The government has to be "open and transparent" about the recent Hepatitis C outbreak at the Singapore General Hospital (SGH), Prime Minister Lee Hsien Loong said on Saturday (10 Oct).

"Establish what happened, learn from the experience to improve and do better in future. And we also always have to be open and transparent with the public and with the patients about what has happened," said Lee, who was speaking at the official opening of the Ng Teng Fong General Hospital.

SGH on Tuesday (6 Oct) revealed 22 patients in its renal ward had been diagnosed with Hepatitis C. Eight patients had died, with four deaths possibly linked to the virus.

It had initially detected five cases of Hepatitis C in April and May, and conducted internal investigations on a dialysis centre, which was cleared as a potential source of infection on 29 May. In June, the hospital stopped using multi-dose vials, another possible source. It informed the Ministry of Health (MOH) of the cluster in late August.

Lee said: "When something like this happens our approach must always be first to put things right, find out what's wrong and to put things right, to safeguard the health and well-being of patients. I can't say yet what has happened, how it happened. But I can tell you that is the approach the MOH is taking and which we will take for any similar cases in the future."

Dr Paul Tambyah, an infectious diseases specialist in Singapore, said there were four major ways in which Hepatitis C outbreaks had previously happened in hospitals, citing a global study: infection control breaches such as misuse of multi-dose vials; anaesthesia-related incidents; surgery by infected surgeons; and theft of drugs by individuals who are Hepatitis C positive with subsequent contamination of medication or equipment.

In the study, the US Centers for Disease Control and Prevention (CDC) found that theft of drugs and subsequent contamination was associated with 17% of the outbreaks, but 53% of the cases.



Wider screening the "best approach"





SGH on Friday (9 Oct) said it was contacting 678 patients and 273 medical workers to be screened for the virus, a figure almost double an earlier estimate. Some of the patients were admitted from January to March, others from April to June.

Tambyah said both the hospital and the MOH were adopting the "best approach" by screening as widely as possible affected individuals and healthcare workers who may possibly be implicated in the outbreak, however remote that risk.

"With any screening exercise, it is however important that individuals at risk know that they are at risk and are contacted to come forward for testing - similarly for those who may be implicated in the origins of the outbreak. That is a bit harder to do," Tambyah said.

The risk of Hepatitis C for the general public is low, he said, "around 0.2-0.3 per cent". However, those who used illicit drugs in Singapore had a rate of infection closer to 40 per cent, a local study showed.

"Individuals who have received illicit injections or used illicit drugs or received transfusions overseas should get screened," Tambyah said. In addition, Hepatitis C is transmitted by blood and bodily fluids, so if a spouse of partner is positive, an individual should seek screening.

Those who are worried they might be carriers should consult their general practitioners and do a test, he said.

As for the costs for Hepatitis C treatment, Tambyah said figures quoted for a course ranged from $50,000 to $100,000.

"The good news is that for the majority, this represents the cost of a cure," he said.