Infecteous Diseases in Singapore:
Information on the avian/bird flu, dengue fever, hand,foot and mouth and dangerous creepy crawlers


Infectious Diseases in Singapore

The information given in this section was chosen to assist expatriates who want to research health risks involved when living in Singapore. It is recommended to make yourself familiar with ways to protect yourself and learn how to identify symptoms by reading the below information and visit further websites recommended below.

you may most vividly remember the outbreak of SARS in Singapore in 2003 which was traced back to a traveler returning from Hong Kong. Severe acute respiratory syndrome (SARS) is an emerging viral infectious disease characterized by high rate of transmission.

In June 2003 the World Health Organization in Geneva announced that Singapore was being removed from its list of countries where the pneumonia-like disease is known to be spreading.

The Singapore authorities have proven to be very much on top of a serious health situtation and have learnt many lessons in the fight against SARS. We are confident that Singapore is well prepared for any pandemic by implementing a number of policies to ensure quick response, control measures, communication and business continuity planning.


Influenza A (H1N1-2009)

Singapore is constantly monitoring its cases of Influenza A (H1N1-2009).

The current strain remains mild, except for high-risk individuals with underlying medical conditions where complications and even deaths may occur. Most patients, including those in Singapore have responded well to treatment.

Members of the public who feel unwell with flu-like symptoms (fever, cough, sore throat, runny nose) should promptly seek medical attention. If the symptoms are mild, their usual GPs, or the nearest Pandemic Preparedness Clinic or polyclinics, would be able to assess them.


Avian Influenza /Bird Flue

There have been no cases of H5N1 avian influenza detected in Singapore, either in humans or poultry. MOH assure the public that there is currently no cause for alarm. Singapore has few bird farms and slaughter of poultry is no longer carried out in wet markets. The Agri-Food and Veterinary Authority (AVA) has taken precautionary measures to prevent the importation of infected birds into Singapore and has a contingency plan to deal with any outbreak of avian influenza in any of our poultry farms. MOH, together with the AVA is monitoring the situation closely and will update the public should the situation change. For more information see the website above.

Avoid places such as poultry farms and bird markets where live poultry are raised or kept, and avoid contact with sick or dead poultry. As with other infectious illnesses, one of the most important preventive practices is careful and frequent hand washing. Cleaning your hands often, using either soap and water or waterless alcohol-based hand rubs, removes potentially infectious materials from your skin and helps prevent disease transmission. Influenza viruses are destroyed by heat; therefore all foods from poultry and ducks, including eggs and blood, should be thoroughly cooked. An additional precaution against the international spread of the disease must be mentioned. Travellers who have visited a farm while in an affected country must ensure that clothing and footwear worn on the farm are free from soil and manure before entering another country and Clothing should be laundered after arrival.

Avian Flu Information Hotline 1800 333 9999

Source: IMC + Travel Doctor

Brucellosis is a disease caused by bacteria called Brucella and is spread from animals to humans. The disease is rare in Singapore but common in less developed countries of the region. Food-borne transmission of brucellosis has become the most common means of exposure to the disease. Travellers should only consume pasteurised dairy products while overseas. Do not buy dairy products from unlicensed retailers, street vendors, or other questionable sources. Dairy products should be avoided unless you can be absolutely certain that they were made from pasteurised milk. It is also unsafe to consume uncooked meat and organs of animals.
Chikungunya Fever

Chikungunya fever is an acute viral disease caused by the chikungunya virus. transmitted to humans by the bite of infected mosquito. Monkeys, and possibly other wild animals, may also serve as reservoirs of the virus.

The main vector is mosquito Aedes aegypti, the same type of mosquito that can transmit dengue fever, although other mosquitoes e.g. Aedes albopictus and Culex can also transmit the disease.

In Singapoer, there have been cases of chikungunya fever in January 2008 and some imported cases in the years before.

Chikungunya fever, like dengue fever, is a mosquito-borne disease and you should take measures to reduce exposure to mosquito bites.


Cholera occurs sporadically in Singapore due to the occasional importation of contaminated seafood. There are two oral cholera vaccines, which provide a high level of protection and fewer side effects.

Cholera can be prevented by following a few simple rules of good hygiene and safe food preparation such as boiling of drinking water.

Dengue Fever and Dengue Haemorrhagic Fever

Dengue fever is a disease caused by the dengue virus which can be transmitted to humans by the bite of an infected mosquito. The incubation period of dengue fever normally ranges from between 3 to 14 days.

Dengue haemorrhagic fever is a more severe form of dengue and can be fatal if unrecognised or not treated. There is no vaccines available that can prevent dengue.

Despite a general upsurge in the region, dengue is under control in Singapore as the country has put in place rigorous control measures

How do I know if I have Dengue?
Dengue is characterised by an abrupt onset of high fever lasting 2 to 7 days, severe headache, severe muscle and joint pain and also abdominal pain. Not for nothing is the local name “break-bone fever”. After about 3 to 5 days, a typical rash appears –flushed skin with little red bumps and islands of normal skin (see picture). This is usually after the fever subsides and the patient starts to feel better.

dengue fever singaporeHowever, this is also the more dangerous phase of the illness as the blood platelet levels start to drop. Platelets are essential for blood to clot. Bleeding can then happen. This is known as dengue haemorrhagic fever and happens in only about 3% of cases. This is manifested as bleeding spots under the skin, nose or gum bleeding or worse; bleeding in the stomach or intestines, which can be life-threatening. DHF is more common if you have previously had dengue.

