Public Health Preparedness Measures to Handle Mpox

NOTICE PAPER NO. 3031

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON 9 SEPTEMBER 2024

Name and Constituency of Member of Parliament

Mr Yip Hon Weng

MP for Yio Chu Kang

Question No. 6470

To ask the Minister for Health with monkeypox (mpox) declared by the World Health Organisation as a public health emergency of international concern (a) whether the Ministry can provide an update on the characteristics of the virus and how it is evolving; (b) what are the border and social measures to deal with the situation; and (c) whether the Ministry has adequate mpox vaccines for our population.

NOTICE PAPER NO. 3031

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON 9 SEPTEMBER 2024

Name and Constituency of Member of Parliament

Dr Wan Rizal

MP for Jalan Besar GRC

Question No. 6473

To ask the Minister for Health in light of the recent rise in monkeypox (mpox) cases in Africa (a) what protocols are in place for screening and monitoring travellers from regions with known mpox outbreaks, especially given the potential for cross-border transmission; and (b) what measures are being implemented to enhance public awareness of (i) mpox symptoms (ii) transmission modes and (iii) preventive practices in Singapore.

NOTICE PAPER NO. 3046

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON 9 SEPTEMBER 2024

Name and Constituency of Member of Parliament

Mr Melvin Yong Yik Chye

MP for Radin Mas

Question No. 6498

To ask the Minister for Health (a) whether the Ministry can provide an update on the local mpox situation; (b) whether mpox poses a severe health risk to vulnerable residents such as seniors and children; and (c) whether there is a need for a nationwide rollout of mpox vaccines for these vulnerable residents.

NOTICE PAPER NO. 3047

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON 9 SEPTEMBER 2024

Name and Constituency of Member of Parliament

Ms Hany Soh

MP for Marsiling-Yew Tee GRC

Question No. 6506

To ask the Minister for Health (a) what is the Ministry's strategy for preventing and mitigating the spread of mpox in Singapore; and (b) what are the applicable precautions and lessons that have been learnt from our whole-of-society effort against the COVID-19 pandemic.

NOTICE PAPER NO. 3033

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON OR AFTER 10 SEPTEMBER 2024

Name and Constituency of Member of Parliament

Ms Joan Pereira

MP for Tanjong Pagar GRC

Question No. 6476

To ask the Minister for Health (a) what are the protocols in place in the event that cases of mpox infection are detected, particularly those caused by clade I type of the virus; (b) what is the Ministry's strategy to minimise Singapore's exposure to infected visitors or returning residents; and (c) whether the Ministry will set up a community monitoring and surveillance programme to detect mpox cases in the Singapore population.

NOTICE PAPER NO. 3057

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON OR AFTER 10 SEPTEMBER 2024

Name and Constituency of Member of Parliament

Mr Sharael Taha

MP for Pasir Ris-Punggol GRC

Question No. 6563

To ask the Minister for Health (a) whether an update can be provided on the status of the precautionary measures against mpox; and (b) whether increased measures are needed in response to the rising number of cases around the world.

Answer

1 Mr Speaker Sir, may I have your permission to address questions number 12 to 15 on today's Order Paper, which are related to Mpox, please? My response will also cover the matters raised in the questions by Ms Joan Pereira and Mr Sharael Taha which are scheduled for a subsequent sitting.

2 I have shared our assessment of mpox Clade I and our response plan in a press conference last week. Let me reiterate the points briefly, and then invite Members to ask supplementary questions.

Situation Update

3 As of 5 September 2024, there have been no mpox Clade I cases in Singapore. As for the less severe mpox Clade II, fifteen confirmed cases have been detected this year. Although there are no Clade I cases in Singapore as yet, we should expect it to arrive here at some point as it spreads beyond Africa.

Characteristics of Mpox Clade I

4 Every pandemic is different - I have to keep emphasising that, and we need to respond according to the characteristics of the virus. This is a key lesson from COVID-19. The key characteristics of mpox Clade I based on what we know so far, are as follows:

5 First, the mode of transmission. This is mainly through close physical contact with infected persons, such as sexual contact, skin-to-mouth, mouth-to-mouth, or skin-to-skin. In Africa, it appears to be family members living in the same household as the primary cases who are infected. We cannot rule out mpox spreading through the air. But based on current evidence, even if it does, it does not spread far and wide like COVID-19. Where a person gives a speech, and many members of the audience can get infected. There is no evidence showing the mpox Clade I or Clade II spreads that way. But this is something we continue to watch, and which will become clearer in the coming months.

6 Second, transmissibility. As of now, the mpox Clade I virus has a known reproduction number, or "R", of about 1.3. This means that for every 10 infected persons, they will spread the disease to an average of 13 people. This is less infectious than other diseases such as COVID-19 with an R value of 5, or chickenpox with an R value of up to 10 and in fact 12.

