Singapore implemented Home Quarantine Orders (HQO) to limit A(H1N1) spread, failing to comply can be prosecuted

Singapore has implemented Home Quarantine Orders (HQO) with the aim of limiting the spread of Influenza A (H1N1-2009) in the community.

HQOs will be issued to those who have had close contact with confirmed cases of Influenza A(H1N1-2009). They will be placed under quarantine for 7 days from the point of their exposure to the virus, either at home or at designated facilities prepared for this purpose.

Close contacts are those who have sustained unprotected exposure to the confirmed case for a significant duration of time and within a close proximity of 2 meters. In an airplane these would include passengers seated in the same row as well as within 3 rows in front and behind the confirmed case.

Why quarantine?

Influenza A(H1N1-2009) is a contagious and potentially dangerous virus which can cause a flu pandemic. HQOs are used to isolate contacts of the virus, so as to limit the spread of the virus in our community.

What will happen when an HQO is served?

Those to be quarantined would be isolated either at their homes or at designated facilities such as Aloha Loyang. There they would be well taken care of and their health monitored.

CISCO officers will serve the HQO and will subsequently install an electronic camera at the homes of those to be quarantined at home. They will be given a home quarantine kit, which includes an oral thermometer and a mask. A nurse will explain the conditions in the HQO which are to be observed.

During the home quarantine period, CISCO officers will make random calls to those quarantined between 8 am and 11 p.m. When called, they will have to turn on and present themselves in front of the electronic camera to show that they are at home.

While under HQO, the person must stay at home or in the facility provided and avoid contact with others. They have to take their temperature twice daily and monitor themselves for flu-like symptoms. Good personal hygiene is especially important. Persons quarantined at home are to wear a surgical mask if they need to be in common areas of the house near other persons.

All persons should respond fully and truthfully to all questions by MOH officers or others acting on behalf of the Director of Medical services. This is to enable the officers to better take care of those quarantined and to limit the spread of the Influenza A(H1N1-2009) virus within Singapore.

Flouting of HQO

Those who flout (deliberately disobey) the HQO may be subject to further conditions.

These may include:

1. Being required to wear an electronic tag to enable the monitoring of movement during the period of the home quarantine.
2. Being required to be detained and isolated in a hospital or other place.

Any person who fails to comply with the HQO can be prosecuted and

• in the case of a first offence, be liable on conviction to a fine not exceeding $10,000 or to imprisonment for a term not exceeding 6 months or to both; and
• in the case of a second or subsequent offence, be liable on conviction to a fine not exceeding $20,000 or to imprisonment for a term not exceeding 12 months or to both.

What should I do if my family member is quarantined at home?

Your family can help the process by following the instructions given to you at the serving of the HQO.

Please avoid contact with your family member who is under HQO and be vigilant against possible indirect ways of contact through common household items. Everyone in the house can go about their daily routines but be sure to pay extra attention to personal hygiene and general household cleanliness. Avoid inviting visitors to your home.

Regularly clean and disinfect the areas used by the family member under HQO and avoid sharing bodily fluids like saliva through the sharing of food and drink. Family members should build up their own immune systems by eating properly and healthily and exercising regularly.

What if the person under HQO, or another household member, starts to display flu symptoms?

Should your family member under HQO start to display flu-like symptoms, he/she should wear a surgical mask and call 993 for the dedicated ambulance service to bring him/her for further assessment.

If the family member under HQO needs medical assistance for other minor illnesses, please call the designated helpline 1800 333 9999.

If another member of the family not on HQO, displays flu-like symptoms please also call 993 and have that family member wear a surgical mask while waiting for the ambulance to bring him/her to TTSH Emergency Department.

It is possible in the initial stages of the disease for the quarantined family member to have contracted the Influenza A(H1N1-2009) virus but not display symptoms such as fever. Hence, it is possible for him to spread the virus on to another household member, even if he still seems well. Hence it is very important that your family follows the instructions given with the HQO kit so that we can all better prevent the virus from spreading in our community.

 

Source: Ministry of Health

Singapore Enhancing its A(H1N1) Flu Surveillance, Measures Being Implemented

As of 18 June 09, Singapore has 77 confirmed cases of influenza A (H1N1). 75 cases were imported while one appeared to have acquired his infection in Singapore, and another one was a close contact of a confirmed case. So far 27 patients have been discharged.  The remaining 50 patients (22nd - 23rd, 25th - 28th, 31st - 32nd, 34th, 36th - 37th, 39th - 77th cases) are still in the hospital and their conditions remain stable.

As quoted in MOH website:

We must press on with our containment efforts and everyone must play his part.  This is especially so for recent travelers from infected areas.  They must not engage in community activities and come forward immediately for screening and isolation as soon as flu-like symptoms develop.

In Alert Yellow, stringent border controls will still be maintained, with temperature screening at air, land and sea checkpoints.

Measures Implemented:

• Stringent border controls will still be maintained, with temperature screening at air, land and sea checkpoints.
• However, temperature screening requirements and screening for flu-like symptoms and travel history have been lifted at work places, schools, buildings and events.
• At healthcare institutions, the current tighter restrictions will continue to be in place for the time being, especially in high risk areas such as A & E and ICU.

