Background Three clusters of coronavirus disease 2019 (COVID-19) linked to a tour group from China, a company conference, and a church were identified in Singapore in February, 2020.Methods We gathered epidemiological and clinical data from individuals with confirmed COVID-19, via interviews and inpatient medical records, and we did field investigations to assess interactions and possible modes of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Open source reports were obtained for overseas cases. We reported the median (IQR) incubation period of SARS-CoV-2. Findings As of Feb 15, 2020, 36 cases of COVID-19 were linked epidemiologically to the first three clusters of circumscribed local transmission in Singapore. 425 close contacts were quarantined. Direct or prolonged close contact was reported among affected individuals, although indirect transmission (eg, via fomites and shared food) could not be excluded. The median incubation period of SARS-CoV-2 was 4 days (IQR 3-6). The serial interval between transmission pairs ranged between 3 days and 8 days.Interpretation SARS-CoV-2 is transmissible in community settings, and local clusters of COVID-19 are expected in countries with high travel volume from China before the lockdown of Wuhan and institution of travel restrictions. Enhanced surveillance and contact tracing is essential to minimise the risk of widespread transmission in the community.Funding None. Articles 2www.thelancet.com Published online March 16, 2020 https://doi.

National Medical Research Council Singapore, Centre for Infectious Disease Epidemiology and Research, and A*STAR Biomedical Research Council.

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.

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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...