7 Third, severity. Out of every 100 cases in the Democratic Republic of the Congo (DRC), there were about three to four fatalities. Three to four out of one hundred. This is a concerning number, similar to COVID-19 when it first broke out. If it comes here, the case fatality rate will most likely be lower because - first, in DRC the recorded number probably has a larger denominator base of undetected cases, and so the fatality rate should be lower; second, there will be better access to quality medical care in Singapore. Evidence also shows that smallpox vaccination renders cross-protection against mpox. Since smallpox vaccination was required in Singapore up till early 1981, there will be some immunity among a large segment of Singaporeans aged 45 and above.

8 Fourth, specific groups that will be affected. One group includes the weak and vulnerable, such as the old, sick and immunocompromised. Further, a large proportion of cases and deaths in the DRC are in children below the age of 15. Some of this is due to socioeconomic reasons such as malnutrition, or the kids are already inflicted with certain diseases. We believe that the clinical outcomes will be different in countries outside Africa, and we are paying close attention to the risks among children.

9 Based on the current evidence, we are not dealing with a respiratory virus like COVID-19 that required extensive Safe Management Measures (SMMs) much less a circuit breaker. With an R of 1.3 and that is a decisive consideration, we think the best way to suppress the spread of the virus is to detect and isolate cases, and quarantine close contacts early, to reduce the risk of spread to the community.

Response Plan

10 That brings me to the key aspects of our response plan.

11 First, border measures. We have retained digital declarations for travellers coming into Singapore using the SG Arrival Card. Several members have asked me why do we keep that. Now you know why? Because such outbreaks will happen from time to time. We have however adjusted the questions, so that travellers are now required to declare mpox-related symptoms and travel history on the SG Arrival Card. We have put in place temperature and visual screening for travellers arriving from higher risk areas, at both air and sea checkpoints.

12 Second, test, trace and isolate. As mpox has a long incubation period of up to 21 days, cases may not be picked up at the borders. They may seek medical help later when they turn ill in Singapore. Therefore, we have notified our doctors to be on the alert to spot and immediately report any suspected mpox Clade I cases to the Ministry of Health (MOH).

13 All suspected mpox Clade I cases will be conveyed to designated hospitals for further assessment and testing. If tested positive, these patients will be isolated in healthcare facilities until they are no longer infectious. Based on what we currently know of the Clade I virus, our existing hospital capacity, including the ICUs, remains adequate to treat and isolate infected cases.

14 Contact tracing will then be conducted for all confirmed cases. The National Environment Agency will oversee environmental cleaning and disinfection for places visited by the infected persons.

15 Close contacts of Clade I cases will be quarantined in a designated government quarantine facility for up to 21 days from their last date of exposure.

16 Third, schools and pre-schools. We have been working closely with the Ministry of Education and Early Childhood Development Agency on contingency plans. Schools have existing protocols to manage outbreaks, such as for hand, foot, and mouth disease, which are relevant in an mpox Clade I outbreak. These include ensuring good hygiene practices and screening students for symptoms. Cases will only be allowed to return to school once fully recovered and no longer infectious. Premises will be cleaned, and contact tracing of students and staff will be conducted promptly. If necessary, outbreak management measures, including temporary closures of a class, a level or a school, may be implemented to contain disease spread.

17 Fourth, vaccination. Although smallpox has been eradicated, we kept some stock of smallpox vaccines, called JYNNEOS, to counter orthopoxviruses, such as the mpox virus. Based on our current understanding of the disease and its relatively low reproduction rate, population-wide mpox vaccination is not necessary and not recommended. It is more effective to focus our vaccination on healthcare workers who need to care for mpox patients, and on close contacts of infected persons as a form of post-exposure vaccination to suppress the transmission of the virus.

18 Based on this vaccination approach, our existing supply of vaccines are projected to be sufficient. To better strengthen our preparedness and resilience, MOH is also looking at procuring more doses when available.

19 Fifth, masking. At present, we do not recommend wearing a mask for people who are well, given that the primary mode of transmission is close physical contact. However, should there be evidence of significant respiratory transmission, such as outside of households, MOH will consider other measures such as masking on public transport, or in crowded indoor settings. Our current mask stockpiles and local manufacturing capabilities will assure us of adequate supply.

Conclusion

20 MOH's bottomline assessment is that mpox Clade I - this is likely a troublesome virus and I think will cause us some inconvenience, but all in all, it is something which we can manage. It is unlike COVID-19 that will lead to widespread SMMs or even Circuit Breaker; very unlikely. Exercising personal responsibility, especially when symptomatic, and practising good personal hygiene, remain effective at reducing the risk of transmission of mpox in the general population.

21 However, we should not be complacent. The situation is evolving, and there is still some uncertainty around the disease characteristics. We will learn more about the disease in the coming months, and should be prepared to change our plans as we understand the disease more.