Introduction:This paper describes the epidemiological, microbiological and environmental investigations conducted during an outbreak of Salmonella gastroenteritis in Singapore. Methods:A case-control study was undertaken to identify the vehicle of transmission. Microbiological testing was performed on faecal, food and environmental samples. Isolates of Salmonella were further characterized by phage typing and ribotyping. Results:There were 216 gastroenteritis cases reported from 20 November to 4 December 2007. The causative agent was identified as Salmonella enterica subspecies enterica serotype Enteritidis for 14 out of 20 cases tested. The vehicle of transmission was traced to cream cakes produced by a bakery and sold at its retail outlets ( P < 0.001, OR = 143.00, 95% Cl = 27.23–759.10). More than two-thirds of the 40 Salmonella strains isolated from hospitalized cases, food samples and asymptomatic food handlers were of phage type 1; the others reacted but did not conform to any phage type. The phage types correlated well with their unique antibiograms. The ribotype patterns of 22 selected isolates tested were highly similar, indicating genetic relatedness. The dendrogram of the strains from the outbreak showed distinct clustering and correlation compared to the non-outbreak strains, confirming a common source of infection. Discussion:The cream cakes were likely contaminated by one of the ingredients used in the icing. Cross-contamination down the production line and subsequent storage of cakes at ambient temperatures for a prolonged period before consumption could have resulted in the outbreak.

Paediatric rheumatology is an exciting field exploding with new knowledge of autoimmune and autoinflammatory conditions and how to treat them. It is, however, a relatively new subspecialisation in Asia. There is thus a great need to educate the public and medical community about paediatric rheumatic diseases so that children with such conditions are given the highest possibility of achieving normal function in their daily lives.
Adolescent ; Arthritis, Juvenile ; diagnosis ; therapy ; Autoimmune Diseases ; diagnosis ; therapy ; Child ; Child, Preschool ; Humans ; Inflammation ; diagnosis ; therapy ; Pediatrics ; methods ; Rheumatic Diseases ; diagnosis ; therapy ; Rheumatology ; methods ; Singapore ; Treatment Outcome

INTRODUCTIONSingapore's defense against imported novel influenza A (H1N1-2009) comprised public health measures in compliance with the World Health Organization's (WHO) International Health Regulations (IHR), 2005. We report herein on the epidemiology and control of the fi rst 350 cases notified between May and June 2009.

MATERIALS AND METHODSWe investigated the fi rst 350 laboratory-confirmed cases of novel influenza A (H1N1-2009) identified from the healthcare institutions between 27 May and 25 June 2009. Epidemiological details of these cases were retrieved and analysed. Contact tracing and active case finding were also instituted for each reported case, and relevant particulars including flight information were provided to WHO and overseas counterparts.

RESULTSThe fi rst 350 novel influenza A (H1N1-2009) cases comprised 221(63%) imported cases, 124 (35%) locally acquired cases and 5 (2%) cases with unknown source. The imported cases consisted of three waves involving the United States (US), Australia and Southeast Asia. In the fi rst wave, 11 (69%) of the 16 imported cases had visited the US within seven days prior to their onset of illness between 25 May and 4 June 2009. In the second wave, 20 (74%) of the 27 imported cases between 5 June and 12 June had travelled to Melbourne, Australia. In the third wave, 90 (51%) of the 178 imported cases between 13 June and 25 June were acquired from intra-regional travel in Southeast Asia. Specifically, 49 cases were from the Philippines and 40 (82%) of them had travelled to Manila. A total of 667 communications were effected through the IHR mechanism; a majority within 24 hours of disease notification.

CONCLUSIONSingapore experienced an unprecedented need for international cooperation in surveillance and response to this novel Influenza A (H1N1-2009) pandemic. The IHR mechanism served as a useful channel to engage in regional cooperation concerning disease surveillance and data sharing, but requires improvement.

Adolescent ; Adult ; Child ; Disease Notification ; Disease Outbreaks ; prevention & control ; Female ; Guideline Adherence ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; epidemiology ; prevention & control ; International Cooperation ; Male ; Singapore ; epidemiology ; Travel ; World Health Organization ; Young Adult

INTRODUCTIONThis study aimed to evaluate the efficacy and safety of intra-articular glucocorticoid (IAG) injections in our institution in children with juvenile idiopathic arthritis (JIA).

METHODSThis is a retrospective assessment of IAG injections performed by the Department of Paediatrics, National University Hospital, Singapore, from October 2009 to October 2011. A total of 26 procedures were evaluated for efficacy, considering parameters such as clinical response, changes in systemic medication, length of time between repeat injections, safety, consent-taking, pre- and post-procedural advice, compliance with aseptic technique, and post-procedural complications.

RESULTSA total of 26 IAG injections of triamcinolone hexacetonide were administered over 17 occasions (i.e. patient encounters) to ten patients with JIA during the study period. After the injections, clinical scoring by a paediatric rheumatologist showed overall improvement by an average of 2.62 points out of 15. Besides six patient encounters that had an increase in systemic medication on the day of the injection, five required an increase within six months post injection, two required no adjustments, and one resulted in a decrease in medications. In all, 21 injections did not require subsequent injections. The mean interval between repeat injections was 7.8 months. Cutaneous side effects were noted in three anatomically difficult joints. Medical documentation with regard to patient progress was found to be lacking.

CONCLUSIONAs per the recommendations of the American College of Rheumatology, we safely used IAG injections as the first-line therapy in our group of patients with oligoarticular JIA, and/or as an adjunct to systemic therapy in our patients with JIA.

Adolescent ; Anti-Inflammatory Agents ; administration & dosage ; Arthritis, Juvenile ; drug therapy ; Child ; Child, Preschool ; Female ; Glucocorticoids ; administration & dosage ; Humans ; Injections, Intra-Articular ; Male ; Pediatrics ; methods ; Retrospective Studies ; Singapore ; Skin ; drug effects ; Treatment Outcome ; Triamcinolone Acetonide ; administration & dosage ; analogs & derivatives