Most young children do not show symptoms when affected with dengue. Adults usually do. Most cases of dengue fever are self-limiting and last about 10 days to 4 weeks. However, due to the risk of DHF, you should seek medical diagnosis and management.

How Can I Prevent Dengue?
Unfortunately there is still no vaccine or medicine for protection against dengue fever.

Dengue is spread by the Aedes aegypti mosquito. It is located both in urban and rural areas. Aedes mosquitoes breed in small pools of stagnant water like blocked roof gutters, car tyres, outdoor plant pot bases, and flower vases. Do check your home regularly and empty out any collected water every 2-3 days. If you’re going on a long holiday make sure your toilets and floor traps are also covered and any containers that can collect water are not left out in the garden or balcony. Educate your domestic helper to be vigilant about these measures. Get your house fogged regularly.

The National Environment Agency (NEA) carries out investigations and fogging around the residence or work place of reported cases of dengue. You would do well to take note of these visits and co-operate with them.

On a personal level, insect avoidance measures using repellents like RID will also help (see our patient infor-mation sheets on Dengue, Insect Avoidance, and RID & DEET).

Source: International Medical Clinic

Hand, Foot and Mouth Disease

HFMD is an illness caused by intestinal viruses, commonest being Coxsackie virus and Enterovirus 71. HFMD is endemic in Singapore. See the Infectious Diseases Bulletin of Singapore for current situation.

The common symptoms are fever lasting 2-3 days, sore throat, red spots or blisters on palms and soles, mouth ulcers, poor appetite, vomiting and diarrhoea. The disease is spread by close contact and indirectly by contaminated articles. The first week is the most contagious.

Affected children should stay at home and avoid contact with other children until they have recovered. They will need a doctor’s certification that they are fit to resume schooling. Maintaining high standards of personal hygiene and disinfecting premises and toys with diluted bleach solution (one part household bleach and ten parts water) will help prevent the spread of the virus.

Who gets HFM disease?
The disease usually occurs in children under 10, being more common in the younger age groups.

How is it spread?
The disease is spread by direct contact with discharges from nose/mouth or faeces of infected people.

What are the symptoms?
Symptoms can include fever, malaise and sore throat which may appear 3-5 days after exposure, usually followed by the rash 1-2 days later. The rash usually fades after 7-10 days.

What can be done to prevent its spread?

Children with the symptoms or rash should be excluded from school/child care until resolution. Thorough hand washing, cleaning of toys and care changing diapers are all important.

Is there a risk for pregnant women?
This is uncertain, and pregnant women are advised to consult their specialist.

Source: International Medical Clinic


According to official statistics, there were 3,482 cases registered in 2007. See latest statistics here

Applicants for employment passes, work permits and permanent resident status (except spouses and children of Singapore citizens) need to undergo HIV testing.

See here for anonymous HIB antibody testing.


There are two subtypes of influenza A and one type of influenza B in seasonal circulation. Singapore has a mixture of these subtypes and strains. Influenza infections happen throughout the year in Singapore with two seasonal peaks, one from May to July, the other from November to January.

An annual vaccination can be taken a few weeks before either one of the 2 influenza infection peaks seen in May-July and Nov-Jan.


Melioidosis is a disease caused by the bacteria known as Burkholderia pseudomallei. The bacteria are found below the soil surface during the dry season. After heavy rainfall, the bacteria can be found in surface water and mud.

Melioidosis can be prevented by adequate body protection when in contact with soil and stagnant water.

Meningococcal Disease

Meningococcal disease is an uncommon but potentially fatal bacterial infection and is transmitted by direct contact via droplets of respiratory secretions from the nose and throat of infected persons.

A meningococcal vaccine is available which provides protection against the most common strains of the disease.

See here for latest official statistics

Necrotising Faciitis (Flesh Eating Bacteria)

Necrotising faciitis is caused by Group A streptococcus (Streptococcus pyogenes), the bacteria that also causes Streptococcal sore throat and Scarlet Fever. It can destroy human tissue rapidly. In 20% of cases, death occurs within 18 hours.

The bacteria enter the body through an opening in the skin. It can enter through a very minor opening such as a paper cut, staple puncture or a pinprick. In rare cases there appears to be no identifiable point of entry.

The spread of all types of GAS infection can be reduced by good hand washing, especially after coughing and sneezing and before preparing foods or eating.

For symptons to watch see the website above.

Norovirus Gastroenteritis (Gastric Flu)
Noroviruses are a group of viruses that cause viral gastroenteritis - inflammation of the stomach and intestines. Outbreaks in Singapore are closely monitored.
Polio (Poliomyelitis)
The risk of polio in Singapore is very low due to a high level of immunity in the population and there have been no local cases since 1973.Singapore is certified by the World Health Organization as a polio-free country.
In 2008, the TB incidence rate was 39.8 cases per 100,000 residents (i.e. 1,451 new cases) compared to 35.1 per 100,000 residents (i.e. 1,256 new cases) in 2007. Of the 1,451 new cases, 860 (i.e. 59.3%) were 50 years old and above, and 1,022 (i.e. 70.4%) were males. There were 145 relapsed cases among residents in 2008.

Salmonellosis is an infection with bacteria called Salmonella. Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts 4 to 7 days

Salmonella live in the intestinal tracts of humans and other animals, including birds. Salmonella are usually transmitted to humans by eating foods contaminated with animal feces. Contaminated foods usually look and smell normal. Thorough cooking kills Salmonella.


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