MOH has been monitoring the flu situation in Singapore, to identify the strains of flu virus circulating. With the threat of an Influenza A (H1N1-2009) outbreak, MOH has enhanced flu surveillance to include up to 3 times more samples from both the community (i.e. polyclinics and GPs) and tertiary care (i.e. hospitals).

The flu A positivity decreased from 21.1% in E-week 22 (31 May - 6 Jun) to 19.9% (preliminary) in E-week 23 (7 Jun - 13 Jun).

Based on past trends, there are 2 peaks in flu activity in Singapore, usually in the months of May to June and December to January.

Update on the number of Influenza A(H1N1) Virus Affected Pinoy in Singapore

Based on the daily update from the DFA website, below is the latest statistics:

• A Filipina was tested positive of the A(H1N1) infection per confirmation by the Singapore Ministry of Foreign Affairs


• 10 Filipinos who had close contact with a confirmed A(H1N1) case were quarantined until 15 June 2009, while 3 more added in the list will be quarantined until 19 June 2009


• The total number of Filipinos in Singapore who were reportedly issued Home Quarantine Orders are now twenty-four (24).

Singapore confirmed 11 new cases of influenza A(H1N1)

Further updates from the Ministry of Health:

Singapore has confirmed another 11 new cases (67th to 77th cases) of Influenza A (H1N1), including one who appeared to have acquired his infection in Singapore. The remaining 10 cases involve travelers returning from countries with known community transmission of H1N1. This brings the total number of confirmed cases here to 77.

• The 73rd case is a 26-year-old Malaysian male who is a PR in Singapore.  He departed from Singapore to Kuala Lumpur for work on SQ108 at 1000 hours on 14 June.  Later that evening, he developed symptoms while he was having dinner at a restaurant.  On 15 June, he attended a conference in the morning and went out in the evening.  On 16 June, he sought medical attention at a GP clinic in the early hours and was prescribed antibiotics and paracetamol. He then went back to the hotel and remained there for the rest of the day. He returned to Singapore from Kuala Lumpur on SilkAir MI335 at 1514 hours on 17 June. He was seated at row 19.  When he arrived at Changi Airport, he immediately approached the airport staff and a 993 ambulance was called to send him to TTSH.  Prior to his travel to KL, his last travel out of Singapore was to Hong Kong from 28 May to 1 June 09. He remained well after his trip to Hong Kong.
  
• While investigations continue, our tentative assessment is that he may be our first unlinked local case as he has no travel history to a known infected area.   He could have come into contact with one of the earlier confirmed cases here, since the virus is not native here.  Unless further investigations turn up evidence otherwise, and if more such unlinked cases emerge over the next few days, this would signal the beginning of community spread in Singapore. We have not reached such a stage yet.  We must press on with our containment efforts and everyone must play his part.  This is especially so for recent travelers from infected areas.  They must not engage in community activities and come forward immediately for screening and isolation as soon as flu-like symptoms develop.
  
• Meanwhile, we have alerted our Malaysian counterparts about this case and his activities in KL.

Details of new imported cases

The nationalities of the 10 imported cases are

• 6 Singaporeans
• 1 Singapore PR (Filipino)
• 3 foreigners (1 Filipino, 1 Australian, 1 Canadian)

Of the 10 cases, one was unwell before boarding the flight, while three developed symptoms during the flight. The remaining six cases, who developed symptoms after arrival in Singapore, sought medical treatment or called 993 soon after onset of symptoms. All six stayed home between onset of symptoms and seeking treatment.

Contact tracing

Contact tracing is ongoing for all new cases, including for close contacts for the following flights:

• SQ919 (Manila to Singapore) on 16 June 2200 hrs rows 54-58
• SQ11 (LA to Singapore via Tokyo) on 17 June 0115 hrs rows 40-44
• SQ351 (Copenhagen to Singapore) on 17 June 0530 hrs rows 33-37
• SQ238 (Melbourne to Singapore) on 17 June 1610 hrs 37-41

Passengers who have not been contacted by MOH yet should call the MOH hotline at 1800-333 9999 to enable us to check on their health condition expeditiously. All close contacts identified will be quarantined and provided with antiviral prophylaxis.

Breakdown of Total Confirmed Cases

The breakdown of the 77* cases is as follows:
Countries - Number of cases

• Australia – 33
• United States – 20
• Philippines – 15
• Thailand – 1
• Canada – 2
• UK – 2
• Chile – 1
• Cruise# – 1

*75 cases were imported while one appeared to have acquired his infection in Singapore, and another one was a close contact of a confirmed case.

The 68th case is a 33-year-old Singaporean woman who went for a holiday in Europe from 28 May to 17 June. She was on a cruise from 4 June to 16 June. She developed symptoms while on the cruise. She was treated on the ship and returned to Singapore on 17 June.

So far, 27 patients have been discharged.  The remaining 50 patients (22nd - 23rd, 25th - 28th, 31st - 32nd, 34th, 36th - 37th, 39th - 77th cases) are still in the hospital and their conditions remain stable.  

Advisory to all travelers

For people who are planning to travel, they should check the MOH website for the latest update on the list of countries with confirmed cases of H1N1 so that they can make considered decisions on whether to proceed with
their travel plans.  For more information on Influenza A (H1N1-2009), please access MOH’s website at www.moh.gov.sg, call our hotline at 1800-333 9999, or visit www.flu.gov.sg.