We conducted in-depth analysis on the use of a popular Chinese social networking and microblogging site, Sina Weibo, to monitor an avian influenza A(H7N9) outbreak in China and to assess the value of social networking sites in the surveillance of disease outbreaks that occur overseas. Two data sets were employed for our analysis: a line listing of confirmed cases obtained from conventional public health information channels and case information from Weibo posts. Our findings showed that the level of activity on Weibo corresponded with the number of new cases reported. In addition, the reporting of new cases on Weibo was significantly faster than those of conventional reporting sites and non-local news media. A qualitative review of the functions of Weibo also revealed that Weibo enabled timely monitoring of other outbreak-relevant information, provided access to additional crowd-sourced epidemiological information and was leveraged by the local government as an interactive platform for risk communication and monitoring public sentiment on the policy response. Our analysis demonstrated the potential for social networking sites to be used by public health agencies to enhance traditional communicable disease surveillance systems for the global surveillance of overseas public health threats. Social networking sites also can be used by governments for calibration of response policies and measures and for risk communication.

Introduction: The delay in HIV diagnosis has been identified as a significant reason for late presentation to medical care. This research aims to elucidate the significant determinants of late-stage HIV infection in Singapore between 1996 and 2009, after the advent of highly active anti-retroviral therapies. Materials and Methods: We included 3735 patients infected via sexual mode of transmission from the National HIV Registry diagnosed between 1996 and 2009. Late-stage HIV infection is defi ned as CD4 count less than 200 mm3 or AIDS-defining opportunistic infections at first diagnosis or within one year of HIV diagnosis. We determined independent epidemiological risk factors for late-stage HIV infection at first diagnosis using multivariate logistic regression. Results: Multivariate analysis showed that older age corresponded significantly with increasing odds of late-stage HIV infection. Compared to persons diagnosed at 15 to 24 years of age, those diagnosed at age 55 years and above were associated with 5-fold increased likelihood of late-stage infection (adjusted odds ratio (AOR): 5.17; 95% CI, 3.21 to 8.33). Chinese ethnicity, singlehood, and non-professional occupations were also significantly associated with late-stage HIV infection. Persons detected in the course of medical care had over 3.5 times the odds of late-stage infection (AOR: 3.55; 95% CI, 2.71 to 4.65). Heterosexual mode of transmission and having sex workers and social escorts as sexual partners, were the other epidemiological risk factors with significant associations. Conclusion: The findings of this study emphasises the need to increase HIV awareness and to encourage early and regular HIV testing among at-risk persons. Key words: AIDS-defining illness, CD4 count, HAART

Cross-matching of records between Singapore's tuberculosis and HIV registries showed that 3.3% of individuals with tuberculosis (TB) were coinfected with HIV (2000À2014), the TB incidence among individuals with HIV infection was 1.65 per 100 person-years, and 53% of coinfections were diagnosed within 1 month of each other. The findings supported joint prevention programmes for early diagnosis and treatment.Keywords: coinfection, demography, HIV infections, registries, Singapore, tuberculosis IntroductionTuberculosis (TB) and HIV pose a dual epidemic threat to global health [1]. Trends of these two diseases in Singapore indicate that TB and HIV coinfection poses a potential public health threat. The TB incidence rate in Singapore residents has markedly declined in the past decades, and is the lowest rate among South-East Asian countries [2]. However, it is still much higher than that in many developed countries [3]. The HIV prevalence among Singaporean adults (≥ 15 years old) in 2014 was 0.15% [4] compared to 0.3% and 0.1% in the SouthEast Asia and Western Pacific regions, respectively [5].In our study, we describe the demographic and clinical characteristics of TB and HIV coinfections in Singapore, and discuss the implications related to public health policy and disease surveillance. MethodsIn Singapore, TB and HIV are notifiable under the Infectious Diseases Act. All suspected and confirmed TB cases are notified to the national TB registry within 72 hours of starting TB treatment and/or receiving laboratory confirmation by acid-fast bacillus smear followed by mycobacterial culture [2]. First-line drug-susceptibility testing (DST) (i.e. susceptibility to streptomycin, rifampicin, isoniazid and ethambutol) is performed for positive TB isolates. Isolates resistant to isoniazid and/or rifampicin are subjected to second-line DST.HIV/AIDS cases are notified to the National Public Health Unit of the Ministry of Health (MOH). HIV screening is performed using enzyme immunoassays or rapid diagnostic tests, followed by a confirmatory western blot test for positive results.Both registries contain information on demographics, such as age at diagnosis, gender, ethnicity, occupation, country of birth and year of immigration to Singapore. The TB registry tracks the progress and treatment outcome of each case, while the HIV registry captures CD4 cell counts, stage of HIV infection at diagnosis and mode of HIV detection.Our study received ethics approval from the Singapore National Healthcare Group Domain Specific Review Board (NHG DSRB reference number 2015/00702). We retrospectively matched records between the HIV registry from 1985 to 2014 and the TB registry from 2000 to 2014. For TB cases with more than one notification, the first episodes were included in the study. The date of TB diagnosis is the earliest of the following dates: date treatment started, registration date, date of first positive smear, and date of first positive culture.This study was confined to Singapore citizens and permanent residents. We defined TB an...

