to oseltamivir, resulting in persistent viral replication and death. There is as yet no effective human H5N1 vaccine.

CONCLUSIONSNational and international preparedness plans are well advised. Clinical trials to evaluate higher dose oseltamivir therapy and immunomodulatory treatment are urgently needed.

Animals ; Birds ; Disease Outbreaks ; prevention & control ; Global Health ; Health Planning ; Humans ; Influenza A Virus, H5N1 Subtype ; Influenza Vaccines ; Influenza in Birds ; epidemiology ; prevention & control ; virology ; Influenza, Human ; epidemiology ; prevention & control ; virology ; Practice Guidelines as Topic

INTRODUCTIONOutbreaks of acute respiratory illness occur commonly in long-term care facilities (LTCF), due to the close proximity of residents. Most influenza outbreak reports have been from temperate countries. This study reports an outbreak of influenza B among a highly immunised resident population in a welfare home in tropical Singapore, and discusses vaccine efficacy and the role of acute respiratory illness surveillance for outbreak prevention and control.

MATERIALS AND METHODSDuring the period from 16 to 21 March 2007, outbreak investigations and active case finding were carried out among residents and nursing staff at the welfare home. Interviews and medical notes review were conducted to obtain epidemiological and clinical data. Hospitalised patients were tested for respiratory pathogens. Further genetic studies were also carried out on positive respiratory samples.

RESULTSThe overall clinical attack rate was 9.4% (17/180) in residents and 6.7% (2/30) in staff. All infected residents and staff had received influenza immunisation. Fifteen residents were hospitalised, with 2 developing severe complications. Genetic sequencing revealed that the outbreak strain had an 8.2% amino acid difference from B/Malaysia/2506/2004, the 2006 southern hemisphere influenza vaccine strain, which the residents and staff had earlier received.

CONCLUSIONSA mismatch between the vaccine and circulating influenza virus strains can result in an outbreak in a highly immunised LTCF resident population. Active surveillance for acute respiratory illness in LTCFs could be implemented for rapid detection of antigenic drift. Enhanced infection control and other preventive measures can then be deployed in a timely manner to mitigate the effect of any outbreaks.

Adult ; Aged ; Disease Outbreaks ; prevention & control ; Female ; Humans ; Influenza B virus ; immunology ; Influenza Vaccines ; therapeutic use ; Influenza, Human ; epidemiology ; prevention & control ; virology ; Interviews as Topic ; Male ; Medical Audit ; Middle Aged ; Nursing Homes ; Singapore ; epidemiology ; Social Welfare ; Young Adult