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Punggol pre-schoolers get screened for TB; second such case in a week

SINGAPORE — In the second case of tuberculosis (TB) at a pre-school to emerge in less than a week, children and staff of Bridges Montessori Preschool have undergone screening after a trainee teacher there was diagnosed with active TB.

Bridges Montessori Preschool. Photo: Google Maps

Bridges Montessori Preschool. Photo: Google Maps

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SINGAPORE — In the second case of tuberculosis (TB) at a pre-school to emerge in less than a week, children and staff of Bridges Montessori Preschool have undergone screening after a trainee teacher there was diagnosed with active TB. 

And at least one pre-schooler, a two-year-old girl, has tested positive for latent TB — the disease in its non-infectious, asymptomatic form.  

The school, located on Punggol Seventeenth Avenue, found out on Aug 12 that the trainee teacher, a foreign national, had been diagnosed with the disease, said its director, Ms Irene Toh, 58.

The next day, it began informing parents of its 50-odd pre-schoolers via email and WhatsApp about the case and the steps the school was taking.

The trainee, who had sat in on classes as an observer, had spent about three weeks in the school. Twenty-nine pre-schoolers, who were in the affected area where the trainee was based, as well as seven staff members were screened for TB last Tuesday. Ms Toh could not say how many others have tested positive for TB. 

Contacted by TODAY, the Ministry of Health (MOH) did not address queries about the case, but noted that latent TB infections are not uncommon in Singapore. Last week, a similar case emerged at Little Greenhouse pre-school in Bukit Batok, where pre-schoolers and staff had to be screened for TB after a teacher from China was diagnosed with active TB the week before.

The Early Childhood Development Agency told TODAY that there have been three reported TB cases among the 1,300 childcare centres here this year. Centres were generally vigilant and have the necessary measures in place to prevent its spread, a spokesperson said, and new employees must undergo a chest X-ray and a doctor must certify them free from active TB before they can start work.

Bridges Montessori’s Ms Toh said before the trainee teacher arrived in Singapore last month, she had undergone a series of medical tests, including one for TB.

It was only after a pre-employment check-up at the Singapore Anti-Tuberculosis Association that a doctor spotted a “scar” in the trainee’s lungs, and referred her for further checks. 

At the time, Ms Toh said that the doctor had advised that she could continue with “normal activities”.

The trainee’s S-Pass was cancelled on Aug 19, after both parties came to a “mutual agreement”. The trainee felt awkward returning to the pre-school and wanted to head home to her family, said Ms Toh.  

The mother of the two-year-old with latent TB, who wanted to be known only as Ms Tan, 40, told 

TODAY she was “very, very upset” that her daughter may have go through a protracted treatment process. Patients with latent TB can receive treatment to prevent the disease progressing to active TB.  
“(It) is a lot to handle for a child. (They) are pre-schoolers,” Ms Tan said.

Ms Toh said the school did not want this to happen. “We’ve (followed) all the necessary SOPs (standard operating procedures) that were given by the ministries and more,” she added. 

The school’s premises were fumigated and sanitised by a health and environmental cleaning agency on Aug 15, and Tuberculosis Control Unit (TBCU) officers conducted a site assessment on Aug 16. 

Figures provided by the MOH showed that the number of new active TB cases among long-staying foreigners has been on a steady decline over the years, as the number of cases among residents edged up to 1,498 last year. Last year, there were 502 cases involving long-staying foreigners, compared with 643 in 2012. 

But doctors TODAY interviewed said TB screening for non-residents could be more stringent. 

Citing global literature, Dr Leong Hoe Nam, an infectious-diseases specialist at the Mount Elizabeth Novena Specialist Centre, said globalisation — including the movement of migrants to the developed world — has contributed to an increase in TB not only in Singapore, but around the world. 

He suggested that Singapore adopt the United States’ practice of employing both blood tests and a chest X-rays when screening individuals planning to work or study in the US. Currently, blood tests are not required. Also, currently, only patients with pulmonary TB — in the lungs — have their contacts screened for the disease, but this should be done for all TB patients, said Dr Leong. TB can occur in different parts of the body, like the gut. 

Mount Elizabeth Hospital respiratory medicine specialist Ong Kian Chung said when abnormalities show up on chest X-rays and TB is a possibility, patients should be required to undergo blood tests. Such blood tests, which cost about S$200 each, should be made available more cheaply to patients, he added. 

Alternatively, all abnormal pre-employment X-rays could be referred to the TBCU, but this might increase their workload “significantly”, Dr Ong said.

TB transmission typically occurs through close and prolonged contact with an infectious individual, but those with active TB become non-infectious rapidly, once treatment begins. All newborns here are given the Bacillus Calmette-Guerin (BCG) vaccine, but this vaccine may work only against certain forms of TB, such as TB in the brain.

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