ObjectiveTo assess the public health risk to Singapore posed by the emergence of artemisinin-resistant (ART-R) malaria in the Greater Mekong Subregion (GMS).MethodsWe assessed the likelihood of importation of drug-resistant malaria into Singapore and the impact on public health of its subsequent secondary spread in Singapore. Literature on the epidemiology and contextual factors associated with ART-R malaria was reviewed. The epidemiology of malaria cases in Singapore was analysed. The vulnerability and receptivity of Singapore were examined, including the connectivity with countries reporting ART-R malaria, as well as the preparedness of Singaporean health authorities. Sources of information include international journals, World Health Organization guidelines, data from the Singapore Ministry of Health and National Public Health Laboratory of the National Centre for Infectious Diseases, and the International Air Transport Association.ResultsThe importation of ART-R malaria into Singapore is possible given the close proximity and significant travel volume between Singapore and the GMS countries reporting artemisinin resistance. Singapore’s vulnerability is further enhanced by the presence of foreign workers from neighbouring endemic countries. Nonetheless, the overall likelihood of such an event is low based on the rarity and decreasing trend of imported malaria incidence.​With the presence of Anopheles vectors in Singapore, imported cases of drug-resistant malaria could cause secondary transmission. Nevertheless, the risk of sustained spread is likely to be mitigated by the comprehensive surveillance and control system in place for both infected vectors and human cases.DiscussionThis risk assessment highlights the need for a continued high degree of vigilance of ART-R malaria locally and globally to minimize the risk and public health impact of drug-resistant malaria in Singapore.

Objective: To assess the public health risk to Singapore posed by the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea in 2015. Methods:The likelihood of importation of MERS cases and the magnitude of the public health impact in Singapore were assessed to determine overall risk. Literature on the epidemiology and contextual factors associated with MERS coronavirus infection was collected and reviewed. Connectivity between the Republic of Korea and Singapore was analysed. Public health measures implemented by the two countries were reviewed. Results: The epidemiology of the 2015 MERS outbreak in the Republic of Korea remained similar to the MERS outbreaks in Saudi Arabia. In addition, strong infection control and response measures were effective in controlling the outbreak. In view of the air traffic between Singapore and MERS-affected areas, importation of MERS cases into Singapore is possible. Nonetheless, the risk of a serious public health impact to Singapore in the event of an imported case of MERS would be mitigated by its strong health-care system and established infection control practices. Discussion: The MERS outbreak was sparked by an exported case from the Middle East, which remains a concern as the reservoir of infection (thought to be camels) continues to exist in the Middle East, and sporadic cases in the community and outbreaks in health-care settings continue to occur there. This risk assessment highlights the need for Singapore to stay vigilant and to continue enhancing core public health capacities to detect and respond to MERS coronavirus.