INTRODUCTIONWe carried out an epidemiological review of cholera in Singapore to determine its trends and the factors contributing to its occurrence.

MATERIALS AND METHODSEpidemiological data of all notified cases of cholera maintained by the Communicable Diseases Division, Ministry of Health, for the period 1992 to 2007 were collated and analysed. Case-control studies were carried out in outbreaks to determine the source of infection and mode of transmission. Linear patterns in age and ethnic distribution of cholera cases were assessed using chi2 test for trend.

RESULTSThere were a total of 210 cholera cases reported between 1992 and 2007. The incidence of cholera declined from 17 cases in 1992 to 7 cases in 2007. About a quarter of the cases were imported from endemic countries in the region. Between 76% and 95% of the reported cases were local residents. Four elderly patients with comorbidities and who sought medical treatment late died, giving a case-fatality rate of 1.9%. Vibrio cholerae 01, biotype El Tor, serotype Ogawa, accounted for 83.8% of the cases. The vehicles of transmission identified in outbreaks included raw fi sh, undercooked seafood and iced drinks cross-contaminated with raw seafood.

CONCLUSIONWith the high standard of environmental hygiene and sanitation, a comprehensive epidemiological surveillance system and licensing and control of food establishments, cholera could not gain a foothold in Singapore despite it being situated in an endemic region. However, health education of the public on the importance of personal and food hygiene is of paramount importance in preventing foodborne outbreaks. Physicians should also maintain a high level of suspicion of cholera in patients presenting with severe gastroenteritis, especially those with a recent travel history to endemic countries.

Adolescent ; Child ; Child, Preschool ; Cholera ; microbiology ; mortality ; Disease Outbreaks ; statistics & numerical data ; Female ; Foodborne Diseases ; epidemiology ; prevention & control ; Humans ; Incidence ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Population Surveillance ; Singapore ; epidemiology ; Vibrio cholerae O1 ; isolation & purification ; Young Adult

INTRODUCTIONThe life expectancy of cancer patients has increased in recent decades due to better diagnostic and screening tools as well as better treatment modalities. Hence, it becomes increasingly important to study trends in long-term cancer patient survival in order to document that medical progress has conveyed benefit at the population level. In this paper, we assessed the long-term survival experience of all incident cancer patients in Singapore.

MATERIALS AND METHODSThe study population consisted of patients diagnosed with single primary invasive cancer from 1 January 1968 to 31 December 2002, and passively followed up to 31 December 2005. The data was derived from the Singapore Cancer Registry, which has been in existence since 1968. Relative survival via the period approach was used to provide a more up-to-date estimate by looking at recent cohorts of patients. Sex- and stage-specific survival was compared for each cancer.

RESULTSThe overall age-standardised 10-year relative survival ratios for the calendar years of 1998 to 2002 were 30.5% in males and 44.2% in females. A steady improvement in overall long-term cancer survival was observed over the study period. This upward trend in survival was observed in localised tumours and cancers with a favourable prognosis such as breast, cervical and colorectal cancers. In contrast, survival of cancers with poor prognosis such as lung, liver and pancreas remained low.

CONCLUSIONSAlthough factors such as changes in diagnostic criteria could influence the trend in survival, we believed that the improvement in survival predominantly reflected real progress in cancer control in Singapore.

Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Neoplasms ; mortality ; Prognosis ; Retrospective Studies ; Sex Distribution ; Singapore ; epidemiology ; Survival Rate ; trends ; Time Factors ; Young Adult

INTRODUCTIONSingapore was substantially affected by three 20th Century pandemics. This study describes the course of the pandemics, and the preventive measures adopted.

MATERIALS AND METHODSWe reviewed and researched a wide range of material including peer-reviewed journal articles, Ministry of Health reports, Straits Settlements reports and newspaper articles. Monthly mortality data were obtained from various official sources in Singapore.

RESULTSThe 1918 epidemic in Singapore occurred in 2 waves--June to July, and October to November--resulting in up to 3500 deaths. The 1957 epidemic occurred in May, and resulted in widespread morbidity, with 77,000 outpatient attendances in government clinics alone. The 1968 epidemic occurred in August and lasted a few weeks, with outpatient attendances increasing by more than 65%. The preventive measures instituted by the Singapore government during the pandemics included the closure of schools, promulgation of public health messages, setting up of influenza treatment centres, and screening at ports. Students, businessmen and healthcare workers were all severely affected by the pandemics.

CONCLUSIONSTropical cities should be prepared in case of a future pandemic. Some of the preventive measures used in previous pandemics may be applicable during the next pandemic.

Disease Outbreaks ; history ; statistics & numerical data ; History, 20th Century ; Humans ; Influenza, Human ; epidemiology ; history ; mortality ; Public Health ; history ; Singapore ; epidemiology